CPT 90964 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 | • 22 - On Campus Outpatient Hospital • 99 - Other POS • 11 - Office |
| Common Modifiers | • None • GC - Service performed by resident under supervision • GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Moderate |
National average reimbursement for CPT 90964 by major payers:
$654.88
$615.60
$607.14
$807.95
| 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 90964 | ||||||
United | 90964 | $889.96 | 1205213261 - TAMAR CACERES | 911780160 | IL | Neurodevelopmental Disabilities Physician (2084P0005X) |
United | 90964 | $751.90 | 1477781649 - BRADLEY CUTLER | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $770.51 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $799.94 | 1568956043 - REID ALLEY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | PA | Psychiatry Physician (2084P0800X) |
United | 90964 | $936.57 | 1144267865 - NITIN PATEL | 364143823 - SIU PHYSICIANS & SURGEONS INC | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90964 | $770.51 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MS | Psychiatry Physician (2084P0800X) |
United | 90964 | $942.40 | 1669524369 - JENNIFER KURTH | 205734385 | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $397.92 | 1255692794 - MELISSA WAGNER-SCHUMAN | 316000064 | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $1146.84 | 1063471159 - MARK WAINWRIGHT | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90964 | $913.32 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 90964 | $598.20 | 1861488132 - JYOTI WARIKOO | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $554.32 | 1417480625 - ELIZABETH WHITHAM | 330633863 | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $940.96 | 1366890857 - STEVEN SHARP | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90964 | $665.14 | 1881012235 - LAUREN PREST | 910843135 | UT | Psychiatry Physician (2084P0800X) |
United | 90964 | $852.04 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IA | 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 90964 vs. Other Dialysis Services and Procedures Codes
The CPT 90964 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 90964 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 |
|---|---|---|
| 90963-CPT | Moderate | End-Stage Renal Disease (Esrd) Related Services For Home Dialysis Per Full Month 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 |
| 90964-CPT | Moderate | End-Stage Renal Disease (Esrd) Related Services For Home Dialysis Per Full Month For Patients 2-11 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents |
| 90965-CPT | Moderate | End-Stage Renal Disease (Esrd) Related Services For Home Dialysis Per Full Month For Patients 12-19 Years Of Age To Include Monitoring For The Adequacy Of Nutrition Assessment Of Growth And Development And Counseling Of Parents |
| 90966-CPT | Moderate | End-Stage Renal Disease (Esrd) Related Services For Home Dialysis Per Full Month For Patients 20 Years Of Age And Older |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90964. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90964 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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