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See a sample rate comparisonCPT 90997 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.
Hemoperfusion (Eg With Activa, Hemoperfusion (Eg With Activated Charcoal Or Resin)Hemoperfusion (Eg With Activated Charcoal Or Resin)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Dialysis Services and Procedures |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | G5 - Most recent URR reading of 75 or greater V7 - Arteriovenous fistula SE - Scene to Residential facility SL |
| Complexity Level | Low |
| Medicare Fee Schedule | $76.15 national non-facility rate (2026) · View Medicare rates for 90997 |
| Medicaid Fee Schedule | $83.65 median of the 8 states in the free preview · View Medicaid rates for 90997 |
National average reimbursement for CPT 90997 by major payers:
$126.11
$118.23
$108.59
$143.98
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CPT 90997
5 of 25 sample ratesHigher to lower in this preview
John Millichap
$321.30Published rateNora Ekeanya
$178.16Published rateJohn Millichap
Warren Clinic Inc
$172.77Published rateJohn Millichap
$125.65Published rateRestorative Health Rehabilitation Inc
$60.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 90997 vs. Other Dialysis Services and Procedures Codes
The CPT 90997 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 90997 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 |
|---|---|---|
| 90989-CPT | Moderate | Training For Dialysis In Home, In-Home Training In The Use Of Equipment For Performing Dialysis. Dialysis Filters Waste From The Blood When The Kidneys No Longer Are Able To Perform That Function. |
| 90993-CPT | Low | Training For Dialysis In Home, In-Home Training In The Use Of Equipment For Performing Dialysis. Dialysis Filters Waste From The Blood When The Kidneys No Longer Are Able To Perform That Function. |
| 90997-CPT | Low | Hemoperfusion (Eg With Activa, Hemoperfusion (Eg With Activated Charcoal Or Resin)Hemoperfusion (Eg With Activated Charcoal Or Resin) |
| 90999-CPT | Moderate | Dialysis For Kidney Failure, Treatment For Kidney Failure In Which Waste Materials Are Removed From The Blood By Passing The Blood Through A Machine Which Filters The Blood (Dialysis). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90997. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90997 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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