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CPT 90963 — Esrd home pt serv p mo <2yrs

CPT code 90963 (Esrd home pt serv p mo <2yrs) carries 12.09 work RVUs under the CMS 2026 Medicare Physician Fee Schedule. Total RVUs are 18.75 in a non-facility setting and 18.75 in a facility setting, which at the 2026 conversion factor of $33.40 works out to $626.27 and $626.27 respectively.

12.09
Work RVU
18.75
Total RVU (non-facility)
$626.27
Medicare, non-facility
$626.27
Medicare, facility
Calculate your total wRVUs →

RVU breakdown for CPT 90963

ComponentRVUsWhat it covers
Work RVU12.09Physician time, skill, effort, and stress.
Practice expense RVU (non-facility)5.91Office overhead, staff, supplies.
Practice expense RVU (facility)5.91Overhead when performed in a hospital.
Malpractice RVU0.75Professional liability cost.
Total RVU (non-facility)18.75Work + non-facility PE + malpractice.
Total RVU (facility)18.75Work + facility PE + malpractice.

How Medicare payment is calculated

Medicare multiplies total RVUs by the annual conversion factor. For CPT 90963 in 2026:

SettingTotal RVUConversion factorNational payment
Non-facility18.75$33.40$626.27
Facility18.75$33.40$626.27

These are national amounts. Actual payment is adjusted by the Geographic Practice Cost Index for your locality — check yours with the GPCI lookup.

Billing rules for CPT 90963

Global period
Global concept does not apply to this code.
Multiple procedure reduction
No multiple-procedure payment reduction applies.
Bilateral surgery
Bilateral adjustment does not apply.
Assistant surgeon
Not permitted unless documentation supports medical necessity.
Co-surgeon
Not permitted unless documentation supports medical necessity.
Team surgery
Not permitted unless documentation supports medical necessity.

Related codes

Codes in the same CMS family, with their work RVU values.

90951 · 23.92 wRVU90954 · 20.86 wRVU90955 · 10.32 wRVU90957 · 15.46 wRVU90964 · 10.25 wRVU

Questions about CPT 90963

How many work RVUs is CPT 90963?

CPT 90963 is assigned 12.09 work RVUs in the CMS 2026 Medicare Physician Fee Schedule.

What does Medicare pay for CPT 90963?

At the 2026 national conversion factor of $33.40, CPT 90963 pays approximately $626.27 in a non-facility setting and $626.27 in a facility setting before geographic adjustment.

What is the global period for CPT 90963?

Global concept does not apply to this code.

RVU values reflect the CMS 2026 Medicare Physician Fee Schedule (conversion factor $33.40). Payment figures are national and unadjusted for geography. Verify against the official fee schedule before using for billing.