$535.46–$569.38
Both codes cover monthly ESRD services for patients ages 2–11. Choose 90956 for one face-to-face visit and 90955 for two or three.
On this page
CMS RVU26D · Effective 2026-10-01
90956 ESRD service Medicare reimbursement rates in Illinois
Reports monthly ESRD-related physician services for a patient ages 2–11 when one face-to-face visit is furnished during the month. Compare 90956 office and facility rates across CMS payment localities in Illinois.
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 90956 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$363.03–$386.68
4 of 4 localities have a supported rate.
Facility setting
$363.03–$386.68
4 of 4 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 90956 pays more and less in Illinois
4 payment localities
$363.03 to $386.68
Nephrology
About 90956: Pediatric ESRD monthly service, one visit
Reports monthly ESRD-related physician services for a patient ages 2–11 when one face-to-face visit is furnished during the month.
This code represents monthly ESRD-related care for a patient who is 2 through 11 years old and receives one face-to-face visit during the month. A nephrologist commonly provides the visit in a dialysis setting, reviewing the child’s clinical course and addressing ESRD management needs such as dialysis tolerance, fluid status, laboratory findings, medications, and growth or nutrition concerns. It represents monthly care, not a separate evaluation for each dialysis treatment.
Select the code by the patient’s age and the number of face-to-face visits furnished in the month. Documentation should support the patient’s age, the date and substance of the visit, and the ESRD-related management performed. Use the corresponding sibling when the monthly visit count or age band differs; the home-dialysis monthly series and per-day services describe different circumstances. CMS assigns physician fee schedule values to this service.
Where the value comes from
- Work RVU6.64 · 60%
- Practice expense (office) RVU3.93 · 36%
- Malpractice RVU0.41 · 4%
57
Medicare services in 2024 · #5276 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.
90956 compared with similar codes
Office rates for Illinois, from the same CMS release.
$1,033.49–$1,097.44
This sibling covers the same pediatric age band but represents four or more face-to-face visits during the month.
$530.86–$564.15
90964 is the monthly ESRD service code for home dialysis patients ages 2–11; 90956 is selected by the one-visit monthly band.
$17.58–$18.68
90968 reports ESRD services per day for patients ages 2–11, rather than the monthly service represented by 90956.
Compare 90956 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$386.68
Facility
$386.68
East St. Louis →
Office / nonfacility
$370.13
Facility
$370.13
Rest Of Illinois →
Office / nonfacility
$363.03
Facility
$363.03
Suburban Chicago →
Office / nonfacility
$382.41
Facility
$382.41
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90956 billing questions
When is 90956 selected instead of 90955?
Use 90956 for a patient ages 2–11 with one face-to-face visit during the month. Code 90955 represents the same age band when two or three visits are furnished.
Does this code represent each dialysis treatment?
No. It represents monthly ESRD-related services and is selected by monthly face-to-face visit count, not by the number of dialysis sessions.
What documentation supports reporting 90956?
Record the patient’s age, the face-to-face visit date, and the ESRD-related assessment and management performed during the visit.
Can 90956 be used for a partial month?
The code describes monthly services with one visit. Per-day ESRD services are represented by a separate code series for partial-month circumstances.
Is 90956 the monthly code for home dialysis?
No. The ESRD monthly series has a separate code for home dialysis patients ages 2–11; select according to the applicable patient and service circumstances.
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.
11,56690953,,Esrd serv 1 visit p mo <2yrs,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,56790954,,Esrd serv 4 vsts p mo 2-11,A,,20.86,8.80,,8.80,,1.31,30.97,30.97,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,56890955,,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