Billing code 90954: ESRD managementMedicare rate & RVUs in Delaware
Monthly ESRD management for a child age 2 through 11 when four or more face-to-face visits are documented during the month.
Medicare pays $1,029.96 for 90954 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 90954 covers
This code represents a month of physician management for a patient with end-stage renal disease who is 2 through 11 years old and receives four or more face-to-face visits that month. A nephrologist or other physician managing the child’s renal disease typically provides these services in connection with ongoing dialysis care. The work may involve assessing the child’s condition, reviewing clinical information, and managing the renal treatment plan across the month.
Select this code using the patient’s age and the documented number of face-to-face visits in the month. The record should support the ESRD-related management and the visits counted, rather than treating each dialysis session as a separate monthly service. Report the monthly service that matches the documented visit count and age; codes 90955 and 90956 distinguish lower visit counts for the same age group. CMS assigns physician fee schedule work, practice expense, and malpractice RVUs to this service.
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.
90954 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $1,029.96 | $1,029.96 |
How the 90954 rate is calculated
Each of 90954’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 90954
RVUs × geographic indexes × conversion factor
Work20.86
20.86 RVUs× 1.000 GPCI
Practice expense8.80
8.80 RVUs× 1.000 GPCI
Malpractice1.31
1.31 RVUs× 1.000 GPCI
Adjusted RVUs
30.9700
Conversion factor
$33.4009
Medicare rate
$1,034.43
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90954
90954 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 90954
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$1,034.43
- Non-facility (office)
- $1,034.43
- Facility
- $1,034.43
Higher because the practice carries its own overhead.
90954 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90955Monthly ESRD care
- Both cover monthly ESRD management for ages 2–11, but 90955 is for two or three face-to-face visits; 90954 is for four or more.
- 90956ESRD service
- 90956 represents one face-to-face visit during the month for ages 2–11. Use 90954 when four or more visits are documented.
- 90957ESRD monthly care
- The visit threshold is the same, but 90957 is for ages 12–19; 90954 is for ages 2–11.
- 90935Hemodialysis
- 90935 describes a hemodialysis service with a single physician evaluation, rather than monthly ESRD management selected by age and monthly visit count.
90954 billing questions
What visit count supports 90954?
Use it for a patient age 2 through 11 when four or more face-to-face visits are documented during the month. The record should support the visits and the related ESRD management.
How does 90954 differ from 90955?
Both are monthly ESRD management codes for patients age 2 through 11. Choose 90954 for four or more visits; 90955 is for two or three.
When should 90956 be selected instead?
90956 is the same-age monthly code for one face-to-face visit. Use 90954 when the documented count reaches four or more.
Is 90954 reported for each dialysis treatment?
No. It represents monthly ESRD-related physician management based on the visit count, not a separate monthly service for each dialysis session.
Which code applies when the patient turns 12?
For a patient age 12 through 19 with four or more face-to-face visits in the month, compare 90957. The applicable age group and documented monthly visit count determine the code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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