$18.03
Both are daily ESRD service codes, but 90967 is for patients younger than 2 and 90968 is for patients ages 2 through 11.
On this page
CMS RVU26D · Effective 2026-10-01
90967 ESRD services Medicare reimbursement rates in Rhode Island
Report 90967 for each day of ESRD-related management furnished to a patient younger than 2 when care covers less than a full month. Compare 90967 office and facility rates across CMS payment localities in Rhode Island.
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 90967 in Rhode Island?
Rhode Island 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
$18.72
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$18.72
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Renal services
About 90967: Daily ESRD services for young child
Report 90967 for each day of ESRD-related management furnished to a patient younger than 2 when care covers less than a full month.
This code represents a day of end-stage renal disease management for a patient younger than 2 years when the clinician’s care covers less than a full month. A nephrologist or other clinician managing the child’s ESRD may report it for daily management related to dialysis, such as assessing the child’s status and directing the renal care plan. The patient’s age and the per-day service basis distinguish this code from monthly ESRD management codes.
Report one unit for each day of qualifying ESRD-related services in the partial month. Documentation should establish the patient’s age, the dates care was furnished, and the ESRD management provided on those dates. This is a per-day code, not a monthly code selected by counting face-to-face visits; use the applicable monthly code when services meet that code’s criteria for a full month of care.
Where the value comes from
- Work RVU0.35 · 64%
- Practice expense (office) RVU0.18 · 33%
- Malpractice RVU0.02 · 4%
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.
90967 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$1,204.73
90951 is a monthly ESRD service code for a patient younger than 2 with four or more visits; 90967 reports qualifying care by day for a partial month.
$637.75
90963 is a monthly ESRD service code for a home-dialysis patient younger than 2. 90967 reports daily services when care covers less than a full month.
Compare 90967 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
Rhode Island →
Office / nonfacility
$18.72
Facility
$18.72
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 90967 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
11,580
- Code
- 90967
- Physician work
- 0.35
- Practice expense
- 0.18
- Malpractice
- 0.02
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.35 | × 1.019 | 0.3566 |
| Practice expense | 0.18 | × 1.033 | 0.1859 |
| Malpractice | 0.02 | × 0.892 | 0.0178 |
| Total RVUs | 0.5604 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$18.72
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.35 | 1.019 |
| Practice expense | 0.18 | 1.033 |
| Malpractice | 0.02 | 0.892 |
(0.35 × 1.019 + 0.18 × 1.033 + 0.02 × 0.892) × $33.4009 = $18.72
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.35 | 1.019 |
| Practice expense | 0.18 | 1.033 |
| Malpractice | 0.02 | 0.892 |
(0.35 × 1.019 + 0.18 × 1.033 + 0.02 × 0.892) × $33.4009 = $18.72
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.
90967 billing questions
When should 90967 be used instead of a monthly ESRD code?
Use 90967 when ESRD-related care for a patient younger than 2 covers less than a full month and is reported by day. Monthly codes apply when the care qualifies for a full-month service.
Does the number of visits determine the units?
No. Report one unit for each day of qualifying ESRD-related services, rather than selecting units by counting visits.
What documentation supports reporting 90967?
Record the patient’s age, the dates of service, and the ESRD-related management furnished on each reported day.
Can 90967 be reported for a patient who is exactly 2 years old?
No. This code is for patients younger than 2; the daily code for patients ages 2 through 11 is 90968.
Is 90967 specific to home dialysis?
No. The code identifies daily ESRD-related services for the under-2 age group, not a home-dialysis monthly service 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.
11,57790964,,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
11,58190968,,Esrd svc pr day pt 2-11,A,,0.34,0.17,,0.17,,0.02,0.53,0.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,58290969,,Esrd svc pr day pt 12-19,A,,0.33,0.17,,0.17,,0.02,0.52,0.52,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,58390970,,Esrd svc pr day pt 20+,A,,0.18,0.11,,0.11,,0.01,0.30,0.30,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537