CPT 90960: ESRD Monthly Services, Four or More Visits
CPT 90960 reports monthly ESRD services for patients 20 and older with four or more face-to-face visits. Visit counting rules.
Billing 90960 Correctly
CPT 90960 reports monthly ESRD services for patients 20 and older with four or more face-to-face visits. Visit counting rules.
- The treatment record must evidence each face-to-face visit claimed.
- Reconcile the attendance log against the claim before submission rather than after a review.
Source: AMA CPT and CMS billing guidance, verified 2026-09-11
90960 in Detail
CPT 90960 reports monthly ESRD management for patients aged 20 and older where four or more face-to-face visits occurred. Payment is monthly capitation, so the billing work is reconciling visit counts rather than coding encounters.
The visit count is what selects the code within the family, which makes the attendance record the controlling document. This is the core of dialysis and ESRD billing and of nephrology billing generally. It is billed inside dialysis billing and nephrology billing, under Medicare billing rules.
Using 90960 Correctly
Documentation Requirements
Ensure clinical notes clearly support the level of service, procedure performed, and medical necessity for this CPT code.
Modifier Requirements
Determine whether any modifiers are required for this code, particularly in bilateral, assistant surgeon, or multiple procedure scenarios.
Payer-Specific Rules
Check payer fee schedules and coverage policies, as reimbursement and coverage rules for this code vary by payer.
Bundling Considerations
Review NCCI edits to confirm this code is not bundled with other procedures billed on the same date of service.
90960 Reference
| Field | Details |
|---|---|
| CPT Code | 90960 |
| Official Descriptor | End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits per month. |
| What It Covers | Monthly management of an ESRD patient aged 20 or older where four or more face-to-face physician visits occurred in the month. Payment is a monthly capitation rather than per encounter. |
| What the Monthly Payment Includes | Dialysis supervision, patient examinations, care coordination and review of documentation across the month. |
| Visit Count Drives the Code | The family is banded by the number of face-to-face visits in the month. Billing the four-or-more code when fewer visits are documented is a recurring source of overpayment recovery. |
| Age Band | This code is for patients 20 years of age and older. Separate codes cover younger age bands. |
| Documentation | The treatment record must evidence each face-to-face visit claimed. Reconcile the attendance log against the claim before submission rather than after a review. |
Source: AMA CPT and CMS billing guidance, verified 2026-09-11
Related Billing Resources
90960, Frequently Asked Questions
End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits per month.
Having Trouble With This Code?
Our billing specialists can help you resolve denials, improve coding accuracy, and reduce claim rejections.
Sign up for our newsletter to receive updates, industry news, and articles about medical billing and revenue cycle management.