Billing code 95991: Pump refillMedicare rate & RVUs in Washington
Report 95991 for a physician-skilled refill and maintenance service on an implanted pump delivering medication into the spinal or brain fluid spaces.
Medicare pays $120.36–$136.82 for 95991 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 95991 covers
This service covers skilled refill and maintenance of an implanted drug-delivery pump or reservoir serving the intrathecal space or a brain ventricle. The clinician accesses the pump’s refill port, manages the reservoir contents, and replenishes medication. Common examples include intrathecal baclofen therapy for severe spasticity and implanted pumps delivering medication for chronic pain. Pain medicine, neurology, and physical medicine and rehabilitation clinicians may perform the service in an office or outpatient facility.
Select 95991 when the refill and maintenance require a physician’s skill; 95990 is the related code for services not requiring that skill. Document the pump and delivery site, the refill performed, medication and reservoir details, and the skilled work supporting code selection. The refill service is distinct from the medication itself, which may be reported separately when applicable. CMS fee-schedule valuation for this code includes physician work and practice expense, with office and facility practice-expense inputs.
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 95991 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $120.36 | $33.84 |
| Seattle (King Cnty) | $136.82 | $36.00 |
How the 95991 rate is calculated
Each of 95991’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 · 95991
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.75Practice expense 2.65Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95991
95991 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 · 95991
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$115.90
The facility rate would be $33.73 (+$82.17). In a facility, the facility bills its own costs separately.
95991 compared with similar codes
Compare codes
95991 vs 95990 vs 62369 vs 62370: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 95990Pump refill
- Both cover implanted spinal or brain drug-pump refill and maintenance. Choose 95991 when the service requires physician skill; 95990 covers services that do not.
- 62369Pump management
- Use 62369 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is simple.
- 62370Pump refill
- Use 62370 for a programmable pump service that includes electronic analysis and reprogramming along with refill and maintenance, when the service is complex.
95991 billing questions
How does 95991 differ from 95990?
95991 is for pump refill and maintenance requiring a physician’s skill. Use 95990 when the service does not require that skill.
Does the refill code include the medication?
The code represents the refill and maintenance service, not the medication supply. Report the drug separately when applicable and supported by the documentation.
What details support reporting 95991?
Document the implanted pump and its intrathecal or intraventricular delivery site, the refill and reservoir details, and the physician-skilled work performed.
When should a programmable-pump code be considered instead?
Consider 62369 or 62370 when the service includes electronic analysis, reprogramming, refill, and maintenance of a programmable pump; those codes distinguish simple from complex services.
Is 95991 selected by the drug or the refill amount?
Selection turns on the physician skill required for the refill and maintenance, not the medication name or amount alone.
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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