CPT 90951
Global XXX ActiveEsrd serv 4 visits p mo <2yr
CPT 90951 Billing & Documentation Guide
CPT code 90951 (Esrd serv 4 visits p mo <2yr) is classified under Dialysis with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 23.92, a non-facility practice expense RVU of 10.06, and a malpractice RVU of 1.46, a total non-facility RVU of 35.44 and facility RVU of 35.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1207.7, though rates vary from $1112.7 to $1583.15 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90951, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90951 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 90951 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 90951
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 23.92 | 23.92 |
| Practice Expense RVU | 10.06 | 10.06 |
| Malpractice RVU | 1.46 | 1.46 |
| Total RVU | 35.44 | 35.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90951
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1251.62 | $1251.62 | $1206.94 - $1397.5 | 29 |
| Florida | $1231.01 | $1231.01 | $1193.47 - $1272.07 | 3 |
| Georgia | $1179.05 | $1179.05 | $1156.8 - $1201.3 | 2 |
| Illinois | $1219.61 | $1219.61 | $1181.95 - $1254.15 | 4 |
| Michigan | $1183.11 | $1183.11 | $1160.79 - $1205.42 | 2 |
| North Carolina | $1143.61 | $1143.61 | $1143.61 - $1143.61 | 1 |
| New York | $1277.98 | $1277.98 | $1152.44 - $1340.16 | 5 |
| Ohio | $1154.88 | $1154.88 | $1154.88 - $1154.88 | 1 |
| Pennsylvania | $1187.4 | $1187.4 | $1153.49 - $1221.3 | 2 |
| Texas | $1179.45 | $1179.45 | $1150.02 - $1206.1 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 90951
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90951 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0405T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0405T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0407U | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0591T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0591T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 0592T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0592T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 0593T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0593T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 90951
What does CPT code 90951 mean? +
CPT code 90951 represents: Esrd serv 4 visits p mo <2yr. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90951? +
The 2026 Medicare national average non-facility payment for CPT 90951 is $1207.7. Rates range from $1112.7 to $1583.15 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90951? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 90951? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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