RxDoctor Payments Data

CPT 90960

Dialysis services, 4 or more physician visits per month (20 years or older)

$347.78Medicare-allowed amount per service, averaged across 1,080,713 services
Providers submitted
$768.62

Asking price, not received

Medicare allowed
$347.78

The fee schedule figure

Medicare paid
$274.47

Balance is patient coinsurance

Providers submitted an average of $768.62 for this code and Medicare allowed $347.782.2× 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 $274.47 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility
$347.68
Hospital / facility
$352.46

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,056,200 services were billed in an office setting and 24,513 in a facility.

Services
1,080,713

Medicare Part B, 2024

Beneficiaries
232,830
Providers billing it
6,383
Total allowed
$375,850,367

Services × allowed amount

What Medicare pays for CPT 90960

Across 1,080,713 services billed by 6,383 providers to 232,830 beneficiaries, Medicare allowed an average of $347.78 per service. That is 4.6 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 90960

SpecialtyServicesBeneficiariesAvg allowedProviders
Nephrology953,679200,728$348.565,368
Internal Medicine99,33420,892$348.53579
Nurse Practitioner13,8767,658$292.92315
Neurology4,8191,041$357.6330
Hospitalist3,700739$341.4423
Physician Assistant1,221834$293.1543
Emergency Medicine831131$340.824
General Practice72495$343.533
Medical Oncology535132$380.511
Osteopathic Manipulative Medicine312107$333.912
Psychiatry27649$333.511
Undefined Physician type26455$347.372
Orthopedic Surgery24962$335.511
Family Practice21443$305.992
Peripheral Vascular Disease17938$389.391

90960 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.

StateServicesAllowedStandardized pmtProviders
California153,236$365.84$270.12619
Texas104,959$337.09$269.62625
New York72,761$371.43$270.65423
Florida68,240$348.27$270.04453
Illinois48,336$352.43$268.67279
Georgia40,146$338.93$270.14245
Pennsylvania39,734$345.17$269.16281
New Jersey39,432$370.37$269.92231
North Carolina38,993$334.37$270.04246
Maryland37,229$361.16$269.62158
Michigan32,079$342.58$269.52194
Virginia29,404$344.43$269.95178
South Carolina23,288$334.97$270.15126
Ohio22,988$334.68$270.05217
Tennessee20,851$324.58$269.49123
Mississippi19,131$321.65$268.1678
Indiana19,108$331.75$267.83136
Massachusetts18,746$361.91$270.01108
Missouri17,840$334.52$269.12118
Arizona17,432$333.01$268.67135
Louisiana15,979$331.89$270.01108
Wisconsin15,928$327.86$269.9793
Alabama15,763$322.09$268.28104
Kentucky12,421$334.24$267.6990
Nevada12,400$344.86$266.9694
Connecticut10,108$365.01$270.2075
Washington9,611$348.29$269.9975
Arkansas9,168$320.15$271.5146
Oklahoma8,925$327.60$268.7255
New Mexico8,250$348.56$268.9839
Hawaii8,193$338.80$260.9239
Colorado8,180$355.98$269.7977
Oregon7,853$344.68$268.4463
Kansas7,450$336.07$268.1938
Delaware6,185$343.94$272.0035
Minnesota6,149$336.07$268.1255
Iowa5,526$328.49$269.5335
District of Columbia5,281$388.02$268.8722
New Hampshire4,898$353.40$270.2723
Utah4,860$336.58$269.9745
West Virginia3,858$336.03$270.7627
Rhode Island3,692$345.39$269.3425
Maine3,583$339.54$269.4121
Idaho3,237$329.48$271.5316
Nebraska2,891$327.55$271.3924
Alaska2,849$441.98$272.038
North Dakota2,799$338.69$269.3812
South Dakota2,740$328.43$269.0716
Guam2,645$339.04$251.059
Montana2,258$343.89$270.8515
U.S. Virgin Islands1,134$342.34$264.724
Puerto Rico848$332.71$270.2911
Wyoming504$343.97$266.735
Vermont497$330.53$265.085
Northern Mariana Islands117$280.72$272.071

Related codes

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.