CPT 90966
Updated 5/6/2025
Reviewed by Nathan Liu, MD

Monthly management of home dialysis for patients with end-stage renal disease

Description

This code describes the comprehensive management of home dialysis services for patients aged 20 and older diagnosed with end-stage renal disease (ESRD). The provider is responsible for coordinating all physician-related services over the course of one month to ensure optimal patient care and treatment adherence.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$284.65
Limiting Charge$310.98
Patient Coinsurance (20%)$56.93

RVU Calculation Breakdown

Work RVU
5.52
Practice Expense RVU
2.94
Malpractice RVU
0.34
Total RVU
8.80
5.52 + 2.94 + 0.34 = 8.80
8.80 RVUs×$32.3465 Conversion Factor
$284.65

Non-Facility Setting

Procedure Price$284.65
Limiting Charge$310.98
Patient Coinsurance (20%)$56.93

RVU Calculation Breakdown

Work RVU
5.52
Practice Expense RVU
2.94
Malpractice RVU
0.34
Total RVU
8.80
5.52 + 2.94 + 0.34 = 8.80
8.80 RVUs×$32.3465 Conversion Factor
$284.65

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2025), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

—

Patient Copayment / Coinsurance

—

Top Modifiers

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HCPCS/CPT 95Telehealth service via real-time interactive audio and video telecommunications(23.49%)
HCPCS/CPT GWService unrelated to hospice patient's terminal condition(8.34%)
HCPCS/CPT GVAttending physician not employed by hospice provider(5.1%)
HCPCS/CPT GTTelehealth services via interactive audio and video telecommunications(3.35%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(1.7%)
HCPCS/CPT 59Distinct procedural service for non-E/M services(1.17%)
HCPCS/CPT AQService rendered in a health professional shortage area(0.96%)
HCPCS/CPT CRCatastrophe or disaster-related service modifier(0.96%)
HCPCS/CPT 25Significant, separately identifiable evaluation and management service on the same day(0.8%)
HCPCS/CPT CCProcedure code change due to administrative or filing error(0.74%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)