90961 — Dialysis services, 2-3 physician visits per month (20 years or older)
What the market charges
Across 10,129 negotiated rates, the middle 80% fall between $241 and $666, with a median of $353.
What Medicare pays
Medicare allowed an average of $286 for this code, across 351,233 services billed by 5,645 providers. At the median, the market charges 1.2 times what Medicare pays for this code.
Where this is billed, and what it costs there
The states billing 90961 most, by Medicare service volume, each compared against the national average of $286. Each links to the providers Mishe lists there.
- California — 614 providers billed it, Medicare allowed $304 — 6% above the national average
- Texas — 517 providers billed it, Medicare allowed $280 — 2% below the national average
- Florida — 373 providers billed it, Medicare allowed $286 — level with the national average
- New York — 292 providers billed it, Medicare allowed $307 — 7% above the national average
- Illinois — 222 providers billed it, Medicare allowed $289 — 1% above the national average
- Georgia — 215 providers billed it, Medicare allowed $278 — 3% below the national average
- Washington — 102 providers billed it, Medicare allowed $293 — 2% above the national average
- New Jersey — 192 providers billed it, Medicare allowed $304 — 6% above the national average
Claim-editing rules
These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.
Codes this one absorbs
Billed together, 90961 is the payable code and these are not separately payable. 22 pairs in total.
- 98000 — a modifier may allow both to be paid
- 98001 — a modifier may allow both to be paid
- 98002 — a modifier may allow both to be paid
- 98003 — a modifier may allow both to be paid
- 98004 — a modifier may allow both to be paid
- 98005 — a modifier may allow both to be paid
- 98006 — a modifier may allow both to be paid
- 98007 — a modifier may allow both to be paid
- 98008 — a modifier may allow both to be paid
- 98009 — a modifier may allow both to be paid
- 98010 — a modifier may allow both to be paid
- 98011 — a modifier may allow both to be paid
Codes that absorb this one
Billed alongside any of these, 90961 is not separately payable. 7 pairs in total.
- 99425 — no modifier can override this edit
- 99437 — no modifier can override this edit
- 99439 — no modifier can override this edit
- 99487 — no modifier can override this edit
- 99489 — no modifier can override this edit
- 99490 — no modifier can override this edit
- 99491 — no modifier can override this edit
Other codes
- 99214 — Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
- 99213 — Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more
- 97530 — Therapy procedure using functional activities
- 99232 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
- 97112 — Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
- 99233 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
- 88305 — Pathology examination of tissue using a microscope, intermediate complexity
- 99309 — Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes
- 87798 — Detection test by nucleic acid for organism, amplified probe technique
- 98941 — Chiropractic manipulative treatment, 3-4 spinal regions
Deploy this for your team
Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.
- Contact Mishe to learn how to deploy these resources for your team
- Guides to direct-pay healthcare
- Cash prices by procedure
- Find a provider by state
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