CPT 90961
Global XXX ActiveEsrd srv 2-3 vsts p mo 20+
CPT 90961 Billing & Documentation Guide
CPT code 90961 (Esrd srv 2-3 vsts p mo 20+) is classified under Dialysis with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.52, a non-facility practice expense RVU of 3.42, and a malpractice RVU of 0.36, a total non-facility RVU of 9.3 and facility RVU of 9.3. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $317.65, though rates vary from $288.69 to $404.84 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90961, 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 90961 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 90961 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 90961
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.52 | 5.52 |
| Practice Expense RVU | 3.42 | 3.42 |
| Malpractice RVU | 0.36 | 0.36 |
| Total RVU | 9.3 | 9.3 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90961
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 | $332.67 | $332.67 | $319.15 - $375.82 | 29 |
| Florida | $322.39 | $322.39 | $311.65 - $333.7 | 3 |
| Georgia | $308.02 | $308.02 | $300.6 - $315.43 | 2 |
| Illinois | $318.37 | $318.37 | $307.46 - $328.06 | 4 |
| Michigan | $308.56 | $308.56 | $302.24 - $314.88 | 2 |
| North Carolina | $298.63 | $298.63 | $298.63 - $298.63 | 1 |
| New York | $336.9 | $336.9 | $301.35 - $354.32 | 5 |
| Ohio | $300.79 | $300.79 | $300.79 - $300.79 | 1 |
| Pennsylvania | $310.78 | $310.78 | $300.6 - $320.95 | 2 |
| Texas | $309.02 | $309.02 | $299.49 - $316.25 | 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 90961
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90961 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 90961
What does CPT code 90961 mean? +
CPT code 90961 represents: Esrd srv 2-3 vsts p mo 20+. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90961? +
The 2026 Medicare national average non-facility payment for CPT 90961 is $317.65. Rates range from $288.69 to $404.84 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90961? +
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 90961? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team