{
    "code": "90966",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/90966/2021/A",
    "release_specific_url": "https://localishealth.com/cpt/90966/2021/C",
    "description": "A full calendar month of overseeing an adult who does dialysis at home, whether peritoneal dialysis or home hemodialysis. The work includes reviewing the patient's records and home logs, adjusting the dialysis prescription, tracking labs, managing blood pressure, anemia and fluid balance, and troubleshooting the catheter or home equipment. Unlike the in-center codes, this one is not sorted by how many face-to-face visits happened; it covers a complete month of home-dialysis oversight for a patient aged twenty or older. Companion codes cover home dialysis in children and partial months when the patient starts, stops, or is hospitalised mid-month.",
    "answer": {
        "question": "How much did Medicare pay for CPT 90966 in Q3 2021?",
        "text": "Medicare paid $299.73 for CPT 90966 in the office (non-facility) setting and $299.73 in a facility under the Q3 2021 Physician Fee Schedule, effective July 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it increased 22.7%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2021,
        "quarter": "C",
        "label": "Q3 2021",
        "effective": "July 1 – September 30, 2021",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 299.73,
        "facility": 299.73,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 5.52,
        "practice_expense_non_facility": 2.74,
        "practice_expense_facility": 2.74,
        "malpractice": 0.33
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.8931,
    "source": {
        "label": "Physician relative value file (Q3 2021)",
        "cms_url": "https://www.cms.gov/files/zip/rvu21c-updated-6302021.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2021/C",
        "file": "PPRRVU21_JUL.csv",
        "row": 15866,
        "sha256": "ee14b5306942acfe4554d2d7cf3fe95d7b1a0f41fc7a0445bc2d06df857dd7b6"
    },
    "modified_at": "2026-08-04T03:10:45+00:00"
}