$88.99
Both cover implanted spinal or brain drug-pump refill and maintenance. Choose 95991 when the service requires physician skill; 95990 covers services that do not.
On this page
CMS RVU26D · Effective 2026-10-01
95991 Pump refill Medicare reimbursement rates in Iowa
Report 95991 for a physician-skilled refill and maintenance service on an implanted pump delivering medication into the spinal or brain fluid spaces. Compare 95991 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 95991 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
$106.97
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$31.79
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.
Neurology procedure
About 95991: Skilled intrathecal pump refill and maintenance
Report 95991 for a physician-skilled refill and maintenance service on an implanted pump delivering medication into the spinal or brain fluid spaces.
This service covers skilled refill and maintenance of an implanted drug-delivery pump or reservoir serving the intrathecal space or a brain ventricle. The clinician accesses the pump’s refill port, manages the reservoir contents, and replenishes medication. Common examples include intrathecal baclofen therapy for severe spasticity and implanted pumps delivering medication for chronic pain. Pain medicine, neurology, and physical medicine and rehabilitation clinicians may perform the service in an office or outpatient facility.
Select 95991 when the refill and maintenance require a physician’s skill; 95990 is the related code for services not requiring that skill. Document the pump and delivery site, the refill performed, medication and reservoir details, and the skilled work supporting code selection. The refill service is distinct from the medication itself, which may be reported separately when applicable. CMS fee-schedule valuation for this code includes physician work and practice expense, with office and facility practice-expense inputs.
Where the value comes from
- Work RVU0.75 · 22%
- Practice expense (office) RVU2.65 · 76%
- Malpractice RVU0.07 · 2%
7.5K
Medicare services in 2024 · #1619 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.
95991 compared with similar codes
Office rates for Iowa, from the same CMS release.
$89.57
Use 62369 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is simple.
$90.05
Use 62370 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is complex.
Compare 95991 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
$106.97
Facility
$31.79
Need rates for a whole code list?
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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 95991 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
12,736
- Code
- 95991
- Physician work
- 0.75
- Practice expense
- 2.65
- Malpractice
- 0.07
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.000 | 0.7500 |
| Practice expense | 2.65 | × 0.915 | 2.4247 |
| Malpractice | 0.07 | × 0.397 | 0.0278 |
| Total RVUs | 3.2025 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$106.97
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 2.65 | 0.915 |
| Malpractice | 0.07 | 0.397 |
(0.75 × 1 + 2.65 × 0.915 + 0.07 × 0.397) × $33.4009 = $106.97
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 0.19 | 0.915 |
| Malpractice | 0.07 | 0.397 |
(0.75 × 1 + 0.19 × 0.915 + 0.07 × 0.397) × $33.4009 = $31.79
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.
95991 billing questions
How does 95991 differ from 95990?
95991 is for pump refill and maintenance requiring a physician’s skill. Use 95990 when the service does not require that skill.
Does the refill code include the medication?
The code represents the refill and maintenance service, not the medication supply. Report the drug separately when applicable and supported by the documentation.
What details support reporting 95991?
Document the implanted pump and its intrathecal or intraventricular delivery site, the refill and reservoir details, and the physician-skilled work performed.
When should a programmable-pump code be considered instead?
Consider 62369 or 62370 when the service includes electronic analysis, reprogramming, refill, and maintenance of a programmable pump; those codes distinguish simple from complex services.
Is 95991 selected by the drug or the refill amount?
Selection turns on the physician skill required for the refill and maintenance, not the medication name or amount alone.
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.
12,73395983,,Alys brn npgt prgrmg 15 min,A,,0.91,0.56,,0.27,,0.08,1.55,1.26,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73495984,,Alys brn npgt prgrmg addl 15,A,,0.80,0.48,,0.24,,0.07,1.35,1.11,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73595990,,Spin/brain pump refil & main,A,,0.00,2.89,,2.89,NA,0.05,2.94,2.94,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73695991,,Spin/brain pump refil & main,A,,0.75,2.65,,0.19,,0.07,3.47,1.01,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73795992,,Canalith repositioning proc,A,,0.73,0.47,,0.14,,0.02,1.22,0.89,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73895999,,Unlisted neurological dx px,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
12,73996000,,Motion analysis video/3d,A,,1.76,0.30,NA,0.30,,0.05,2.11,2.11,7,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,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