Billing code 95990: Pump refillMedicare rate & RVUs in Illinois
Reports refill and maintenance of an implanted drug-delivery pump serving the spinal or brain space, such as a pump used for intrathecal baclofen or pain medication.
Medicare pays $90.74–$102.09 for 95990 in the office in Illinois, from Rest Of Illinois to Suburban 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 95990 covers
This service replenishes and maintains an implanted pump or reservoir that delivers medication into the spinal space or brain ventricles. Typical patients include people receiving intrathecal baclofen for severe spasticity or implanted-pump medication for chronic pain. A clinician accesses the pump’s refill port, withdraws or accounts for residual medication as appropriate, adds the prescribed drug, and may check pump status as part of the service. It is commonly performed in an outpatient pain-management, rehabilitation, or neurosurgical setting.
Report 95990 for the pump refill and maintenance service, not simply for a medication injection or an office visit. Documentation should identify the implanted pump and delivery site, medication and amount instilled, relevant residual volume, and the work performed. CMS classifies this as an incident-to service: it may be billed only when performed under physician supervision. CMS assigns no work RVU to the code; its listed RVUs include practice expense and malpractice.
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 95990 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
$90.74 to $102.09
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $100.84 | Unavailable |
| East St. Louis | $92.17 | Unavailable |
| Rest Of Illinois | $90.74 | Unavailable |
| Suburban Chicago | $102.09 | Unavailable |
How the 95990 rate is calculated
Each of 95990’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 · 95990
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense2.89
2.89 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.9400
Conversion factor
$33.4009
Medicare rate
$98.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95990
The CMS indicators that decide how 95990 is paid alongside other services.
CMS payment indicators · 95990
Pump refill
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
95990 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95991Pump refill
- Both concern implanted spinal or brain drug-pump refill and maintenance. Distinguish 95990’s incident-to, physician-supervised service from 95991 when physician skill is required.
- 62369Pump management
- Consider 62369 for a programmable implanted pump when the performed work meets that code’s electronic-analysis, reprogramming, refill, and maintenance criteria; 95990 describes the pump refill and maintenance service.
- 62370Pump refill
- Use the applicable programmable-pump code when electronic analysis and reprogramming accompany refill and maintenance and the work meets 62370’s criteria, rather than treating the encounter as a refill alone.
95990 billing questions
When should 95990 be chosen instead of 95991?
Use 95990 for the refill and maintenance service when it is performed under physician supervision as an incident-to service. The related 95991 code is used when the service requires physician skill.
Does 95990 describe an ordinary medication injection?
No. It covers refilling and maintaining an implanted pump or reservoir that delivers medication into the spinal space or brain ventricles, not a separately administered injection.
What documentation supports reporting 95990?
Record the implanted pump and delivery site, the medication and amount placed in the reservoir, relevant residual volume, and the refill and maintenance performed. The record must also support physician supervision for incident-to billing.
Can pump programming be reported with 95990?
Do not use 95990 alone to represent a distinct pump-analysis or reprogramming service. For a programmable pump, select the applicable analysis code based on whether analysis, reprogramming, and refill were performed.
Is 95990 reported per pump or per refill access?
Report the completed pump refill and maintenance service for the encounter; do not count each access maneuver or medication component as a separate unit.
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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