CPT code 90967: ESRD services2026 Medicare rate & RVUs in Illinois
Report 90967 for each day of ESRD-related management furnished to a patient younger than 2 when care covers less than a full month.
Medicare pays $18.22–$19.35 for 90967 in the office in Illinois, from Rest Of Illinois to Chicago. 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 90967 covers
This code represents a day of end-stage renal disease management for a patient younger than 2 years when the clinician’s care covers less than a full month. A nephrologist or other clinician managing the child’s ESRD may report it for daily management related to dialysis, such as assessing the child’s status and directing the renal care plan. The patient’s age and the per-day service basis distinguish this code from monthly ESRD management codes.
Report one unit for each day of qualifying ESRD-related services in the partial month. Documentation should establish the patient’s age, the dates care was furnished, and the ESRD management provided on those dates. This is a per-day code, not a monthly code selected by counting face-to-face visits; use the applicable monthly code when services meet that code’s criteria for a full month of care.
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.
Where 90967 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$18.22 to $19.35
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $19.35 | $19.35 |
| East St. Louis | $18.57 | $18.57 |
| Rest Of Illinois | $18.22 | $18.22 |
| Suburban Chicago | $19.13 | $19.13 |
How the 90967 rate is calculated
Each of 90967’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 · 90967
RVUs × geographic indexes × conversion factor
Work0.35
0.35 RVUs× 1.000 GPCI
Practice expense0.18
0.18 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.5500
Conversion factor
$33.4009
Medicare rate
$18.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90967
90967 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 · 90967
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$18.37
- Non-facility (office)
- $18.37
- Facility
- $18.37
Higher because the practice carries its own overhead.
90967 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 90968ESRD daily care
- Both are daily ESRD service codes, but 90967 is for patients younger than 2 and 90968 is for patients ages 2 through 11.
- 90951ESRD monthly care
- 90951 is a monthly ESRD service code for a patient younger than 2 with four or more visits; 90967 reports qualifying care by day for a partial month.
- 90963ESRD management
- 90963 is a monthly ESRD service code for a home-dialysis patient younger than 2. 90967 reports daily services when care covers less than a full month.
90967 billing questions
When should 90967 be used instead of a monthly ESRD code?
Use 90967 when ESRD-related care for a patient younger than 2 covers less than a full month and is reported by day. Monthly codes apply when the care qualifies for a full-month service.
Does the number of visits determine the units?
No. Report one unit for each day of qualifying ESRD-related services, rather than selecting units by counting visits.
What documentation supports reporting 90967?
Record the patient’s age, the dates of service, and the ESRD-related management furnished on each reported day.
Can 90967 be reported for a patient who is exactly 2 years old?
No. This code is for patients younger than 2; the daily code for patients ages 2 through 11 is 90968.
Is 90967 specific to home dialysis?
No. The code identifies daily ESRD-related services for the under-2 age group, not a home-dialysis monthly service category.
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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