How much does Medicare pay for CPT 90937?

Medicare allowed an average of $102.75 per service and paid $81.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $415.99, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90937?

Hemodialysis procedure requiring repeated evaluation. It was billed 19,305 times to 7,388 Medicare beneficiaries by 251 providers in 2024.

Does 90937 pay differently in an office than a hospital?

Yes. The allowed amount averaged $97.42 in an office setting and $102.77 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 90937 most?

Nephrology, with 14,419 services from 207 clinicians. Next are Internal Medicine, Neurology, Nurse Practitioner.

CPT 90937

Hemodialysis procedure requiring repeated evaluation

$102.75Medicare-allowed amount per service, averaged across 19,305 services

Providers submitted

$415.99

Asking price, not received

Medicare allowed

$102.75

The fee schedule figure

Medicare paid

$81.50

Balance is patient coinsurance

Providers submitted an average of $415.99 for this code and Medicare allowed $102.75 — 4.0× 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 $81.50 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $97.42
Hospital / facility: $102.77

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 79 services were billed in an office setting and 19,226 in a facility.

Services: 19,305
Beneficiaries: 7,388
Providers billing it: 251
Total allowed: $1,983,589

What Medicare pays for CPT 90937

Across 19,305 services billed by 251 providers to 7,388 beneficiaries, Medicare allowed an average of $102.75 per service. That is 2.6 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 90937

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	14,419	6,000	$102.45	207
Internal Medicine	4,396	1,197	$104.35	36
Neurology	235	42	$108.24	2
Nurse Practitioner	150	94	$84.72	4
Emergency Medicine	62	44	$97.63	1
Physician Assistant	43	11	$79.58	1

90937 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	4,215	$109.75	$78.30	48
California	3,694	$103.34	$78.24	28
New Jersey	2,406	$104.77	$78.27	29
Florida	2,055	$100.61	$77.92	28
Texas	2,011	$99.20	$78.28	14
North Carolina	588	$94.91	$78.33	12
Missouri	453	$95.89	$78.19	7
Tennessee	420	$93.15	$77.81	6
Pennsylvania	363	$101.49	$78.59	12
Ohio	337	$96.71	$78.21	6
U.S. Virgin Islands	331	$98.71	$78.19	1
New Hampshire	247	$89.48	$80.25	5
Michigan	220	$97.28	$77.90	5
Indiana	180	$93.76	$78.13	6
Louisiana	177	$100.00	$78.48	5
New Mexico	171	$103.60	$78.78	3
Virginia	163	$99.98	$78.17	5
Maryland	150	$113.98	$78.28	1
Oklahoma	147	$94.85	$78.72	1
Arkansas	135	$97.11	$78.22	1
Connecticut	125	$104.64	$78.79	4
Kentucky	113	$93.23	$73.72	3
Alaska	90	$123.76	$78.53	1
Washington	84	$103.53	$78.76	3
Guam	79	$99.72	$78.27	2
Minnesota	76	$85.59	$68.97	3
South Carolina	69	$96.99	$76.22	3
Georgia	63	$103.54	$78.59	3
Nebraska	43	$79.58	$66.84	1
Nevada	23	$93.78	$78.48	1
Massachusetts	20	$106.40	$78.81	1
Iowa	20	$94.23	$78.69	1
Alabama	20	$93.77	$78.81	1
Kansas	17	$97.84	$78.66	1

Related codes

90960Dialysis services$347.78
90935Hemodialysis procedure$68.67
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
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.