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CMS RVU26D · Effective 2026-10-01

95991 in El Centro

Office / nonfacility

$123.75

Base rate per service

Facility setting

$33.70

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Neurology procedure

About 95991: Skilled intrathecal pump refill and maintenance

Report 95991 for a physician-skilled refill and maintenance service on an implanted pump delivering medication into the spinal or brain fluid spaces.

This service covers skilled refill and maintenance of an implanted drug-delivery pump or reservoir serving the intrathecal space or a brain ventricle. The clinician accesses the pump’s refill port, manages the reservoir contents, and replenishes medication. Common examples include intrathecal baclofen therapy for severe spasticity and implanted pumps delivering medication for chronic pain. Pain medicine, neurology, and physical medicine and rehabilitation clinicians may perform the service in an office or outpatient facility.

Select 95991 when the refill and maintenance require a physician’s skill; 95990 is the related code for services not requiring that skill. Document the pump and delivery site, the refill performed, medication and reservoir details, and the skilled work supporting code selection. The refill service is distinct from the medication itself, which may be reported separately when applicable. CMS fee-schedule valuation for this code includes physician work and practice expense, with office and facility practice-expense inputs.

Where the value comes from

  • Work RVU0.75 · 22%
  • Practice expense (office) RVU2.65 · 76%
  • Malpractice RVU0.07 · 2%

7.5K

Medicare services in 2024 · #1619 by national volume

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

95991 compared with similar codes

Office rates for El Centro, from the same CMS release.

95990

Pump refill

Spinal or brain drug pump

$106.70

Both cover implanted spinal or brain drug-pump refill and maintenance. Choose 95991 when the service requires physician skill; 95990 covers services that do not.

62369

Pump management

Refill and reprogramming

$103.51

Use 62369 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is simple.

62370

Pump refill

Professional reprogramming

$102.72

Use 62370 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is complex.

The same code, a different location

How does El Centro compare?

In Bakersfield, the office rate for 95991 is $123.96—$0.21 higher than the $123.75 rate in El Centro. Both use the same code, release and participation basis.

95991 across payment areas

Same release and payment basis · bars start at $0

  1. El Centro · This locality

    $123.75

  2. $0.21 higher than El Centro

  3. Chico

    $123.74

    $0.01 lower than El Centro

  4. Fresno

    $123.74

    $0.01 lower than El Centro

  5. $0.01 lower than El Centro

  6. $8.59 higher than El Centro

  7. Madera

    $123.74

    $0.01 lower than El Centro

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 95991 ranges from $102.29 in Arkansas to $156.69 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas
  • Merced

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Modesto

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Napa

    California · 95991

    Office

    $144.48

    Facility

    $36.18

    $20.73 higher than El Centro for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 95991

    Office

    $131.83

    Facility

    $34.71

    $8.08 higher than El Centro for the office setting.

  • Redding

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Rest Of California

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 95991

    Office

    $124.51

    Facility

    $34.45

    $0.76 higher than El Centro for the office setting.

  • Sacramento-Roseville-Folsom

    California · 95991

    Office

    $130.15

    Facility

    $34.59

    $6.40 higher than El Centro for the office setting.

  • Salinas

    California · 95991

    Office

    $129.67

    Facility

    $34.44

    $5.92 higher than El Centro for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 95991

    Office

    $132.93

    Facility

    $34.66

    $9.18 higher than El Centro for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 95991

    Office

    $153.31

    Facility

    $37.45

    $29.56 higher than El Centro for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 95991

    Office

    $153.23

    Facility

    $37.37

    $29.48 higher than El Centro for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 95991

    Office

    $156.69

    Facility

    $38.21

    $32.94 higher than El Centro for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 95991

    Office

    $156.37

    Facility

    $37.89

    $32.62 higher than El Centro for the office setting.

  • San Luis Obispo-Paso Robles

    California · 95991

    Office

    $127.55

    Facility

    $33.96

    $3.80 higher than El Centro for the office setting.

  • Santa Cruz-Watsonville

    California · 95991

    Office

    $134.37

    Facility

    $34.54

    $10.62 higher than El Centro for the office setting.

  • Santa Maria-Santa Barbara

    California · 95991

    Office

    $130.21

    Facility

    $34.40

    $6.46 higher than El Centro for the office setting.

  • Santa Rosa-Petaluma

    California · 95991

    Office

    $135.75

    Facility

    $34.85

    $12.00 higher than El Centro for the office setting.

  • Stockton

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Vallejo

    California · 95991

    Office

    $144.36

    Facility

    $36.07

    $20.61 higher than El Centro for the office setting.

  • Visalia

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Yuba City

    California · 95991

    Office

    $123.74

    Facility

    $33.69

    $0.01 lower than El Centro for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 95991

    Office

    $133.27

    Facility

    $36.48

    $9.52 higher than El Centro for the office setting.

  • Miami

    Florida · 95991

    Office

    $123.11

    Facility

    $37.57

    $0.64 lower than El Centro for the office setting.

  • Chicago

    Illinois · 95991

    Office

    $119.55

    Facility

    $36.97

    $4.20 lower than El Centro for the office setting.

  • Manhattan

    New York · 95991

    Office

    $133.21

    Facility

    $37.74

    $9.46 higher than El Centro for the office setting.

  • Alaska*

    Alaska · 95991

    Office

    $133.13

    Facility

    $45.62

    $9.38 higher than El Centro for the office setting.

  • Alabama

    Alabama · 95991

    Office

    $103.82

    Facility

    $31.93

    $19.93 lower than El Centro for the office setting.

  • Arkansas

    Arkansas · 95991

    Office

    $102.29

    Facility

    $31.71

    $21.46 lower than El Centro for the office setting.

  • Arizona

    Arizona · 95991

    Office

    $112.82

    Facility

    $33.20

    $10.93 lower than El Centro for the office setting.

  • Colorado

    Colorado · 95991

    Office

    $121.35

    Facility

    $33.93

    $2.40 lower than El Centro for the office setting.

  • Connecticut

    Connecticut · 95991

    Office

    $123.71

    Facility

    $35.22

    $0.04 lower than El Centro for the office setting.

  • Delaware

    Delaware · 95991

    Office

    $114.73

    Facility

    $33.55

    $9.02 lower than El Centro for the office setting.

  • Fort Lauderdale

    Florida · 95991

    Office

    $118.94

    Facility

    $35.71

    $4.81 lower than El Centro for the office setting.

  • Rest Of Florida

    Florida · 95991

    Office

    $113.18

    Facility

    $34.63

    $10.57 lower than El Centro for the office setting.

  • Atlanta

    Georgia · 95991

    Office

    $117.86

    Facility

    $34.38

    $5.89 lower than El Centro for the office setting.

  • Rest Of Georgia

    Georgia · 95991

    Office

    $106.79

    Facility

    $33.50

    $16.96 lower than El Centro for the office setting.

  • Hawaii, Guam

    Hawaii · 95991

    Office

    $127.04

    Facility

    $33.62

    $3.29 higher than El Centro for the office setting.

  • Iowa

    Iowa · 95991

    Office

    $106.97

    Facility

    $31.79

    $16.78 lower than El Centro for the office setting.

  • Idaho

    Idaho · 95991

    Office

    $107.59

    Facility

    $32.00

    $16.16 lower than El Centro for the office setting.

  • East St. Louis

    Illinois · 95991

    Office

    $111.19

    Facility

    $35.60

    $12.56 lower than El Centro for the office setting.

  • Rest Of Illinois

    Illinois · 95991

    Office

    $109.52

    Facility

    $34.50

    $14.23 lower than El Centro for the office setting.

  • Suburban Chicago

    Illinois · 95991

    Office

    $120.27

    Facility

    $35.89

    $3.48 lower than El Centro for the office setting.

  • Indiana

    Indiana · 95991

    Office

    $108.24

    Facility

    $32.07

    $15.51 lower than El Centro for the office setting.

  • Kansas

    Kansas · 95991

    Office

    $106.24

    Facility

    $31.97

    $17.51 lower than El Centro for the office setting.

  • Kentucky

    Kentucky · 95991

    Office

    $105.88

    Facility

    $32.83

    $17.87 lower than El Centro for the office setting.

  • New Orleans

    Louisiana · 95991

    Office

    $111.00

    Facility

    $33.68

    $12.75 lower than El Centro for the office setting.

  • Rest Of Louisiana

    Louisiana · 95991

    Office

    $105.62

    Facility

    $32.91

    $18.13 lower than El Centro for the office setting.

  • Metropolitan Boston

    Massachusetts · 95991

    Office

    $133.84

    Facility

    $35.74

    $10.09 higher than El Centro for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 95991

    Office

    $120.52

    Facility

    $34.00

    $3.23 lower than El Centro for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 95991

    Office

    $123.32

    Facility

    $35.15

    $0.43 lower than El Centro for the office setting.

  • Rest Of Maryland

    Maryland · 95991

    Office

    $117.02

    Facility

    $33.87

    $6.73 lower than El Centro for the office setting.

  • Rest Of Maine

    Maine · 95991

    Office

    $107.94

    Facility

    $32.34

    $15.81 lower than El Centro for the office setting.

  • Southern Maine

    Maine · 95991

    Office

    $114.24

    Facility

    $32.82

    $9.51 lower than El Centro for the office setting.

  • Detroit

    Michigan · 95991

    Office

    $114.41

    Facility

    $35.12

    $9.34 lower than El Centro for the office setting.

  • Rest Of Michigan

    Michigan · 95991

    Office

    $108.50

    Facility

    $33.48

    $15.25 lower than El Centro for the office setting.

  • Minnesota

    Minnesota · 95991

    Office

    $116.82

    Facility

    $32.27

    $6.93 lower than El Centro for the office setting.

  • Metropolitan Kansas City

    Missouri · 95991

    Office

    $110.45

    Facility

    $33.29

    $13.30 lower than El Centro for the office setting.

  • Metropolitan St. Louis

    Missouri · 95991

    Office

    $111.66

    Facility

    $33.43

    $12.09 lower than El Centro for the office setting.

  • Rest Of Missouri

    Missouri · 95991

    Office

    $103.63

    Facility

    $32.80

    $20.12 lower than El Centro for the office setting.

  • Mississippi

    Mississippi · 95991

    Office

    $102.99

    Facility

    $32.24

    $20.76 lower than El Centro for the office setting.

  • Montana**

    Montana · 95991

    Office

    $115.90

    Facility

    $33.73

    $7.85 lower than El Centro for the office setting.

  • North Carolina

    North Carolina · 95991

    Office

    $109.13

    Facility

    $32.47

    $14.62 lower than El Centro for the office setting.

  • North Dakota**

    North Dakota · 95991

    Office

    $114.51

    Facility

    $32.35

    $9.24 lower than El Centro for the office setting.

  • Nebraska

    Nebraska · 95991

    Office

    $107.63

    Facility

    $31.79

    $16.12 lower than El Centro for the office setting.

  • New Hampshire

    New Hampshire · 95991

    Office

    $119.24

    Facility

    $33.70

    $4.51 lower than El Centro for the office setting.

  • Northern Nj

    New Jersey · 95991

    Office

    $131.80

    Facility

    $36.49

    $8.05 higher than El Centro for the office setting.

  • Rest Of New Jersey

    New Jersey · 95991

    Office

    $125.27

    Facility

    $35.55

    $1.52 higher than El Centro for the office setting.

  • New Mexico

    New Mexico · 95991

    Office

    $109.02

    Facility

    $33.68

    $14.73 lower than El Centro for the office setting.

  • Nevada**

    Nevada · 95991

    Office

    $115.60

    Facility

    $33.35

    $8.15 lower than El Centro for the office setting.

  • Nyc Suburbs/Long Island

    New York · 95991

    Office

    $136.24

    Facility

    $38.54

    $12.49 higher than El Centro for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 95991

    Office

    $125.93

    Facility

    $35.96

    $2.18 higher than El Centro for the office setting.

  • Queens

    New York · 95991

    Office

    $134.65

    Facility

    $37.53

    $10.90 higher than El Centro for the office setting.

  • Rest Of New York

    New York · 95991

    Office

    $110.78

    Facility

    $32.72

    $12.97 lower than El Centro for the office setting.

  • Ohio

    Ohio · 95991

    Office

    $108.22

    Facility

    $33.20

    $15.53 lower than El Centro for the office setting.

  • Oklahoma

    Oklahoma · 95991

    Office

    $105.91

    Facility

    $32.53

    $17.84 lower than El Centro for the office setting.

  • Portland

    Oregon · 95991

    Office

    $125.53

    Facility

    $34.24

    $1.78 higher than El Centro for the office setting.

  • Rest Of Oregon

    Oregon · 95991

    Office

    $114.85

    Facility

    $33.02

    $8.90 lower than El Centro for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 95991

    Office

    $120.43

    Facility

    $34.90

    $3.32 lower than El Centro for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 95991

    Office

    $108.51

    Facility

    $33.09

    $15.24 lower than El Centro for the office setting.

  • Puerto Rico

    Puerto Rico · 95991

    Office

    $116.84

    Facility

    $33.77

    $6.91 lower than El Centro for the office setting.

  • Rhode Island

    Rhode Island · 95991

    Office

    $119.05

    Facility

    $34.17

    $4.70 lower than El Centro for the office setting.

  • South Carolina

    South Carolina · 95991

    Office

    $108.82

    Facility

    $32.90

    $14.93 lower than El Centro for the office setting.

  • South Dakota**

    South Dakota · 95991

    Office

    $114.35

    Facility

    $32.18

    $9.40 lower than El Centro for the office setting.

  • Tennessee

    Tennessee · 95991

    Office

    $106.76

    Facility

    $32.07

    $16.99 lower than El Centro for the office setting.

  • Austin

    Texas · 95991

    Office

    $120.82

    Facility

    $33.89

    $2.93 lower than El Centro for the office setting.

  • Beaumont

    Texas · 95991

    Office

    $107.77

    Facility

    $33.00

    $15.98 lower than El Centro for the office setting.

  • Brazoria

    Texas · 95991

    Office

    $114.79

    Facility

    $33.36

    $8.96 lower than El Centro for the office setting.

  • Dallas

    Texas · 95991

    Office

    $115.44

    Facility

    $33.60

    $8.31 lower than El Centro for the office setting.

  • Fort Worth

    Texas · 95991

    Office

    $114.59

    Facility

    $33.57

    $9.16 lower than El Centro for the office setting.

  • Galveston

    Texas · 95991

    Office

    $115.08

    Facility

    $33.49

    $8.67 lower than El Centro for the office setting.

  • Houston

    Texas · 95991

    Office

    $116.36

    Facility

    $34.77

    $7.39 lower than El Centro for the office setting.

  • Rest Of Texas

    Texas · 95991

    Office

    $111.16

    Facility

    $33.18

    $12.59 lower than El Centro for the office setting.

  • Utah

    Utah · 95991

    Office

    $110.35

    Facility

    $33.12

    $13.40 lower than El Centro for the office setting.

  • Virginia

    Virginia · 95991

    Office

    $113.71

    Facility

    $32.94

    $10.04 lower than El Centro for the office setting.

  • Virgin Islands

    United States Virgin Islands · 95991

    Office

    $116.84

    Facility

    $33.77

    $6.91 lower than El Centro for the office setting.

  • Vermont

    Vermont · 95991

    Office

    $113.86

    Facility

    $32.52

    $9.89 lower than El Centro for the office setting.

  • Rest Of Washington

    Washington · 95991

    Office

    $120.36

    Facility

    $33.84

    $3.39 lower than El Centro for the office setting.

  • Seattle (King Cnty)

    Washington · 95991

    Office

    $136.82

    Facility

    $36.00

    $13.07 higher than El Centro for the office setting.

  • Wisconsin

    Wisconsin · 95991

    Office

    $110.57

    Facility

    $31.85

    $13.18 lower than El Centro for the office setting.

  • West Virginia

    West Virginia · 95991

    Office

    $105.31

    Facility

    $33.91

    $18.44 lower than El Centro for the office setting.

  • Wyoming**

    Wyoming · 95991

    Office

    $115.29

    Facility

    $33.13

    $8.46 lower than El Centro for the office setting.

See how rates vary across the country

95991 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$102.29

$140.22

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$133.131
AL$103.821
AR$102.291
AZ$112.821
CA$123.74–$156.6929
CO$121.351
CT$123.711
DC$133.271
DE$114.731
FL$113.18–$123.113
GA$106.79–$117.862
GU$127.041
HI$127.041
IA$106.971
ID$107.591
IL$109.52–$120.274
IN$108.241
KS$106.241
KY$105.881
LA$105.62–$111.002
MA$120.52–$133.842
MD$117.02–$133.273
ME$107.94–$114.242
MI$108.50–$114.412
MN$116.821
MO$103.63–$111.663
MS$102.991
MT$115.901
NC$109.131
ND$114.511
NE$107.631
NH$119.241
NJ$125.27–$131.802
NM$109.021
NV$115.601
NY$110.78–$136.245
OH$108.221
OK$105.911
OR$114.85–$125.532
PA$108.51–$120.432
PR$116.841
RI$119.051
SC$108.821
SD$114.351
TN$106.761
TX$107.77–$120.828
UT$110.351
VA$113.71–$133.272
VI$116.841
VT$113.861
WA$120.36–$136.822
WI$110.571
WV$105.311
WY$115.291

Explore 95991 on the national rate map →

Where does this rate apply?

El Centro is a Medicare payment area. Our Census mapping connects it to 18 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Why are the office and facility amounts different?

For 95991 in El Centro, the physician’s office rate is $123.75 and the facility-setting rate is $33.70: a difference of $90.05.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 95991 in El Centro. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$136.13

$123.75 × 110% = $136.13

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95991 in El Centro.

PPRRVU2026_Oct_nonQPP.csv

12,736

Code
95991
Physician work
0.75
Practice expense
2.65
Malpractice
0.07

GPCI2026.csv

10

Locality
El Centro
Physician work
1.017
Practice expense
1.096
Malpractice
0.541
Office / nonfacility calculation for 95991 in El Centro
ComponentRVULocality factorAdjusted
Physician work0.75× 1.0170.7627
Practice expense2.65× 1.0962.9044
Malpractice0.07× 0.5410.0379
Total RVUs3.7050
Conversion factor× 33.4009

Office / nonfacility rate, El Centro$123.75

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 95991 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.751.017
Practice expense2.651.096
Malpractice0.070.541

(0.75 × 1.017 + 2.65 × 1.096 + 0.07 × 0.541) × $33.4009 = $123.75

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.751.017
Practice expense0.191.096
Malpractice0.070.541

(0.75 × 1.017 + 0.19 × 1.096 + 0.07 × 0.541) × $33.4009 = $33.70

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

95991 · Office / nonfacility

$123.75

Effective 2026-10-01

The base rate is $11.46 higher than on 2025-10-01, moving from $112.29 to $123.75 (10.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $112.29changed to$123.75

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.77 changed to 0.75
    • Practice expense RVU 2.42 changed to 2.65
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.570 changed to 0.541

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $112.29

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$123.75$33.70RVU26D
2026-07-01$123.75$33.70RVU26C
2026-04-01$123.75$33.70RVU26B
2026-01-01$123.75$33.70RVU26A
2025-10-01$112.29$38.04RVU25D
2025-07-01$112.29$38.04RVU25C
2025-04-01$112.29$38.04RVU25B
2025-01-01$112.29$38.04RVU25A

95991 billing questions

How does 95991 differ from 95990?

95991 is for pump refill and maintenance requiring a physician’s skill. Use 95990 when the service does not require that skill.

Does the refill code include the medication?

The code represents the refill and maintenance service, not the medication supply. Report the drug separately when applicable and supported by the documentation.

What details support reporting 95991?

Document the implanted pump and its intrathecal or intraventricular delivery site, the refill and reservoir details, and the physician-skilled work performed.

When should a programmable-pump code be considered instead?

Consider 62369 or 62370 when the service includes electronic analysis, reprogramming, refill, and maintenance of a programmable pump; those codes distinguish simple from complex services.

Is 95991 selected by the drug or the refill amount?

Selection turns on the physician skill required for the refill and maintenance, not the medication name or amount alone.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 95991PPRRVU2026_Oct_nonQPP.csv, line 12,736 (RVU26D)
Geographic factors for El CentroGPCI2026.csv, line 10 (RVU26D)