90957
Esrd srv 4 vsts p mo 12-19
Code typePrimary
Payment statusActive (A)
Global periodNone
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary90957Esrd srv 4 vsts p mo 12-19
1
$796.95
$796.95
RVU Breakdown
Component
Office
Facility
Work
15.46
15.46
Practice expense
7.42
7.42
Malpractice
0.98
0.98
Total RVU
23.86
23.86
Payment Policy & Modifiers
Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66Prof / tech split