CPT 90960 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 • 95 - Telemedicine - audio and video • AQ - Service in Health Professional Shortage Area |
| Complexity Level | Moderate |
National average reimbursement for CPT 90960 by major payers:
$420.61
$375.17
$406.79
$527.99
| 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 90960 | ||||||
United | 90960 | $625.63 | 1518037126 - MARY LAKE | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90960 | $476.76 | 1811383334 - MAYURIKA PISE | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 90960 | $334.05 | 1144476136 - STEVE PASCHOS | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 90960 | $585.71 | 1285712851 - MOHAMMAD IKRAMUDDIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90960 | $480.29 | 1518124932 - RITU TALWAR | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 90960 | $625.63 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90960 | $274.38 | 1043405301 - ANKUR PATEL | 860846208 - SOUTHWEST KIDNEY INSTITUTE PLC | AZ | Nephrology Physician (207RN0300X) |
United | 90960 | $234.03 | 1760499594 - SHAILESH PATEL | 860846208 - SOUTHWEST KIDNEY INSTITUTE PLC | OH | Internal Medicine Physician (207R00000X) |
United | 90960 | $320.36 | 1063483865 - RUSSELL SILVERSTEIN | 751366650 - DALLAS NEPHROLOGY ASSOCIATES, P.A. | TX | Nephrology Physician (207RN0300X) |
United | 90960 | $242.10 | 1114014438 - AJIT SAWHNEY | 952848091 - BALBOA NEPHROLOGY MEDICAL GROUP, INC. | CA | Nephrology Physician (207RN0300X) |
United | 90960 | $247.55 | 1164753679 - SOHAIL RIAZ | 751366650 - DALLAS NEPHROLOGY ASSOCIATES, P.A. | TX | Nephrology Physician (207RN0300X) |
United | 90960 | $291.24 | 1457658007 - SOHAIL ABDUL SALIM | 860846208 - SOUTHWEST KIDNEY INSTITUTE PLC | MS | Nephrology Physician (207RN0300X) |
United | 90960 | $232.99 | 1861440109 - DALLAS NEPHROLOGY ASSOCIATES | 751366650 - DALLAS NEPHROLOGY ASSOCIATES | TX | Nephrology Physician (207RN0300X) |
United | 90960 | $320.36 | 1902891690 - ENRIQUE CARINO | 751366650 - DALLAS NEPHROLOGY ASSOCIATES | TX | Nephrology Physician (207RN0300X) |
United | 90960 | $274.38 | 1407226285 - JOSIE JOY BALBOA-AZURA | 860846208 - SOUTHWEST KIDNEY INSTITUTE PLC | AZ | Family Nurse Practitioner (363LF0000X) |
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 90960 vs. Other Dialysis Services and Procedures Codes
The CPT 90960 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 90960 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 90960. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90960 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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