Billing code 90963: ESRD managementMedicare rate & RVUs in Texas
Monthly ESRD-related management for a child younger than 2 years receiving home dialysis, reported for the applicable month of care.
Medicare pays $606.72–$637.53 for 90963 in the office in Texas, from Beaumont to Houston. 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 90963 covers
Code 90963 covers a physician’s month-level management of a child younger than 2 years who receives dialysis at home. The nephrologist or other clinician managing the renal replacement plan assesses the child’s clinical course, dialysis prescription, fluid balance, blood pressure, laboratory findings, medications, nutrition, growth, and dialysis access, and adjusts care as needed. This work commonly occurs through a pediatric nephrology practice, with coordination among caregivers, home dialysis nurses, and the dialysis program.
Select this code based on the home-dialysis setting, the patient’s age, and the billing period. It represents monthly ESRD-related management, rather than a dialysis treatment session. Dated documentation should support the clinician’s assessment and management during the month. When ESRD-related services are furnished for less than a full month, the age-specific per-day code 90967 is the related reporting option. CMS PFS pricing assigns work, practice-expense, and malpractice RVUs to this monthly service.
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 90963 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$606.72 to $637.53
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $635.67 | $635.67 |
| Beaumont | $606.72 | $606.72 |
| Brazoria | $622.21 | $622.21 |
| Dallas | $625.55 | $625.55 |
| Fort Worth | $623.91 | $623.91 |
| Galveston | $623.81 | $623.81 |
| Houston | $637.53 | $637.53 |
| Rest Of Texas | $613.77 | $613.77 |
How the 90963 rate is calculated
Each of 90963’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 · 90963
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.09Practice expense 5.91Malpractice 0.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 90963
90963 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 · 90963
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$626.27
The facility rate would be $626.27 (−$0.00). In a facility, the facility bills its own costs separately.
90963 compared with similar codes
Compare codes
90963 vs 90964 vs 90967 vs 90951: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 90964ESRD services
- Both codes cover monthly ESRD-related management for home dialysis. Use 90963 for patients younger than 2 and 90964 for patients ages 2 through 11.
- 90967ESRD services
- 90963 is the monthly code for a patient younger than 2 receiving home dialysis; 90967 is the per-day option when services cover less than a full month.
- 90951ESRD monthly care
- 90951 is for in-center ESRD management of a patient younger than 2 at the four-or-more-visit level. 90963 is for monthly management of a home-dialysis patient in that age group.
90963 billing questions
Which patients qualify for 90963?
Use it for monthly ESRD-related services for a patient younger than 2 years who receives dialysis at home. The age and dialysis setting distinguish it from the other monthly ESRD management codes.
Is 90963 selected by the number of monthly visits?
No visit-count tier is built into this home-dialysis code. Select it by the patient’s age, home-dialysis status, and monthly service period.
When is 90967 used instead?
90967 is the related per-day code for a patient younger than 2 years when ESRD-related services cover less than a full month.
Does the number of home dialysis treatments determine units?
No. 90963 represents monthly ESRD-related management, not individual dialysis treatments; document the monthly assessment and management furnished.
How does 90963 differ from 90951?
90963 is for home dialysis and is selected by age and monthly service period. 90951 is an in-center ESRD management code for a patient younger than 2 years with a four-or-more-visit monthly level.
What documentation supports 90963?
Record the patient’s age and home-dialysis status, the month of service, and the clinician’s ESRD-related assessment and management, such as review of the dialysis plan, clinical status, and relevant results.
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 90963 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 →