What documentation does 90951 require?

- 4+ face-to-face visits documented. - Monthly assessment of growth, dialysis adequacy, access, nutrition.

What are common 90951 billing pitfalls?

- Age class must match — wrong code class is the top denial reason.

How much does 90951 pay in 2026?

2026 work RVU for 90951 is 7.21. National Medicare non-facility allowable is approximately $331.34 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

Nephrology · CMS status A

90951

Q: When should I use 90951?

Pediatric ESRD <2 years, 4+ face-to-face dialysis visits in the calendar month.

ESRD service mo 0-1 yrs full month

ESRD related services monthly, for patients younger than 2 years of age, with 4 or more face-to-face visits per month.

Nephro

Model in calculator →Audit a note

Work RVU

7.21

2026 Medicare pays

$331.34

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 7.21 + Practice 2.20 + Malpractice 0.51 = 9.92 total

Work (your effort)Practice expenseMalpractice

When to use it

Pediatric ESRD <2 years, 4+ face-to-face dialysis visits in the calendar month.

Documentation checklist

✓4+ face-to-face visits documented.
✓Monthly assessment of growth, dialysis adequacy, access, nutrition.

Common pitfalls

!Age class must match — wrong code class is the top denial reason.

Common ICD-10 pairings

N18.6

Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.