$594.38
Both report monthly ESRD-related services for home dialysis; 90963 is for patients younger than 2, while 90964 is for ages 2 through 11.
On this page
CMS RVU26D · Effective 2026-10-01
90964 ESRD services Medicare reimbursement rates in Iowa
Report this monthly physician service for ongoing ESRD-related care of a patient ages 2 through 11 who receives dialysis at home. Compare 90964 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 90964 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
$507.06
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$507.06
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 90964: Pediatric home dialysis monthly management
Report this monthly physician service for ongoing ESRD-related care of a patient ages 2 through 11 who receives dialysis at home.
This code represents a month of physician management for a child ages 2 through 11 receiving home dialysis. A nephrologist typically assesses the child’s dialysis-related status, reviews treatment and laboratory information, and manages issues such as fluid balance, blood pressure, medications, vascular access, and dialysis complications. Care may involve coordination with the family and the home dialysis team in an outpatient setting.
Select the code based on the patient’s age and home-dialysis status for the month. Documentation should support the patient’s age, home dialysis, and the physician’s ESRD-related management during that month. This is a monthly service code, not a code for each home dialysis session. For a partial month, compare the circumstances with the applicable per-day ESRD service code rather than treating this as a per-session service.
Where the value comes from
- Work RVU10.25 · 64%
- Practice expense (office) RVU5.12 · 32%
- Malpractice RVU0.62 · 4%
605
Medicare services in 2024 · #3387 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.
90964 compared with similar codes
Office rates for Iowa, from the same CMS release.
$489.62
Both are monthly home-dialysis ESRD service codes. Use 90965 for ages 12 through 19 and 90964 for ages 2 through 11.
$16.82
Code 90968 represents per-day ESRD services for home-dialysis patients ages 2 through 11; 90964 represents the monthly service for that age group.
$983.06
Code 90954 applies to a different dialysis setting and visit-count category for patients ages 2 through 11; 90964 is the monthly home-dialysis code.
Compare 90964 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
$507.06
Facility
$507.06
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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 90964 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
11,577
- Code
- 90964
- Physician work
- 10.25
- Practice expense
- 5.12
- Malpractice
- 0.62
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.25 | × 1.000 | 10.2500 |
| Practice expense | 5.12 | × 0.915 | 4.6848 |
| Malpractice | 0.62 | × 0.397 | 0.2461 |
| Total RVUs | 15.1809 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$507.06
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.25 | 1 |
| Practice expense | 5.12 | 0.915 |
| Malpractice | 0.62 | 0.397 |
(10.25 × 1 + 5.12 × 0.915 + 0.62 × 0.397) × $33.4009 = $507.06
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.25 | 1 |
| Practice expense | 5.12 | 0.915 |
| Malpractice | 0.62 | 0.397 |
(10.25 × 1 + 5.12 × 0.915 + 0.62 × 0.397) × $33.4009 = $507.06
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.
90964 billing questions
How is 90964 distinguished from 90963 and 90965?
These are monthly home-dialysis ESRD service codes distinguished by patient age. Code 90964 is for ages 2 through 11; 90963 is for patients younger than 2, and 90965 is for ages 12 through 19.
Is 90964 reported for every home dialysis treatment?
No. It represents monthly ESRD-related physician management, not an individual dialysis session.
What documentation supports reporting 90964?
Document the patient’s age, home-dialysis status, and the ESRD-related assessment and management provided during the month.
When should a per-day code be considered instead?
Consider the age-appropriate per-day ESRD service code when the applicable circumstances involve a partial month. Code 90968 is the per-day code for ages 2 through 11.
How does 90964 differ from 90954?
Both relate to patients ages 2 through 11, but 90964 is for home dialysis. Code 90954 is a monthly ESRD service code for a different dialysis setting and visit-count 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 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.
11,57490961,,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
11,58090967,,Esrd svc pr day pt <2,A,,0.35,0.18,,0.18,,0.02,0.55,0.55,0,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