CPT 90964
Global XXX ActiveEsrd home pt serv p mo 2-11
CPT 90964 Billing & Documentation Guide
CPT code 90964 (Esrd home pt serv 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 10.25, a non-facility practice expense RVU of 5.12, and a malpractice RVU of 0.62, a total non-facility RVU of 15.99 and facility RVU of 15.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $545.56, though rates vary from $499.92 to $707.08 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90964, 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 90964 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 90964 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 90964
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.25 | 10.25 |
| Practice Expense RVU | 5.12 | 5.12 |
| Malpractice RVU | 0.62 | 0.62 |
| Total RVU | 15.99 | 15.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90964
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 | $568.21 | $568.21 | $546.71 - $637.72 | 29 |
| Florida | $554.26 | $554.26 | $536.97 - $572.76 | 3 |
| Georgia | $530.8 | $530.8 | $519.59 - $542.01 | 2 |
| Illinois | $548.37 | $548.37 | $530.86 - $564.15 | 4 |
| Michigan | $532.09 | $532.09 | $521.87 - $542.3 | 2 |
| North Carolina | $515.15 | $515.15 | $515.15 - $515.15 | 1 |
| New York | $577.52 | $577.52 | $519.38 - $606.06 | 5 |
| Ohio | $519.37 | $519.37 | $519.37 - $519.37 | 1 |
| Pennsylvania | $535.09 | $535.09 | $518.92 - $551.25 | 2 |
| Texas | $531.84 | $531.84 | $517.22 - $543.41 | 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 90964
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90964 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 90964
What does CPT code 90964 mean? +
CPT code 90964 represents: Esrd home pt serv p mo 2-11. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90964? +
The 2026 Medicare national average non-facility payment for CPT 90964 is $545.56. Rates range from $499.92 to $707.08 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90964? +
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 90964? +
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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