CPT 90958 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Dialysis Services and Procedures |
| Common Place of Service | • 99 - Other POS • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • AQ - Service in Health Professional Shortage Area • GC - Service performed by resident under supervision • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 90958 by major payers:
$622.51
$571.43
$577.26
$765.95
| 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 90958 | ||||||
United | 90958 | $1200.90 | 1063471159 - MARK WAINWRIGHT | 911336707 - THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90958 | $565.52 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 90958 | $865.10 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | RI | Psychiatry Physician (2084P0800X) |
United | 90958 | $708.96 | 1780651588 - PATRICIA MUMBY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $854.19 | 1366883555 - DAVID BANAYAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 90958 | $532.42 | 1407848286 - ELIZABETH MIRKIN | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $708.26 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90958 | $740.75 | 1306474986 - MELVIN JOSEPH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $865.10 | 1730263617 - MARK ALTER | 910844563 | NJ | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90958 | $873.85 | 1730263617 - MARK ALTER | 811324691 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90958 | $657.23 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $865.10 | 1962664789 - JAMIE EVANS | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $781.71 | 1952387318 - MELANY DANEHY | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90958 | $1073.81 | 1992904197 - JOANNA BLACKBURN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90958 | $450.29 | 1922111657 - CLINT ANTHONY | 208106540 - DISTRICT MEDICAL GROUP INC | AZ | Psychiatry Physician (2084P0800X) |
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 90958 vs. Other Dialysis Services and Procedures Codes
The CPT 90958 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 90958 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 |
|---|---|---|
| 90957 | Moderate | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 12-19 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 1/1/2013) |
| 90958 | Moderate | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 12-19 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 (Revised 1/1/2013) |
| 90959 | Moderate | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 12-19 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) |
| 90960 | Moderate | End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 20 Years Of Age And Older; 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 90958. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90958 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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