CPT 90956
Global XXX ActiveEsrd srv 1 visit p mo 2-11
CPT 90956 Billing & Documentation Guide
CPT code 90956 (Esrd srv 1 visit p mo 2-11) is classified under Dialysis with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 6.64, a non-facility practice expense RVU of 3.93, and a malpractice RVU of 0.41, a total non-facility RVU of 10.98 and facility RVU of 10.98. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $375.03, though rates vary from $341.59 to $480.02 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90956, 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 90956 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 90956 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 90956
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 6.64 | 6.64 |
| Practice Expense RVU | 3.93 | 3.93 |
| Malpractice RVU | 0.41 | 0.41 |
| Total RVU | 10.98 | 10.98 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90956
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 | $392.48 | $392.48 | $376.76 - $442.8 | 29 |
| Florida | $380.14 | $380.14 | $367.85 - $393.06 | 3 |
| Georgia | $363.73 | $363.73 | $355.19 - $372.26 | 2 |
| Illinois | $375.56 | $375.56 | $363.03 - $386.68 | 4 |
| Michigan | $364.32 | $364.32 | $357.09 - $371.54 | 2 |
| North Carolina | $353 | $353 | $353 - $353 | 1 |
| New York | $397.35 | $397.35 | $356.11 - $417.48 | 5 |
| Ohio | $355.43 | $355.43 | $355.43 - $355.43 | 1 |
| Pennsylvania | $366.99 | $366.99 | $355.22 - $378.76 | 2 |
| Texas | $364.95 | $364.95 | $353.96 - $373.24 | 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 90956
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90956 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 |
| 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 |
| 0592T | 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 | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90952 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 90952 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 90953 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
Frequently Asked Questions, CPT 90956
What does CPT code 90956 mean? +
CPT code 90956 represents: Esrd srv 1 visit p mo 2-11. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90956? +
The 2026 Medicare national average non-facility payment for CPT 90956 is $375.03. Rates range from $341.59 to $480.02 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90956? +
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 90956? +
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 July 16, 2026.
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