$751.76
Both cover monthly ESRD management for ages 12-19; 90957 is the four-visit tier, while 90958 is for two or three visits.
On this page
CMS RVU26D · Effective 2026-10-01
90958 ESRD management Medicare reimbursement rates in Alabama
Monthly ESRD management for patients ages 12 through 19, reported when the physician or qualified professional provides two or three face-to-face visits. Compare 90958 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 90958 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$488.79
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$488.79
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Nephrology
About 90958: Monthly ESRD management, 2-3 visits
Monthly ESRD management for patients ages 12 through 19, reported when the physician or qualified professional provides two or three face-to-face visits.
This monthly service covers a physician’s or qualified health care professional’s management of a patient ages 12 through 19 receiving treatment for end-stage renal disease. A nephrologist commonly provides the visits in a dialysis facility, hospital, or office, addressing the patient’s dialysis plan and related clinical needs, such as treatment response, laboratory findings, medications, and dialysis-related complications. The code’s visit tier is based on two or three face-to-face visits during the month, not on the number of dialysis sessions the patient receives.
Report the monthly code when the patient’s age and documented face-to-face visit count match this tier. The record should identify the services and visit dates supporting ongoing ESRD management. It is one monthly service, not a separate unit for each encounter or dialysis treatment. CMS payment is based on the physician fee schedule values for this code; the supplied CMS rules list no additional payment rule for it.
Where the value comes from
- Work RVU9.87 · 64%
- Practice expense (office) RVU5.05 · 33%
- Malpractice RVU0.61 · 4%
318
Medicare services in 2024 · #3953 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.
90958 compared with similar codes
Office rates for Alabama, from the same CMS release.
$318.46
90959 is the one-visit monthly tier for ages 12-19. Choose 90958 when two or three face-to-face visits support the monthly service.
$291.13
90961 has the same two-to-three-visit monthly tier but applies to patients age 20 and older; 90958 is for ages 12-19.
$16.37
90969 reports ESRD services per day for ages 12-19, rather than the monthly two-to-three-visit service represented by 90958.
Compare 90958 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$488.79
Facility
$488.79
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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 90958 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
11,571
- Code
- 90958
- Physician work
- 9.87
- Practice expense
- 5.05
- Malpractice
- 0.61
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.87 | × 1.000 | 9.8700 |
| Practice expense | 5.05 | × 0.875 | 4.4188 |
| Malpractice | 0.61 | × 0.566 | 0.3453 |
| Total RVUs | 14.6340 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$488.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.87 | 1 |
| Practice expense | 5.05 | 0.875 |
| Malpractice | 0.61 | 0.566 |
(9.87 × 1 + 5.05 × 0.875 + 0.61 × 0.566) × $33.4009 = $488.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.87 | 1 |
| Practice expense | 5.05 | 0.875 |
| Malpractice | 0.61 | 0.566 |
(9.87 × 1 + 5.05 × 0.875 + 0.61 × 0.566) × $33.4009 = $488.79
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.
90958 billing questions
How does 90958 differ from 90957?
Both are monthly ESRD management codes for patients ages 12 through 19. Use 90958 for two or three face-to-face visits; 90957 is the four-visit tier.
Can 90958 be reported when there is only one face-to-face visit?
No. The one-visit monthly tier for a patient ages 12 through 19 is 90959.
Do dialysis sessions count as the face-to-face visits?
The tier is based on face-to-face visits for monthly ESRD management, not simply the number of dialysis treatments. Document the management encounters and their dates.
What code applies if ESRD services cover only part of the month?
90969 is the per-day ESRD services code for patients ages 12 through 19. It differs from 90958’s monthly visit-count tier.
Is 90958 reported once for each visit?
No. It represents the monthly service at the two-to-three-visit level, rather than a separate unit for each face-to-face encounter.
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.
11,56890955,,Esrd srv 2-3 vsts p mo 2-11,A,,10.32,5.16,,5.16,,0.64,16.12,16.12,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,56990956,,Esrd srv 1 visit p mo 2-11,A,,6.64,3.93,,3.93,,0.41,10.98,10.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57090957,,Esrd srv 4 vsts p mo 12-19,A,,15.46,7.42,,7.42,,0.98,23.86,23.86,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57190958,,Esrd srv 2-3 vsts p mo 12-19,A,,9.87,5.05,,5.05,,0.61,15.53,15.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57290959,,Esrd serv 1 vst p mo 12-19,A,,6.19,3.57,,3.57,,0.39,10.15,10.15,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57390960,,Esrd srv 4 visits p mo 20+,A,,6.77,3.96,,3.96,,0.43,11.16,11.16,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57490961,,Esrd srv 2-3 vsts p mo 20+,A,,5.52,3.42,,3.42,,0.36,9.30,9.30,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515