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See a sample rate comparisonCPT 90955 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Esrd Srv 2 3 Vsts P Mo 2 11, 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 2 3 Face To Face Visits By A Physician Or Other Qualified Health Care Professional Per Month
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Dialysis Services and Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office 99 - Other POS |
| Common Modifiers | G5 - Most recent URR reading of 75 or greater |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $538.42 national non-facility rate (2026) · View Medicare rates for 90955 |
| Medicaid Fee Schedule | $437.035 median of the 8 states in the free preview · View Medicaid rates for 90955 |
National average reimbursement for CPT 90955 by major payers:
$652.36
$597.61
$585.27
$800.32
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CPT 90955
5 of 25 sample ratesHigher to lower in this preview
Ravi Ramasamy
Seattle Childrens Hospital
$1,248.93Published rateDeborah Couch
Loyola University Medical Center
$877.16Published rateRosario Cosme Cruz
$793.96Published rateAsifa Choudhry
Carle West Physician Group Inc
$685.61Published rateAbbas Naqvi
Town Center Orthopaedic Associates, P.C.
$418.07Published rate
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See a sample payer proposalCPT 90955 vs. Other Dialysis Services and Procedures Codes
The CPT 90955 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 90955 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) |
| 90955-CPT | Moderate | Esrd Srv 2 3 Vsts P Mo 2 11, 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 2 3 Face To Face Visits By A Physician Or Other Qualified Health Care Professional Per Month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90955. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90955 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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