CPT 90965 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 |
| Common Modifiers | • None • G1 - URR reading <60 • V7 - Arteriovenous fistula |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 90965 |
National average reimbursement for CPT 90965 by major payers:
$623.36
$587.19
$578.32
$773.34
| 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 90965 | ||||||
United | 90965 | $409.03 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 90965 | $1013.63 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | MI | Psychiatry Physician (2084P0800X) |
United | 90965 | $1152.67 | 1104230036 - AFSANEH TALAI | 756002868 | TX | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90965 | $730.34 | 1215025309 - DEBORAH GARRELTS-DAOUD | 237076080 - (IL) CRUSADERS CENTRAL CLINIC ASSOCIATION | IL | Psychiatry Physician (2084P0800X) |
United | 90965 | $420.36 | 1487732103 - NITIN BHOSALE | 371140016 - CARLE HEALTH CARE INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 90965 | $899.21 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 90965 | $454.48 | 1962614933 - JAMES REEVES | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 90965 | $589.78 | 1497767719 - ELIZABETH CHARNEY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90965 | $1612.30 | 1962791343 - JEREMY WONG | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90965 | $409.03 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 90965 | $736.14 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 90965 | $714.44 | 1962431726 - MARTINS ADEOYE | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90965 | $409.03 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 90965 | $415.74 | 1548536774 - ASHLEY BOYLE | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 90965 | $963.72 | 1831335850 - CLAUDINE SINSIOCO | 540620889 - INOVA HEALTH CARE SERVICES | VA | 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 90965 vs. Other Dialysis Services and Procedures Codes
The CPT 90965 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 90965 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 90965. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90965 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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