{
    "code": "90961",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/90961/2016/A",
    "release_specific_url": "https://localishealth.com/cpt/90961/2016/C",
    "description": "A full month of end-stage renal disease care for an adult on dialysis, at the middle visit frequency: the clinician saw the patient in person two or three times during the month. The content of the care is the same as the higher-frequency version, covering lab review, dialysis prescription changes, anemia and blood pressure management, mineral and bone issues, and dialysis access. What sets this code apart from its neighbours is purely how many face-to-face encounters happened that month, with separate codes for four or more visits and for a single visit. It applies to adults; parallel codes handle children by age band.",
    "answer": {
        "question": "How much did Medicare pay for CPT 90961 in Q3 2016?",
        "text": "Medicare paid $241.32 for CPT 90961 in the office (non-facility) setting and $241.32 in a facility under the Q3 2016 Physician Fee Schedule, effective July 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2016, when it decreased 0.4%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2016,
        "quarter": "C",
        "label": "Q3 2016",
        "effective": "July 1 – September 30, 2016",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 241.32,
        "facility": 241.32,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 4.26,
        "practice_expense_non_facility": 2.23,
        "practice_expense_facility": 2.23,
        "malpractice": 0.25
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.8043,
    "source": {
        "label": "Physician relative value file (Q3 2016)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16c.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2016/C",
        "file": "PPRRVU16_V0517.csv",
        "row": 14845,
        "sha256": "81464316ee60bdd4aa33b47a636b521a77a73481c795300cbab67f48dbe432d9"
    },
    "modified_at": "2026-08-04T03:06:56+00:00"
}