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See a sample rate comparisonCPT 90956 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 1 Visit 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 1 Face To Face Visit 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 | SA 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $366.74 national non-facility rate (2026) · View Medicare rates for 90956 |
| Medicaid Fee Schedule | $297.67 median of the 8 states in the free preview · View Medicaid rates for 90956 |
National average reimbursement for CPT 90956 by major payers:
$441.80
$411.63
$392.14
$541.95
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CPT 90956
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$1,815.84Published rateMusaddiq Tariq
Loyola University Medical Center
$622.09Published rateMichael Byrne
$595.78Published rateTrixie Lipke
Beaver Dam Community Hospitals Inc
$471.92Published rateDavid Miller
Town Center Orthopaedic Associates, P.C.
$291.90Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 90956 vs. Other Dialysis Services and Procedures Codes
The CPT 90956 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 90956 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) |
| 90956-CPT | Moderate | Esrd Srv 1 Visit 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 1 Face To Face Visit 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 90956. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90956 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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