CPT 90967 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 | • 11 - Office • None |
| Common Modifiers | • None • GT - Via interactive audio and video telecommunication systems • PD - Service within three-day inpatient admit |
| Complexity Level | Low |
National average reimbursement for CPT 90967 by major payers:
$25.20
$23.88
$21.53
$37.86
| 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 90967 | ||||||
United | 90967 | $45.45 | 1063471159 - MARK WAINWRIGHT | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90967 | $31.11 | 1689166027 - ANIRUDDHA DEKA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $23.70 | 1780847020 - AMBER KAZI | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $31.56 | 1972543080 - HOSSAM ABDELSALAM | 205521741 - SOUTHERN ILLINOIS MEDICAL SERVICES NFP | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90967 | $34.36 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | NC | Psychiatry Physician (2084P0800X) |
United | 90967 | $37.34 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90967 | $30.37 | 1629181037 - DUKE RUKTANONCHAI | 742958277 - SCOTT & WHITE CLINIC | PA | Psychiatry Physician (2084P0800X) |
United | 90967 | $37.45 | 1295297497 - NICOLE SHAW | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $18.89 | 1922111657 - CLINT ANTHONY | 860830701 | AZ | Psychiatry Physician (2084P0800X) |
United | 90967 | $30.32 | 1356397210 - M SHEIKH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $34.68 | 1952460933 - LARISSA CHISM BUGGS | 810231784 - BILLINGS CLINIC | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $12.36 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 90967 | $34.72 | 1164417481 - JOSHUA STRAUS | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $27.30 | 1063905339 - KATHRYN ABELL | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90967 | $20.64 | 1568533701 - REGINALD GIVENS | 362235167 - ROSECRANCE INC | IL | 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 90967 vs. Other Dialysis Services and Procedures Codes
The CPT 90967 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 90967 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 |
| 90967-CPT | Low | End-Stage Renal Disease (Esrd) Related Services For Dialysis Less Than A Full Month Of Service Per Day; For Patients Younger Than 2 Years Of Age |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90967. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90967 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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