CPT 90960: monthly ESRD services for age 20 and over
90960 is the monthly management code for an in-center dialysis patient aged 20 or over when four or more face-to-face visits occur in the calendar month. Medicare pays one monthly payment per patient to the physician or practitioner who does the complete assessment, sets the plan of care and manages the patient.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 90960 is the adult monthly ESRD code for four or more visits in a calendar month. The patient's age at the end of the month sets the age band, the limit is one unit, and the contractor pays only after the month has passed. With two or three visits the claim moves to 90961, and with one visit to 90962.
What does CPT 90960 report?
90960 reports the monthly management of an adult on maintenance dialysis in a dialysis center, bundled into one payment instead of a bill for each visit. Chapter 8, section 140, says the monthly capitation payment (MCP) covers most outpatient dialysis-related physician services for a Medicare ESRD patient and varies with the number of visits and the patient's age.
| Item | Value |
|---|---|
| Payment status | A (active, paid under the fee schedule if covered) |
| Global period | XXX (the global concept does not apply) |
| Work RVU | 6.77 |
| Total RVU | 11.16 in both settings |
| Practitioner MUE, Q4 2026 | 1 per date, indicator 2, rationale code descriptor |
An MAI of 2 is an absolute per-day edit based on policy, so a second unit cannot be overridden on appeal. NCCI Policy Manual Chapter I says that is what an MAI of 2 means.
Medicare pays 80 percent of the approved amount after the Part B deductible (section 140).
Where does 90960 sit among the adult monthly codes?
It is the top of three in-center codes for patients 20 and over. Section 140.1 says the lowest payment applies to one visit, a higher payment to two to three visits, and the highest to at least four ESRD-related visits.
| Code | Fee schedule label | Work RVU | Total RVU |
|---|---|---|---|
| 90960 | ESRD services, 4 visits per month, age 20+ | 6.77 | 11.16 |
| 90961 | ESRD services, 2 to 3 visits per month, age 20+ | 5.52 | 9.30 |
| 90962 | ESRD services, 1 visit per month, age 20+ | 3.57 | 6.44 |
Section 140.1 judges age on the last day: the patient's age at the end of the month sets the code. A patient who turns 20 on March 28 is billed for March on the age 20 and over code, and for February on the 12 to 19 code, 90957 being the four-visit code in that band.
Which visits count toward the four?
A visit counts if a physician, clinical nurse specialist, nurse practitioner or physician assistant furnished it face to face. Section 140.1 lets partners and employees of the group or of the MCP physician furnish some visits, but the physician doing the complete assessment bills the month.
- A resident's visit counts only if the teaching physician was present. Chapter 12, section 100.1.6, says the teaching physician must document being present and having reviewed the resident's notes, which one monthly MCP note can do.
- Visits to a patient in hospital observation status, and visits to a patient living in a skilled nursing facility, count.
- Inpatient visits do not count. If a nursing home resident is admitted as an inpatient, the inpatient visit code is billed for that visit.
Telehealth can supply some of the visits. Chapter 12, section 190.3.4, says the four-or-more visit MCP may be paid as a telehealth service, but at least one visit must be furnished face to face "hands on" to examine the vascular access site.
How is 90960 reported on the claim?
Report one unit on the CMS-1500. Section 140.4 says the contractor pays only after the month has passed, so bill once the month's visits are done. Section 140.3 says item 24A shows the dates of service in the month covered, which is the full calendar month the physician was responsible, or the dates from the first dialysis treatment to month end in the first month.
Item 32 must carry the name and address of the facility involved in the patient's maintenance care, and item 32a its NPI. Section 140.4 allows one monthly payment per patient and denies duplicate MCP charges.
Section 140 bills these outside the payment: dialysis catheter placement, access repair, thrombectomy of a clotted cannula, interpretation of tests such as electrocardiograms, the complete transplant evaluation and home dialysis training. See nephrology billing.
What fields carry a monthly dialysis visit code?
A monthly end-stage renal disease line is one code per month. 90960 sits in Item 24D with 1 unit in Item 24G, the date in Item 24A and a pointer in Item 24E to the kidney diagnosis. Only one monthly code is reported for a patient in a month, so the visit count in the chart decides which code.
RVU26D gives 90960 status A, work RVU 6.77 and global XXX, and the MUE table allows 1 per date with indicator 2, a policy edit.
Example: A patient seen four times in October has the claim 90960, pointer A (N18.6), 1 unit, $380.00, dated 10/31. If the chart shows only two visits, the lower monthly code is the match, and the payer may downcode.
Why does a 90960 claim deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 18 | Exact duplicate claim/service (use only with group code OA except where state workers' compensation regulations require CO) | A second MCP claim for the same patient and month, from a partner or after a resubmission |
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | A separate visit or covered service billed on top of the monthly payment |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services | The record does not show four qualifying visits |
| 22 | This care may be covered by another payer per coordination of benefits | A group health plan is responsible first for the patient |
If these denials keep coming back, our denial management team can work them. Frequency cases are covered under CO-151.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill the monthly ESRD service?
Choose the code by the patient's age at the end of the month and the number of face-to-face visits, then bill one unit after the month ends. For an adult in-center patient with four or more visits that is 90960, with the month's dates in item 24A and the facility in items 32 and 32a.
02Is the patient's age taken at the start or end of the month?
At the end. Chapter 8, section 140.1.b, says the beneficiary's age at the end of the month is the age used to pick the code. A patient who turns 20 during the month is billed on the age 20 and over code for that month.
03Can resident visits count toward the four visits?
Yes, if the teaching MCP physician was present during the visit, and the note says so. Chapter 12, section 100.1.6, says the teaching physician must document being physically present and having reviewed the resident's notes. One extensive monthly MCP note can carry that documentation.
04Can telehealth visits count?
Chapter 12, section 190.3.4, says the four-or-more visit code may be paid as a telehealth service when at least one visit is furnished face to face to examine the vascular access site. Additional visits can use interactive audio and video. Check current telehealth rules with your MAC.
05What if the patient is hospitalized for part of the month?
If the MCP physician furnished a complete monthly assessment, section 140.2.1 says to bill the MCP code for the visits furnished, and the inpatient visit is billed by whoever saw the patient. Without a complete assessment, the per-day code applies for the days responsible.
Monthly ESRD claims paid at the wrong visit tier?
We match each month's visit log and age band to the right code before the claim is sent.