$507.06
Both codes cover monthly ESRD-related management for home dialysis. Use 90963 for patients younger than 2 and 90964 for patients ages 2 through 11.
On this page
CMS RVU26D · Effective 2026-10-01
90963 ESRD management Medicare reimbursement rates in Iowa
Monthly ESRD-related management for a child younger than 2 years receiving home dialysis, reported for the applicable month of care. Compare 90963 office and facility rates across CMS payment localities in Iowa.
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 90963 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$594.38
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$594.38
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
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.
Nephrology
About 90963: Home dialysis management, under age two
Monthly ESRD-related management for a child younger than 2 years receiving home dialysis, reported for the applicable month of care.
Code 90963 covers a physician’s month-level management of a child younger than 2 years who receives dialysis at home. The nephrologist or other clinician managing the renal replacement plan assesses the child’s clinical course, dialysis prescription, fluid balance, blood pressure, laboratory findings, medications, nutrition, growth, and dialysis access, and adjusts care as needed. This work commonly occurs through a pediatric nephrology practice, with coordination among caregivers, home dialysis nurses, and the dialysis program.
Select this code based on the home-dialysis setting, the patient’s age, and the billing period. It represents monthly ESRD-related management, rather than a dialysis treatment session. Dated documentation should support the clinician’s assessment and management during the month. When ESRD-related services are furnished for less than a full month, the age-specific per-day code 90967 is the related reporting option. CMS PFS pricing assigns work, practice-expense, and malpractice RVUs to this monthly service.
Where the value comes from
- Work RVU12.09 · 64%
- Practice expense (office) RVU5.91 · 32%
- Malpractice RVU0.75 · 4%
108
Medicare services in 2024 · #4825 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.
90963 compared with similar codes
Office rates for Iowa, from the same CMS release.
$17.46
90963 is the monthly code for a patient younger than 2 receiving home dialysis; 90967 is the per-day option when services cover less than a full month.
$1,125.76
90951 is for in-center ESRD management of a patient younger than 2 at the four-or-more-visit level. 90963 is for monthly management of a home-dialysis patient in that age group.
Compare 90963 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.
1 of 1 payment localities
Iowa →
Office / nonfacility
$594.38
Facility
$594.38
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 90963 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
11,576
- Code
- 90963
- Physician work
- 12.09
- Practice expense
- 5.91
- Malpractice
- 0.75
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.09 | × 1.000 | 12.0900 |
| Practice expense | 5.91 | × 0.915 | 5.4077 |
| Malpractice | 0.75 | × 0.397 | 0.2978 |
| Total RVUs | 17.7954 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$594.38
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.09 | 1 |
| Practice expense | 5.91 | 0.915 |
| Malpractice | 0.75 | 0.397 |
(12.09 × 1 + 5.91 × 0.915 + 0.75 × 0.397) × $33.4009 = $594.38
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.09 | 1 |
| Practice expense | 5.91 | 0.915 |
| Malpractice | 0.75 | 0.397 |
(12.09 × 1 + 5.91 × 0.915 + 0.75 × 0.397) × $33.4009 = $594.38
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
90963 billing questions
Which patients qualify for 90963?
Use it for monthly ESRD-related services for a patient younger than 2 years who receives dialysis at home. The age and dialysis setting distinguish it from the other monthly ESRD management codes.
Is 90963 selected by the number of monthly visits?
No visit-count tier is built into this home-dialysis code. Select it by the patient’s age, home-dialysis status, and monthly service period.
When is 90967 used instead?
90967 is the related per-day code for a patient younger than 2 years when ESRD-related services cover less than a full month.
Does the number of home dialysis treatments determine units?
No. 90963 represents monthly ESRD-related management, not individual dialysis treatments; document the monthly assessment and management furnished.
How does 90963 differ from 90951?
90963 is for home dialysis and is selected by age and monthly service period. 90951 is an in-center ESRD management code for a patient younger than 2 years with a four-or-more-visit monthly level.
What documentation supports 90963?
Record the patient’s age and home-dialysis status, the month of service, and the clinician’s ESRD-related assessment and management, such as review of the dialysis plan, clinical status, and relevant results.
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.
11,57390960,,Esrd srv 4 visits p mo 20+,A,,6.77,3.96,,3.96,,0.43,11.16,11.16,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57490961,,Esrd srv 2-3 vsts p mo 20+,A,,5.52,3.42,,3.42,,0.36,9.30,9.30,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57590962,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136