CPT 90962
Global XXX ActiveEsrd serv 1 visit p mo 20+
CPT 90962 Billing & Documentation Guide
CPT code 90962 (Esrd serv 1 visit 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 3.57, a non-facility practice expense RVU of 2.65, and a malpractice RVU of 0.22, a total non-facility RVU of 6.44 and facility RVU of 6.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $220.34, though rates vary from $199.06 to $277.18 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90962, 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 90962 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 90962 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 90962
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.57 | 3.57 |
| Practice Expense RVU | 2.65 | 2.65 |
| Malpractice RVU | 0.22 | 0.22 |
| Total RVU | 6.44 | 6.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90962
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 | $232.23 | $232.23 | $222.22 - $263.93 | 29 |
| Florida | $222.35 | $222.35 | $214.9 - $229.97 | 3 |
| Georgia | $212.65 | $212.65 | $206.95 - $218.35 | 2 |
| Illinois | $219.23 | $219.23 | $211.54 - $225.89 | 4 |
| Michigan | $212.7 | $212.7 | $208.35 - $217.04 | 2 |
| North Carolina | $206.52 | $206.52 | $206.52 - $206.52 | 1 |
| New York | $233.63 | $233.63 | $208.49 - $245.76 | 5 |
| Ohio | $207.46 | $207.46 | $207.46 - $207.46 | 1 |
| Pennsylvania | $214.87 | $214.87 | $207.44 - $222.3 | 2 |
| Texas | $213.86 | $213.86 | $206.61 - $219.64 | 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 90962
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90962 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 90962
What does CPT code 90962 mean? +
CPT code 90962 represents: Esrd serv 1 visit p mo 20+. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90962? +
The 2026 Medicare national average non-facility payment for CPT 90962 is $220.34. Rates range from $199.06 to $277.18 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90962? +
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 90962? +
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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