CPT code 90957: ESRD monthly care2026 Medicare rate & RVUs in Oregon
Monthly ESRD-related management for a patient age 12 through 19 when the clinician provides at least four face-to-face visits during the month.
Medicare pays $786.23–$824.34 for 90957 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 90957 covers
Code 90957 represents monthly management of end-stage renal disease for a patient age 12 through 19 who receives four or more face-to-face visits during the month. A nephrologist or other qualified clinician typically provides this care in connection with the patient’s dialysis program. The work may include assessing dialysis adequacy, volume status, nutrition, vascular access, complications, and the ongoing treatment plan, as well as coordinating care with the dialysis team.
Report one monthly service when the age and visit-count criteria are met; this is not a per-dialysis-session code. Documentation should support the patient’s age, the ESRD-related management provided, and at least four face-to-face visits in that calendar month. Select a different monthly code when the patient has fewer qualifying visits, falls into another age band, or receives home dialysis services represented by the home-dialysis series. CMS lists no payment rules for this code in the supplied facts.
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 90957 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $824.34 | $824.34 |
| Rest Of Oregon | $786.23 | $786.23 |
How the 90957 rate is calculated
Each of 90957’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 · 90957
RVUs × geographic indexes × conversion factor
Work15.46
15.46 RVUs× 1.000 GPCI
Practice expense7.42
7.42 RVUs× 1.000 GPCI
Malpractice0.98
0.98 RVUs× 1.000 GPCI
Adjusted RVUs
23.8600
Conversion factor
$33.4009
Medicare rate
$796.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90957
90957 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 · 90957
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$796.95
- Non-facility (office)
- $796.95
- Facility
- $796.95
Higher because the practice carries its own overhead.
90957 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90958ESRD management
- Both codes cover monthly ESRD management for ages 12–19. Choose 90957 for four or more face-to-face visits and 90958 for two or three.
- 90959ESRD monthly care
- Both apply to ages 12–19, but 90959 represents one face-to-face visit during the month; 90957 requires four or more.
- 90960Monthly ESRD services
- Both represent monthly ESRD management with four or more face-to-face visits. Code 90960 is for patients age 20 or older, while 90957 is for ages 12–19.
- 90935Hemodialysis
- Code 90935 describes hemodialysis with one evaluation. Code 90957 represents monthly ESRD-related management for a patient ages 12–19 with four or more face-to-face visits.
90957 billing questions
When should I choose 90957 instead of 90958?
Use 90957 for a patient age 12 through 19 with four or more face-to-face visits during the month. Code 90958 is the same age group with two or three visits.
Is 90957 reported for each dialysis treatment?
No. It represents monthly ESRD-related management, with the number of face-to-face visits determining the applicable monthly code.
What supports reporting four or more visits?
Keep documentation of the face-to-face ESRD-related encounters during the month, along with the assessments and management provided. The record should support the patient’s age and the monthly service.
How does this differ from 90935?
Code 90957 describes monthly ESRD-related management for the specified age and visit count. Code 90935 describes a hemodialysis service with one evaluation, rather than monthly management.
What if the patient received only one visit that month?
For a patient age 12 through 19 with one face-to-face visit, use the corresponding one-visit monthly code, 90959, rather than 90957.
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
Fee sheets
Put 90957 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →