CPT 90969
Global XXX ActiveEsrd svc pr day pt 12-19
CPT 90969 Billing & Documentation Guide
CPT code 90969 (Esrd svc pr day pt 12-19) is classified under Dialysis with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.33, a non-facility practice expense RVU of 0.17, and a malpractice RVU of 0.02, a total non-facility RVU of 0.52 and facility RVU of 0.52. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $17.75, though rates vary from $16.24 to $22.95 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90969, 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 90969 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 90969 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 90969
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.33 | 0.33 |
| Practice Expense RVU | 0.17 | 0.17 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.52 | 0.52 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90969
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 | $18.5 | $18.5 | $17.79 - $20.78 | 29 |
| Florida | $18.02 | $18.02 | $17.45 - $18.62 | 3 |
| Georgia | $17.26 | $17.26 | $16.88 - $17.63 | 2 |
| Illinois | $17.82 | $17.82 | $17.25 - $18.34 | 4 |
| Michigan | $17.3 | $17.3 | $16.96 - $17.63 | 2 |
| North Carolina | $16.75 | $16.75 | $16.75 - $16.75 | 1 |
| New York | $18.79 | $18.79 | $16.89 - $19.72 | 5 |
| Ohio | $16.88 | $16.88 | $16.88 - $16.88 | 1 |
| Pennsylvania | $17.4 | $17.4 | $16.87 - $17.93 | 2 |
| Texas | $17.29 | $17.29 | $16.81 - $17.67 | 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 90969
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90969 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 90969
What does CPT code 90969 mean? +
CPT code 90969 represents: Esrd svc pr day pt 12-19. It's in the Dialysis category with a global period of XXX.
What is the Medicare reimbursement for CPT 90969? +
The 2026 Medicare national average non-facility payment for CPT 90969 is $17.75. Rates range from $16.24 to $22.95 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90969? +
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 90969? +
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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