How much does Medicare pay for CPT 90961?

Medicare allowed an average of $286.31 per service and paid $226.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $654.28, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90961?

Dialysis services, 2-3 physician visits per month (20 years or older). It was billed 351,233 times to 145,720 Medicare beneficiaries by 5,645 providers in 2024.

Does 90961 pay differently in an office than a hospital?

Yes. The allowed amount averaged $286.18 in an office setting and $290.21 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 90961 most?

Nephrology, with 294,567 services from 4,424 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

CPT 90961

Dialysis services, 2-3 physician visits per month (20 years or older)

$286.31Medicare-allowed amount per service, averaged across 351,233 services

Providers submitted

$654.28

Asking price, not received

Medicare allowed

$286.31

The fee schedule figure

Medicare paid

$226.15

Balance is patient coinsurance

Providers submitted an average of $654.28 for this code and Medicare allowed $286.31 — 2.3× 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 $226.15 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $286.18
Hospital / facility: $290.21

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 339,701 services were billed in an office setting and 11,532 in a facility.

Services: 351,233
Beneficiaries: 145,720
Providers billing it: 5,645
Total allowed: $100,561,520

What Medicare pays for CPT 90961

Across 351,233 services billed by 5,645 providers to 145,720 beneficiaries, Medicare allowed an average of $286.31 per service. That is 2.4 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 90961

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	294,567	116,982	$289.55	4,424
Internal Medicine	30,032	11,737	$288.95	441
Nurse Practitioner	20,664	13,761	$241.36	639
Physician Assistant	2,127	1,543	$242.83	78
Hospitalist	1,294	533	$284.69	20
Neurology	963	437	$298.20	18
Emergency Medicine	336	103	$278.72	4
Certified Clinical Nurse Specialist	268	173	$231.31	7
Critical Care (Intensivists)	209	70	$266.58	3
Osteopathic Manipulative Medicine	156	72	$276.70	2
Psychiatry	140	35	$277.09	1
Orthopedic Surgery	118	56	$278.19	1
Endocrinology	116	89	$296.27	1
Undefined Physician type	108	46	$292.10	2
Medical Oncology	51	37	$317.34	1

90961 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	56,895	$303.64	$223.23	616
Texas	31,964	$279.74	$224.34	516
Florida	20,062	$286.33	$222.90	374
New York	17,658	$307.17	$224.72	296
Illinois	13,160	$289.48	$221.85	224
Georgia	11,192	$278.22	$221.67	214
Washington	10,902	$292.90	$225.06	100
New Jersey	9,719	$303.53	$222.48	191
Missouri	9,218	$274.62	$221.88	124
Michigan	9,121	$283.11	$222.29	165
Minnesota	8,702	$277.51	$222.24	97
Pennsylvania	8,660	$282.27	$222.91	195
North Carolina	8,618	$271.11	$218.50	235
Massachusetts	8,406	$303.31	$224.45	107
Ohio	8,322	$272.84	$221.24	198
Maryland	8,161	$297.94	$222.94	148
Louisiana	7,121	$269.67	$222.18	101
Arizona	6,802	$274.85	$219.38	121
Indiana	6,722	$274.51	$222.44	116
Virginia	6,576	$281.29	$222.03	143
Tennessee	6,337	$266.91	$221.36	110
Oklahoma	5,881	$270.51	$220.68	70
South Carolina	5,272	$274.01	$221.07	124
Mississippi	4,543	$267.58	$218.82	76
Alabama	4,522	$260.15	$217.88	101
Arkansas	4,131	$264.58	$222.93	49
Wisconsin	3,940	$270.99	$222.29	67
Oregon	3,845	$282.40	$218.65	71
Colorado	3,840	$292.86	$222.26	74
New Mexico	3,716	$286.59	$220.39	50
Kentucky	3,561	$275.71	$220.99	68
District of Columbia	2,836	$321.71	$224.80	21
Iowa	2,790	$269.30	$221.73	33
Connecticut	2,596	$305.53	$225.20	53
South Dakota	2,556	$275.87	$223.38	16
Nebraska	2,419	$266.16	$220.18	33
Kansas	2,385	$271.21	$222.84	27
Nevada	2,304	$275.15	$213.58	50
West Virginia	2,146	$272.25	$224.78	31
Hawaii	1,955	$276.50	$210.27	32
Utah	1,578	$271.84	$212.30	34
Idaho	1,448	$266.96	$222.15	23
North Dakota	1,387	$274.47	$219.47	18
Montana	1,203	$281.83	$220.17	18
Delaware	1,104	$270.79	$214.00	36
Alaska	995	$360.11	$221.27	6
Maine	961	$280.82	$222.82	20
New Hampshire	957	$293.78	$224.94	22
Wyoming	587	$282.97	$225.57	5
Puerto Rico	502	$281.76	$226.28	8
Vermont	482	$272.22	$217.08	5
Rhode Island	271	$291.25	$225.69	9
U.S. Virgin Islands	133	$267.40	$219.29	1
Guam	69	$265.76	$202.22	3

Related codes

90960Dialysis services$347.78
90935Hemodialysis procedure$68.67
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.