How much does Medicare pay for CPT 90947?

Medicare allowed an average of $118.72 per service and paid $94.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $405.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90947?

Dialysis procedure requiring repeat evaluation. It was billed 3,220 times to 1,121 Medicare beneficiaries by 62 providers in 2024.

Which specialty bills 90947 most?

Nephrology, with 2,683 services from 52 clinicians. Next are Internal Medicine, Critical Care (Intensivists).

CPT 90947

Dialysis procedure requiring repeat evaluation

$118.72Medicare-allowed amount per service, averaged across 3,220 services

Providers submitted

$405.39

Asking price, not received

Medicare allowed

$118.72

The fee schedule figure

Medicare paid

$94.50

Balance is patient coinsurance

Providers submitted an average of $405.39 for this code and Medicare allowed $118.72 — 3.4× 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 $94.50 (80%); the rest is the patient’s coinsurance and deductible.

Services: 3,220
Beneficiaries: 1,121
Providers billing it: 62
Total allowed: $382,278

What Medicare pays for CPT 90947

Across 3,220 services billed by 62 providers to 1,121 beneficiaries, Medicare allowed an average of $118.72 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 90947

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	2,683	939	$117.68	52
Internal Medicine	356	128	$124.16	9
Critical Care (Intensivists)	181	54	$123.40	1

90947 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
Florida	486	$120.46	$93.97	7
Texas	451	$121.17	$94.16	6
Arkansas	254	$107.84	$94.28	2
California	242	$124.01	$94.21	4
Maryland	197	$123.46	$94.07	2
New York	189	$125.33	$93.50	4
Tennessee	184	$113.12	$94.51	4
Michigan	169	$122.05	$94.20	7
Oklahoma	146	$113.79	$94.42	2
Alabama	136	$111.51	$91.93	3
Virginia	114	$116.14	$93.93	2
Ohio	110	$115.13	$94.30	3
Nebraska	100	$111.57	$94.13	3
North Carolina	65	$113.52	$94.40	2
Colorado	55	$120.63	$94.47	1
Wisconsin	44	$110.55	$94.83	1
Connecticut	43	$124.02	$94.22	1
Missouri	35	$117.31	$94.25	1
New Jersey	34	$125.22	$94.15	1
Pennsylvania	31	$122.81	$94.17	1
Alaska	31	$147.86	$94.12	1
Massachusetts	30	$127.35	$94.47	1
Washington	30	$118.93	$94.27	1
Indiana	28	$116.57	$94.20	1
New Hampshire	16	$111.49	$95.95	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
90937Hemodialysis procedure requiring repeated evaluation$102.75
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.