How much does Medicare pay for CPT 90935?

Medicare allowed an average of $68.67 per service and paid $54.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $250.19, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90935?

Hemodialysis procedure with physician evaluation. It was billed 448,759 times to 199,051 Medicare beneficiaries by 5,598 providers in 2024.

Does 90935 pay differently in an office than a hospital?

Yes. The allowed amount averaged $66.17 in an office setting and $68.72 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 90935 most?

Nephrology, with 362,448 services from 4,610 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

CPT 90935

Hemodialysis procedure with physician evaluation

$68.67Medicare-allowed amount per service, averaged across 448,759 services

Providers submitted

$250.19

Asking price, not received

Medicare allowed

$68.67

The fee schedule figure

Medicare paid

$54.36

Balance is patient coinsurance

Providers submitted an average of $250.19 for this code and Medicare allowed $68.67 — 3.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $54.36 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $66.17
Hospital / facility: $68.72

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 8,876 services were billed in an office setting and 439,883 in a facility.

Services: 448,759
Beneficiaries: 199,051
Providers billing it: 5,598
Total allowed: $30,816,281

What Medicare pays for CPT 90935

Across 448,759 services billed by 5,598 providers to 199,051 beneficiaries, Medicare allowed an average of $68.67 per service. That is 2.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 90935

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	362,448	164,276	$69.68	4,610
Internal Medicine	39,956	15,912	$69.24	452
Nurse Practitioner	31,639	12,952	$58.76	377
Physician Assistant	7,036	3,049	$57.98	81
Hospitalist	3,315	875	$68.24	25
Neurology	2,216	1,034	$69.64	26
Emergency Medicine	489	185	$67.52	4
Critical Care (Intensivists)	330	200	$70.90	7
General Practice	317	115	$69.66	2
Osteopathic Manipulative Medicine	262	93	$67.13	2
Orthopedic Surgery	141	52	$67.48	1
Family Practice	115	63	$67.40	2
Certified Clinical Nurse Specialist	98	50	$56.53	2
Peripheral Vascular Disease	85	12	$77.73	1
Undefined Physician type	85	31	$69.85	1

90935 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	39,442	$73.01	$53.68	373
California	38,012	$72.42	$54.30	425
Texas	29,616	$67.52	$53.92	413
Florida	28,149	$69.11	$53.44	298
Pennsylvania	24,607	$68.21	$53.53	342
New Jersey	18,935	$73.66	$54.03	217
Illinois	18,395	$68.93	$53.27	231
Ohio	17,158	$65.69	$52.83	274
Massachusetts	17,019	$71.50	$53.36	170
North Carolina	16,345	$65.82	$53.55	233
Maryland	15,568	$71.21	$53.91	157
Michigan	12,462	$68.78	$53.99	165
Tennessee	11,344	$65.10	$53.89	120
Georgia	10,830	$67.05	$53.48	153
Virginia	10,785	$67.56	$52.87	150
Missouri	10,251	$67.02	$53.84	131
South Carolina	10,132	$65.45	$52.80	120
Indiana	10,027	$64.77	$53.12	144
Alabama	8,539	$64.47	$54.13	104
Louisiana	7,894	$65.49	$53.64	77
Mississippi	7,775	$64.14	$53.67	65
Wisconsin	7,754	$64.05	$52.28	109
Minnesota	6,682	$64.55	$51.80	119
Washington	5,884	$70.17	$54.11	101
Connecticut	5,170	$71.27	$53.50	66
Oklahoma	4,780	$63.75	$52.17	66
Arkansas	4,521	$63.76	$54.25	47
Arizona	4,109	$65.41	$52.66	76
Kentucky	3,718	$67.68	$54.02	65
Oregon	3,687	$69.30	$53.87	43
Colorado	3,313	$70.45	$54.10	67
New Mexico	2,982	$65.70	$51.69	46
Nebraska	2,919	$64.27	$53.39	35
Delaware	2,913	$67.81	$53.86	37
West Virginia	2,812	$67.71	$54.03	39
Iowa	2,698	$64.98	$54.08	41
District of Columbia	2,668	$76.72	$53.98	26
Nevada	2,468	$65.99	$52.49	44
New Hampshire	2,358	$66.70	$53.90	28
North Dakota	2,103	$67.46	$53.93	15
Maine	1,996	$65.25	$51.96	29
Kansas	1,895	$66.40	$54.45	32
Alaska	1,612	$91.01	$53.69	7
South Dakota	1,089	$66.00	$53.78	12
Vermont	1,057	$60.17	$48.71	7
Hawaii	818	$69.37	$54.12	13
Utah	783	$65.29	$52.37	22
Rhode Island	775	$69.95	$53.87	16
Montana	610	$68.74	$53.67	10
Guam	522	$69.29	$54.22	2
Idaho	355	$61.55	$52.41	10
Puerto Rico	188	$69.11	$53.64	3
Wyoming	176	$66.52	$54.44	2
U.S. Virgin Islands	59	$69.83	$54.81	1

Related codes

90960Dialysis services$347.78
90961Dialysis services$286.31
90970Dialysis services$9.13
90966Home dialysis services per month (20 years or older)$281.93
90901Biofeedback training$40.14
90962Dialysis services$199.48
90945Dialysis procedure including 1 evaluation$83.22
90913Biofeedback training for bowel or bladder control$30.27
90912Biofeedback training for bowel or bladder control$74.05
90937Hemodialysis procedure requiring repeated evaluation$102.75
90947Dialysis procedure requiring repeat evaluation$118.72
90999Other inpatient or outpatient dialysis procedure$107.25

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.