CPT 90968 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 • 11 - Office |
| Common Modifiers | • None • V5 - Any vascular catheter • G5 - Most recent URR reading of 75 or greater |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90968 |
National average reimbursement for CPT 90968 by major payers:
$22.74
$20.43
$20.44
$35.37
| 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 90968 | ||||||
United | 90968 | $56.47 | 1225211600 - JOHN MILLICHAP | 800863895 | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $27.59 | 1801849559 - CHARLES MARCUCCILLI | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $31.02 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MS | Psychiatry Physician (2084P0800X) |
United | 90968 | $27.27 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 90968 | $27.59 | 1144203753 - HAIDAR KABBANI | 911780160 | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $14.50 | 1487755955 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 90968 | $20.60 | 1235766916 - AMIRREZA FALLAHI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 90968 | $99.81 | 1871912683 - LAUREN SCHUMACHER | 943281657 | IL | Psychiatry Physician (2084P0800X) |
United | 90968 | $33.45 | 1609039163 - HUMA ABBAS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90968 | $23.95 | 1497767719 - ELIZABETH CHARNEY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90968 | $22.87 | 1629046735 - AQEEL KHAN | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 90968 | $30.63 | 1740505569 - MEGHAN O'NEILL | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $34.43 | 1225211600 - JOHN MILLICHAP | 383852646 - OSF MULTI-SPECIALTY GROUP | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $25.59 | 1639111248 - ROBERT EGEL | 363155454 - (IL) ROBERT T EGEL M D S C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90968 | $15.96 | 1922111657 - CLINT ANTHONY | 208106540 - DISTRICT MEDICAL GROUP INC | AZ | 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 90968 vs. Other Dialysis Services and Procedures Codes
The CPT 90968 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 90968 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 |
| 90968-CPT | Low | End-Stage Renal Disease (Esrd) Related Services For Dialysis Less Than A Full Month Of Service Per Day; For Patients 2-11 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 90968. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90968 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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