$536.97–$572.76
Use 90964 for home-dialysis patients ages 2 through 11; 90965 is for ages 12 through 19.
On this page
CMS RVU26D · Effective 2026-10-01
90965 Home dialysis Medicare reimbursement rates in Florida
Monthly ESRD-related physician services for a home dialysis patient ages 12 through 19, covering ongoing clinical management rather than individual dialysis sessions. Compare 90965 office and facility rates across CMS payment localities in Florida.
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 90965 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$518.70–$553.60
3 of 3 localities have a supported rate.
Facility setting
$518.70–$553.60
3 of 3 localities have a supported rate.
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.
Where 90965 pays more and less in Florida
3 payment localities
$518.70 to $553.60
ESRD services
About 90965: Home dialysis ESRD services, adolescent
Monthly ESRD-related physician services for a home dialysis patient ages 12 through 19, covering ongoing clinical management rather than individual dialysis sessions.
This code represents a month of ESRD-related physician or qualified health care professional services for a patient ages 12 through 19 who receives dialysis at home. Care may include managing the dialysis prescription, reviewing treatment adequacy and relevant laboratory results, assessing fluid status and complications, and coordinating the patient’s renal care. The service is reported for the patient’s monthly home-dialysis management, not for each dialysis treatment or each contact during the month.
Select this code when the patient’s age and home-dialysis status match the code’s criteria and the practitioner provides the corresponding monthly ESRD-related services. Documentation should support the patient’s age, home treatment status, and clinical management during the month. Report the age-specific sibling for a different age group; when services cover only part of a month, use the applicable per-day code rather than this monthly code.
Where the value comes from
- Work RVU9.80 · 63%
- Practice expense (office) RVU5.05 · 33%
- Malpractice RVU0.60 · 4%
716
Medicare services in 2024 · #3239 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.
90965 compared with similar codes
Office rates for Florida, from the same CMS release.
$311.33–$333.35
Use 90966 for home-dialysis patients age 20 or older; 90965 is for ages 12 through 19.
$17.45–$18.62
90969 reports per-day services for a partial month for a patient ages 12 through 19. Use 90965 for monthly services when the patient’s care covers the month.
$802.51–$857.16
90957 belongs to the age 12-through-19 monthly ESRD visit-count series, not the home-dialysis series represented by 90965.
Compare 90965 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
$534.43
Facility
$534.43
Miami →
Office / nonfacility
$553.60
Facility
$553.60
Rest Of Florida →
Office / nonfacility
$518.70
Facility
$518.70
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90965 billing questions
How does this differ from 90964 or 90966?
Those codes represent monthly ESRD-related services for home dialysis patients in different age groups: 90964 for ages 2 through 11 and 90966 for age 20 or older. Use 90965 for ages 12 through 19.
Is this billed for each home dialysis treatment?
No. It represents monthly ESRD-related management, not an individual dialysis session.
What if the practitioner provides services for only part of the month?
Use the applicable age-specific per-day code, 90969, for a patient ages 12 through 19 when the service period is less than a full month.
What documentation supports reporting 90965?
Document the patient’s age, home-dialysis status, and the ESRD-related clinical management provided during the month.
When would 90957 be considered instead?
90957 is in the age 12-through-19 ESRD monthly service series based on monthly visit count, rather than the home-dialysis series. Choose the code family that matches the patient’s dialysis situation and services.
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.
11,57590962,,Esrd serv 1 visit p mo 20+,A,,3.57,2.65,,2.65,,0.22,6.44,6.44,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57690963,,Esrd home pt serv p mo <2yrs,A,,12.09,5.91,,5.91,,0.75,18.75,18.75,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57790964,,Esrd home pt serv p mo 2-11,A,,10.25,5.12,,5.12,,0.62,15.99,15.99,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57890965,,Esrd home pt serv p mo 12-19,A,,9.80,5.05,,5.05,,0.60,15.45,15.45,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57990966,,Esrd home pt serv p mo 20+,A,,5.52,3.41,,3.41,,0.36,9.29,9.29,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,58090967,,Esrd svc pr day pt <2,A,,0.35,0.18,,0.18,,0.02,0.55,0.55,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,58190968,,Esrd svc pr day pt 2-11,A,,0.34,0.17,,0.17,,0.02,0.53,0.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00