$503.88
Both cover monthly home dialysis management, but 90965 is for patients ages 12 through 19; 90966 is for patients age 20 or older.
On this page
CMS RVU26D · Effective 2026-10-01
90966 Home dialysis Medicare reimbursement rates in Utah
Monthly ESRD-related management for a patient age 20 or older receiving dialysis at home, including ongoing assessment and management of the dialysis plan. Compare 90966 office and facility rates across CMS payment localities in Utah.
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 90966 in Utah?
Utah 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
$302.23
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$302.23
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Nephrology
About 90966: Adult home dialysis monthly management
Monthly ESRD-related management for a patient age 20 or older receiving dialysis at home, including ongoing assessment and management of the dialysis plan.
This code represents a month of ESRD-related management for an adult receiving dialysis at home, such as home hemodialysis or peritoneal dialysis. A nephrologist or other qualified clinician manages the patient’s dialysis care, assessing clinical status and addressing the treatment plan, relevant results, and related care needs. Services may be furnished through an outpatient nephrology practice while the patient performs dialysis at home.
Select the code based on the patient’s age and home dialysis setting, not on the number of monthly visits. Documentation should identify the home modality and support the ESRD-related assessment and management furnished during the month. For a patient age 20 or older whose ESRD services cover only part of a month, consider the age-matched per-day code rather than reporting this monthly service as a visit-count level.
Where the value comes from
- Work RVU5.52 · 59%
- Practice expense (office) RVU3.41 · 37%
- Malpractice RVU0.36 · 4%
296.3K
Medicare services in 2024 · #313 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.
90966 compared with similar codes
Office rates for Utah, from the same CMS release.
$9.77
90970 reports ESRD services per day for patients age 20 or older when care covers part of a month; 90966 is the monthly home dialysis code.
$363.35
90960 is for in-center ESRD management at the four-or-more-visit level for patients age 20 or older. 90966 is for home dialysis management and is not selected by visit count.
$209.04
90962 is for in-center ESRD management at the one-visit level for patients age 20 or older. 90966 applies to monthly home dialysis management.
Compare 90966 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
Utah →
Office / nonfacility
$302.23
Facility
$302.23
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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 90966 in Utah.
PPRRVU2026_Oct_nonQPP.csv
11,579
- Code
- 90966
- Physician work
- 5.52
- Practice expense
- 3.41
- Malpractice
- 0.36
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.52 | × 1.000 | 5.5200 |
| Practice expense | 3.41 | × 0.940 | 3.2054 |
| Malpractice | 0.36 | × 0.898 | 0.3233 |
| Total RVUs | 9.0487 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$302.23
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.52 | 1 |
| Practice expense | 3.41 | 0.94 |
| Malpractice | 0.36 | 0.898 |
(5.52 × 1 + 3.41 × 0.94 + 0.36 × 0.898) × $33.4009 = $302.23
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.52 | 1 |
| Practice expense | 3.41 | 0.94 |
| Malpractice | 0.36 | 0.898 |
(5.52 × 1 + 3.41 × 0.94 + 0.36 × 0.898) × $33.4009 = $302.23
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.
90966 billing questions
Does the number of visits during the month determine whether 90966 applies?
No. The monthly home dialysis code is selected by age and dialysis setting, rather than by the visit-count levels used for in-center ESRD services.
How does 90966 differ from 90965?
Both are monthly home dialysis management codes; 90966 is for patients age 20 or older, while 90965 is for patients ages 12 through 19.
What code is used when home dialysis services cover only part of a month?
For a patient age 20 or older, the per-day counterpart is 90970. Use the code that reflects the patient’s age and the service period.
Is 90966 for home hemodialysis, peritoneal dialysis, or both?
It applies to home dialysis management, including home hemodialysis and peritoneal dialysis.
What should the record support?
Document the patient’s age, home dialysis modality, month of management, and the ESRD-related assessment and management provided.
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.
11,57690963,,Esrd home pt serv p mo <2yrs,A,,12.09,5.91,,5.91,,0.75,18.75,18.75,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,57790964,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985