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See a sample rate comparisonCPT 90968 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 For Dialysis Less Than A Full Month Of Service Per Day For Patients 2-11 Years Of Age
| 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 | V5 - Any vascular catheter G5 - Most recent URR reading of 75 or greater |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.70 national non-facility rate (2026) · View Medicare rates for 90968 |
| Medicaid Fee Schedule | $14.385 median of the 8 states in the free preview · View Medicaid rates for 90968 |
National average reimbursement for CPT 90968 by major payers:
$22.74
$20.43
$20.44
$35.70
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CPT 90968
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$99.81Published rateRhonda Lampen
Multicare Health System
$38.22Published rateMeghan O'Neill
Pediatric Faculty Foundation In
$30.63Published rateElizabeth Charney
The Board Of Trustees Of The University Of Illinois
$23.95Published rateTown Center Orthopaedic Associates, P.C.
$14.50Published rate
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See a sample payer proposalCPT 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 | Esrd Home Pt Serv P Mo 2yrs, 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 | Esrd Home Pt Serv P Mo 2 11, 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 | Esrd Home Pt Serv P Mo 12 19, 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), 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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