How much does Medicare pay for CPT 90966?

Medicare allowed an average of $281.93 per service and paid $220.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $655.99, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90966?

Home dialysis services per month (20 years or older). It was billed 174,484 times to 37,256 Medicare beneficiaries by 1,881 providers in 2024.

Does 90966 pay differently in an office than a hospital?

Yes. The allowed amount averaged $281.66 in an office setting and $289.56 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 90966 most?

Nephrology, with 155,534 services from 1,646 clinicians. Next are Internal Medicine, Nurse Practitioner, Physician Assistant.

CPT 90966

Home dialysis services per month (20 years or older)

$281.93Medicare-allowed amount per service, averaged across 174,484 services

Providers submitted

$655.99

Asking price, not received

Medicare allowed

$281.93

The fee schedule figure

Medicare paid

$220.94

Balance is patient coinsurance

Providers submitted an average of $655.99 for this code and Medicare allowed $281.93 — 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 $220.94 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $281.66
Hospital / facility: $289.56

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 168,488 services were billed in an office setting and 5,996 in a facility.

Services: 174,484
Beneficiaries: 37,256
Providers billing it: 1,881
Total allowed: $49,192,274

What Medicare pays for CPT 90966

Across 174,484 services billed by 1,881 providers to 37,256 beneficiaries, Medicare allowed an average of $281.93 per service. That is 4.7 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 90966

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nephrology	155,534	32,294	$283.05	1,646
Internal Medicine	13,465	2,997	$281.11	152
Nurse Practitioner	3,326	1,401	$240.62	60
Physician Assistant	416	145	$235.50	5
Neurology	400	106	$278.15	5
General Practice	289	40	$281.44	2
Hospitalist	268	45	$287.16	3
Critical Care (Intensivists)	223	94	$273.57	1
Emergency Medicine	133	21	$285.32	1
Family Practice	129	18	$290.81	1
Certified Clinical Nurse Specialist	112	48	$242.91	2
Osteopathic Manipulative Medicine	75	16	$270.92	1
Undefined Physician type	59	11	$286.10	1
Orthopedic Surgery	55	20	$276.98	1

90966 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	15,879	$300.40	$222.44	138
Texas	14,339	$274.30	$221.08	163
Florida	11,150	$286.87	$223.44	109
Illinois	10,919	$287.01	$221.18	127
North Carolina	8,053	$276.45	$220.26	101
Michigan	5,852	$282.53	$223.25	63
Virginia	5,828	$281.36	$221.18	74
Georgia	5,822	$276.65	$223.41	65
Pennsylvania	5,655	$284.96	$223.12	71
Ohio	4,919	$276.99	$222.63	59
Maryland	4,910	$300.03	$223.85	56
New York	4,774	$293.13	$225.04	47
Missouri	4,715	$270.96	$221.00	54
South Carolina	4,627	$274.85	$219.57	62
Tennessee	4,433	$267.37	$223.75	43
Arizona	4,097	$273.42	$223.49	29
Oklahoma	4,064	$267.55	$223.00	35
Indiana	3,837	$277.04	$222.24	42
Alabama	3,372	$267.24	$220.56	34
Mississippi	3,345	$261.84	$220.75	29
Washington	3,257	$283.83	$225.20	30
Arkansas	2,935	$257.63	$224.45	30
Louisiana	2,527	$271.15	$222.70	28
New Mexico	2,411	$280.90	$220.18	20
Kansas	2,341	$274.15	$223.07	20
Kentucky	2,314	$275.14	$222.14	27
Nevada	2,302	$287.91	$220.98	23
Wisconsin	2,195	$268.50	$222.05	29
Iowa	2,050	$270.62	$220.55	24
Colorado	1,964	$296.90	$223.31	22
Massachusetts	1,889	$304.57	$223.91	19
Oregon	1,554	$285.19	$221.97	20
Idaho	1,500	$267.76	$225.23	13
Utah	1,495	$277.64	$223.00	15
New Jersey	1,481	$303.59	$223.98	22
Minnesota	1,287	$276.22	$222.65	16
Nebraska	1,135	$270.46	$225.43	10
Hawaii	1,115	$285.41	$222.86	15
Delaware	1,094	$287.85	$224.85	11
Alaska	952	$375.81	$220.86	5
Montana	935	$283.37	$223.69	11
Connecticut	892	$299.56	$222.58	17
New Hampshire	776	$291.52	$222.69	8
South Dakota	730	$275.94	$219.42	7
West Virginia	695	$284.26	$223.15	9
Maine	647	$274.76	$223.13	10
North Dakota	602	$278.78	$220.42	6
District of Columbia	331	$323.37	$225.53	5
Rhode Island	226	$284.21	$222.29	4
Guam	139	$291.94	$217.43	2
Wyoming	123	$274.32	$227.53	2

Related codes

90960Dialysis services$347.78
90935Hemodialysis procedure$68.67
90961Dialysis services$286.31
90970Dialysis services$9.13
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.