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CMS RVU26D · Effective 2026-10-01

90954 ESRD management Medicare reimbursement rates in Georgia

Monthly ESRD management for a child age 2 through 11 when four or more face-to-face visits are documented during the month. Compare 90954 office and facility rates across CMS payment localities in Georgia.

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 90954 in Georgia?

Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.

Office / nonfacility

$1011.08–$1050.01

2 of 2 localities have a supported rate.

Lowest: Rest Of Georgia

Highest: Atlanta

A spread of $38.93 per service.

Facility setting

$1011.08–$1050.01

2 of 2 localities have a supported rate.

Lowest: Rest Of Georgia

Highest: Atlanta

A spread of $38.93 per service.

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.

Find 90954 in your payment locality →

Nephrology

About 90954: Pediatric monthly ESRD management, four visits

Monthly ESRD management for a child age 2 through 11 when four or more face-to-face visits are documented during the month.

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.

Where the value comes from

  • Work RVU20.86 · 67%
  • Practice expense (office) RVU8.80 · 28%
  • Malpractice RVU1.31 · 4%

368

Medicare services in 2024 · #3805 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.

90954 compared with similar codes

Office rates for Georgia, from the same CMS release.

90955

Monthly ESRD care

Ages 2–11, 2–3 visits

$523.91–$546.51

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.

90956

ESRD service

Ages 2–11, one monthly visit

$355.19–$372.26

90956 represents one face-to-face visit during the month for ages 2–11. Use 90954 when four or more visits are documented.

90957

ESRD monthly care

Age 12–19, four or more visits

$776.46–$809.04

The visit threshold is the same, but 90957 is for ages 12–19; 90954 is for ages 2–11.

90935

Hemodialysis

One clinician evaluation

No office rate

90935 describes a hemodialysis service with a single physician evaluation, rather than monthly ESRD management selected by age and monthly visit count.

Compare 90954 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.

2 of 2 payment localities

Office and facility base rates · shared scale starting at $0

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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 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 90954PPRRVU2026_Oct_nonQPP.csv, line 11,567 (RVU26D)
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