How much does Medicare pay for CPT 90945?

Medicare allowed an average of $83.22 per service and paid $65.99 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $317.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90945?

Dialysis procedure including 1 evaluation. It was billed 52,576 times to 18,076 Medicare beneficiaries by 1,078 providers in 2024.

Does 90945 pay differently in an office than a hospital?

Yes. The allowed amount averaged $80.42 in an office setting and $83.24 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 90945 most?

Nephrology, with 46,776 services from 957 clinicians. Next are Internal Medicine, Nurse Practitioner, Neurology.

CPT 90945

Dialysis procedure including 1 evaluation

$83.22Medicare-allowed amount per service, averaged across 52,576 services

Providers submitted

$317.46

Asking price, not received

Medicare allowed

$83.22

The fee schedule figure

Medicare paid

$65.99

Balance is patient coinsurance

Providers submitted an average of $317.46 for this code and Medicare allowed $83.22 — 3.8× 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 $65.99 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $80.42
Hospital / facility: $83.24

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 347 services were billed in an office setting and 52,229 in a facility.

Services: 52,576
Beneficiaries: 18,076
Providers billing it: 1,078
Total allowed: $4,375,375

What Medicare pays for CPT 90945

Across 52,576 services billed by 1,078 providers to 18,076 beneficiaries, Medicare allowed an average of $83.22 per service. That is 2.9 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 90945

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	46,776	16,071	$83.81	957
Internal Medicine	2,980	1,063	$81.59	67
Nurse Practitioner	1,438	527	$68.97	29
Neurology	299	126	$84.10	7
Physician Assistant	294	110	$68.43	6
Critical Care (Intensivists)	245	29	$88.69	2
Hospitalist	107	35	$81.20	2
General Surgery	104	35	$86.39	2
Cardiac Surgery	89	16	$87.21	1
Obstetrics & Gynecology	74	18	$87.04	1
Thoracic Surgery	65	11	$87.24	1
Undefined Physician type	37	12	$83.09	1
Osteopathic Manipulative Medicine	37	12	$76.16	1
General Practice	31	11	$86.19	1

90945 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
California	5,408	$91.60	$65.79	97
Maryland	4,026	$86.80	$65.48	72
Ohio	3,754	$78.52	$64.25	69
Texas	2,872	$82.97	$65.62	48
North Carolina	2,842	$78.73	$65.85	64
Alabama	2,769	$77.39	$65.65	45
Florida	2,321	$82.73	$65.26	48
New York	2,299	$86.06	$65.49	50
Indiana	2,196	$78.17	$64.80	45
Pennsylvania	2,148	$81.61	$65.72	58
Missouri	1,840	$80.52	$66.09	37
Virginia	1,637	$84.34	$65.61	37
Illinois	1,581	$84.34	$65.42	35
Massachusetts	1,562	$89.54	$65.44	29
Tennessee	1,391	$78.99	$65.81	32
New Jersey	1,128	$88.35	$65.71	32
Georgia	1,069	$79.27	$64.19	20
Michigan	998	$82.47	$65.95	31
Wisconsin	802	$79.34	$65.63	20
Colorado	759	$85.90	$65.89	15
Iowa	757	$78.88	$66.11	15
Mississippi	666	$76.20	$64.41	14
Oklahoma	652	$79.88	$66.11	12
Alaska	646	$108.56	$65.69	6
Arizona	575	$82.63	$65.95	12
New Hampshire	574	$80.86	$64.72	13
Arkansas	517	$74.83	$66.48	12
South Carolina	471	$80.07	$65.60	12
Oregon	463	$84.35	$65.35	12
West Virginia	383	$83.52	$65.68	10
Kansas	363	$79.05	$66.30	5
Washington	351	$84.19	$65.50	10
Minnesota	348	$81.36	$65.61	8
North Dakota	333	$82.42	$65.72	6
Connecticut	320	$87.33	$65.67	6
Nebraska	284	$78.32	$66.12	8
Kentucky	233	$79.44	$65.13	5
Idaho	190	$71.38	$60.70	3
Delaware	151	$82.72	$65.86	5
Nevada	131	$81.16	$65.94	2
Maine	108	$87.19	$66.13	2
Louisiana	106	$76.88	$65.39	3
Hawaii	99	$83.51	$66.14	2
District of Columbia	98	$96.43	$65.50	3
South Dakota	97	$81.17	$66.11	2
New Mexico	79	$77.04	$66.24	1
Montana	75	$82.91	$65.63	2
Utah	58	$82.77	$66.20	2
Rhode Island	46	$90.57	$62.31	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
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.