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See a sample rate comparisonCPT 90969 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 12-19 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 G1 - URR reading <60 |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.37 national non-facility rate (2026) · View Medicare rates for 90969 |
| Medicaid Fee Schedule | $14.10 median of the 8 states in the free preview · View Medicaid rates for 90969 |
National average reimbursement for CPT 90969 by major payers:
$22.05
$19.76
$19.82
$35.05
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CPT 90969
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$85.58Published rateSteven Sharp
Loyola University Medical Center
$29.68Published rateAnoosh Salman
Presence Healthcare Services
$21.88Published rateNidhi Mehta
Town Center Orthopaedic Associates, P.C.
$13.84Published rateClint Anthony
District Medical Group Inc
$12.47Published rate
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See a sample payer proposalCPT 90969 vs. Other Dialysis Services and Procedures Codes
The CPT 90969 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 90969 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 |
|---|---|---|
| 90966-CPT | Moderate | End-Stage Renal Disease (Esrd), End-Stage Renal Disease (Esrd) Related Services For Home Dialysis Per Full Month For Patients 20 Years Of Age And Older |
| 90967-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 Younger Than 2 Years Of Age |
| 90969-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 12-19 Years Of Age |
| 90970-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 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 90969. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90969 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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