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See a sample rate comparisonCPT 90954 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 2-11 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents; With 4 Or More Face- To-Face Visits By A Physician Or Other Qualified Health Care Professional Per Month (Revised 1/1/13)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Dialysis Services and Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 99 - Other POS 11 - Office |
| Common Modifiers | GC - Service performed by resident under supervision 95 - Telemedicine - audio and video 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | $1,034.43 national non-facility rate (2026) · View Medicare rates for 90954 |
| Medicaid Fee Schedule | $840.07 median of the 8 states in the free preview · View Medicaid rates for 90954 |
National average reimbursement for CPT 90954 by major payers:
$1,200.69
$1,066.44
$1,097.62
$1,469.53
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CPT 90954
5 of 25 sample ratesHigher to lower in this preview
Ravi Ramasamy
The Association Of Chrmc And University Physicians
$2,417.25Published rateSuraya Kawadry
Loyola University Medical Center
$1,586.82Published rateAliya Hafeez
Advocate Health And Hospitals Corporation
$1,376.07Published rateGhassan Aldurra
Edward Health Ventures
$1,284.81Published rateThomas Fleeter
Town Center Orthopaedic Associates, P.C.
$740.12Published rate
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See a sample payer proposalCPT 90954 vs. Other Dialysis Services and Procedures Codes
The CPT 90954 code is part of the Medicine Services and Procedures services used for Dialysis Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90954 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90951-CPT | High | Esrd Serv 4 Visits P Mo 2yr, End Stage Renal Disease Esrd Related Services Monthly For Patients Younger Than 2 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents With 4 Or More Face To Face Visits By A Physician Or Other Qualified Health Care Professional Per Month |
| 90952-CPT | Moderate | Esrd Serv 2 3 Vsts P Mo 2yr, End Stage Renal Disease Esrd Related Services Monthly For Patients Younger Than 2 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents With 2 3 Face To Face Visits By A Physician Or Other Qualified Health Care Professional Per Month |
| 90953-CPT | Moderate | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients Younger Than 2 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents; With 1 Face-To-Face Visit By A Physician Or Other Qualified Health Care Professional Per Month (Revised 1/1/13) |
| 90954-CPT | High | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 2-11 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents; With 4 Or More Face- To-Face Visits By A Physician Or Other Qualified Health Care Professional Per Month (Revised 1/1/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90954. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90954 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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