CPT 90954 Fee Schedule
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.
| 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 | • None • GC - Service performed by resident under supervision • 95 - Telemedicine - audio and video • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 90954 by major payers:
$1,200.69
$1,066.44
$1,097.62
$1,466.60
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 90954 | ||||||
United | 90954 | $1586.82 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90954 | $1284.81 | 1770014920 - JOSEPH PEPITONE | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1376.07 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1467.01 | 1245484740 - CHALONGCHAI PHITSANUWONG | 362177139 - UNIVERSITY OF CHICAGO | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90954 | $1054.14 | 1376040014 - JODY WONG | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1365.98 | 1558620146 - RAUNAK KHISTY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90954 | $1054.14 | 1225171614 - RUBEENA MIAN | 362709982 - (IL) PRESENCE BEHAVIORAL HEALTH | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1981.60 | 1629335260 - DIVYA DESAI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90954 | $1251.04 | 1891180170 - SURYA SABHAPATHY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1239.22 | 1497198832 - GABRIEL FUQUA | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1586.82 | 1306340880 - GEORGE GIANAKAKOS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | FL | Psychiatry Physician (2084P0800X) |
United | 90954 | $940.05 | 1679739148 - THANH THAI | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 90954 | $1678.16 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 90954 | $940.05 | 1386755486 - DOUGLAS NORDLI | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90954 | $1541.18 | 1710275110 - PRAVESH DEOTALE | 430654872 - ST LOUIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 | High | 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 (Revised 1/1/13) |
| 90952 | 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 2-3 Face-To-Face Visits By A Physician Or Other Qualified Health Care Professional Per Month (Revsied 1/1/13) |
| 90953 | 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 | 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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