How much does Medicare pay for CPT 90962?

Medicare allowed an average of $199.48 per service and paid $157.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $507.88, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90962?

Dialysis services, 1 physician visit per month (20 years or older). It was billed 84,294 times to 33,770 Medicare beneficiaries by 1,637 providers in 2024.

Does 90962 pay differently in an office than a hospital?

Yes. The allowed amount averaged $198.93 in an office setting and $209.96 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 90962 most?

Nephrology, with 69,433 services from 1,238 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

CPT 90962

Dialysis services, 1 physician visit per month (20 years or older)

$199.48Medicare-allowed amount per service, averaged across 84,294 services

Providers submitted

$507.88

Asking price, not received

Medicare allowed

$199.48

The fee schedule figure

Medicare paid

$157.03

Balance is patient coinsurance

Providers submitted an average of $507.88 for this code and Medicare allowed $199.48 — 2.5× 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 $157.03 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $198.93
Hospital / facility: $209.96

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 80,145 services were billed in an office setting and 4,149 in a facility.

Services: 84,294
Beneficiaries: 33,770
Providers billing it: 1,637
Total allowed: $16,814,967

What Medicare pays for CPT 90962

Across 84,294 services billed by 1,637 providers to 33,770 beneficiaries, Medicare allowed an average of $199.48 per service. That is 2.5 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 90962

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	69,433	26,223	$201.73	1,238
Internal Medicine	7,849	2,955	$202.18	142
Nurse Practitioner	4,796	3,404	$169.31	191
Physician Assistant	998	648	$170.34	35
Hospitalist	356	176	$203.78	10
Critical Care (Intensivists)	325	88	$196.76	5
Neurology	242	93	$205.94	5
Certified Clinical Nurse Specialist	115	73	$157.94	3
Undefined Physician type	47	26	$205.61	2
Psychiatry	43	16	$190.83	1
Emergency Medicine	40	25	$188.93	2
Family Practice	20	19	$182.39	1
Orthopedic Surgery	17	11	$191.01	1
Osteopathic Manipulative Medicine	13	13	$191.30	1

90962 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	21,239	$212.63	$153.47	266
Florida	6,534	$196.50	$153.63	138
Washington	4,737	$201.37	$152.76	70
Oklahoma	3,565	$187.41	$151.72	48
Illinois	3,108	$195.94	$154.32	62
Minnesota	2,887	$188.24	$151.47	53
Missouri	2,857	$192.62	$153.15	50
New York	2,768	$214.09	$154.51	76
Texas	2,712	$192.30	$154.70	77
New Jersey	2,648	$212.71	$154.32	52
Georgia	2,058	$192.84	$153.51	63
Arizona	1,919	$187.86	$150.10	44
Michigan	1,807	$196.92	$154.54	42
Hawaii	1,790	$187.18	$145.95	23
Louisiana	1,726	$184.33	$152.19	40
Ohio	1,650	$188.35	$152.52	38
Indiana	1,570	$187.86	$151.72	40
Tennessee	1,480	$183.54	$153.98	32
Massachusetts	1,389	$210.62	$155.20	33
Oregon	1,027	$194.00	$149.12	27
Virginia	962	$195.47	$153.47	25
Maryland	928	$207.56	$153.34	36
West Virginia	879	$192.91	$156.12	12
Pennsylvania	844	$192.48	$150.54	34
Arkansas	841	$181.04	$154.49	15
North Dakota	804	$191.12	$150.96	5
District of Columbia	797	$217.27	$155.27	13
Nebraska	728	$187.61	$154.93	13
Kansas	690	$184.69	$155.24	12
Kentucky	688	$192.95	$154.79	18
Iowa	686	$183.69	$152.09	15
Mississippi	640	$178.03	$147.94	25
South Dakota	635	$189.65	$151.32	10
Montana	495	$198.25	$149.97	10
Alaska	456	$254.29	$155.65	5
Wisconsin	443	$183.69	$155.14	14
New Mexico	427	$200.60	$152.78	11
Utah	425	$197.78	$153.08	6
Wyoming	322	$191.41	$155.70	2
Puerto Rico	319	$195.46	$155.56	4
Alabama	317	$175.16	$148.78	9
Nevada	279	$182.17	$142.47	11
Colorado	268	$202.68	$151.27	8
North Carolina	229	$182.02	$148.63	14
South Carolina	190	$171.28	$141.08	12
Connecticut	156	$218.54	$156.67	8
Idaho	138	$177.99	$152.21	5
Delaware	82	$185.88	$147.90	3
New Hampshire	63	$201.74	$157.73	4
Vermont	44	$192.77	$156.75	1
Maine	28	$188.09	$156.93	2
Northern Mariana Islands	20	$182.39	$156.97	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
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.