Billing code 90951: ESRD monthly careMedicare rate & RVUs in Oregon
Monthly ESRD management for a patient younger than 2 years, reported when the physician or qualified professional provides at least four face-to-face visits.
Medicare pays $1,167.90–$1,221.32 for 90951 in the office in Oregon, from Rest Of Oregon to Portland. 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 90951 covers
billing code 90951 represents a month of ongoing end-stage renal disease management for a child younger than 2 years who receives at least four face-to-face visits from a physician or other qualified health care professional during that month. A nephrologist commonly provides this care in connection with dialysis, assessing matters such as the dialysis plan, fluid status, vascular access, laboratory findings, and related complications. The service is distinct from documenting a single dialysis treatment encounter.
Choose the monthly code using both the patient’s age category and the number of face-to-face visits in the month. The record should support the visits and the ESRD-related assessment and management provided; report the service for the month, not as one unit for each visit. For a patient receiving home dialysis, compare the home-dialysis monthly family, 90963–90966. When management covers only part of a month, compare the age-specific daily service family, 90967–90970.
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 90951 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $1,221.32 | $1,221.32 |
| Rest Of Oregon | $1,167.90 | $1,167.90 |
How the 90951 rate is calculated
Each of 90951’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 · 90951
RVUs × geographic indexes × conversion factor
Work23.92
23.92 RVUs× 1.000 GPCI
Practice expense10.06
10.06 RVUs× 1.000 GPCI
Malpractice1.46
1.46 RVUs× 1.000 GPCI
Adjusted RVUs
35.4400
Conversion factor
$33.4009
Medicare rate
$1,183.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90951
90951 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 · 90951
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$1,183.73
- Non-facility (office)
- $1,183.73
- Facility
- $1,183.73
Higher because the practice carries its own overhead.
90951 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90952Esrd serv 2-3 vsts p mo <2yr
- Both codes cover monthly ESRD-related management for patients younger than 2 years. Use 90952 for two or three face-to-face visits; 90951 requires at least four.
- 90953Esrd serv 1 visit p mo <2yrs
- 90953 is the one-visit monthly level for a patient younger than 2 years. 90951 requires at least four face-to-face visits during the month.
- 90963ESRD management
- 90963 is the monthly code family for home dialysis patients younger than 2 years. 90951 is selected by the four-or-more visit level in the other monthly ESRD service family.
- 90967ESRD services
- 90967 reports age-specific ESRD services by day for a patient younger than 2 years; 90951 represents the monthly service at the four-or-more visit level.
90951 billing questions
How many visits support 90951?
The patient must have at least four face-to-face visits with a physician or other qualified health care professional during the month. The record should support the visits and the ESRD-related management.
Is 90951 billed once for each visit?
No. It represents monthly ESRD-related management, selected by the monthly visit count rather than billed as a separate unit for each visit.
When should 90952 or 90953 be used instead?
For a patient younger than 2 years, 90952 is the sibling for two or three face-to-face visits in the month, and 90953 is for one visit.
Does 90951 describe home dialysis management?
For a patient receiving home dialysis, compare the age-based home-dialysis monthly codes 90963–90966 rather than choosing this code solely by visit count.
What documentation supports the monthly service?
Document the patient's age category, dates of face-to-face visits, and the ESRD-related assessment and management performed, such as review of dialysis needs, fluid status, access, or relevant laboratory findings.
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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