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See a sample rate comparisonCPT 90962 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.
End-Stage Renal Disease (Esrd), End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 20 Years Of Age And Older 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 | 99 - Other POS 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 95 - Telemedicine - audio and video AQ - Service in Health Professional Shortage Area |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $215.10 national non-facility rate (2026) · View Medicare rates for 90962 |
| Medicaid Fee Schedule | $174.49 median of the 8 states in the free preview · View Medicaid rates for 90962 |
National average reimbursement for CPT 90962 by major payers:
$250.22
$234.51
$241.89
$316.57
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CPT 90962
5 of 25 sample ratesHigher to lower in this preview
Jennifer Kurth
$434.60Published rateMatthew Niedzwiecki
Loyola University Medical Center
$358.73Published rateJohn Millichap
Monument Health Rapid City Hospital Inc
$331.94Published rateAnu Mathur
Edward Health Ventures
$289.80Published rateMichael Jacobson
Hroa 401k Plan
$159.35Published rate
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See a sample payer proposalCPT 90962 vs. Other Dialysis Services and Procedures Codes
The CPT 90962 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 90962 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-CPT | 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-CPT | Moderate | Esrd Srv 2 3 Vsts P Mo 12 19, 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 |
| 90959-CPT | Moderate | Esrd Serv 1 Vst P Mo 12 19, 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 |
| 90962-CPT | Moderate | End-Stage Renal Disease (Esrd), End-Stage Renal Disease (Esrd) Related Services Monthly For Patients 20 Years Of Age And Older 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 90962. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90962 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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