CPT code 90961 covers monthly management of adult patients (age 20 and older) with end stage renal disease (ESRD), requiring the provider to perform two to three face-to-face encounters per month to manage all related services. Nationally, this code captures a key component of outpatient ESRD care coordination and ongoing clinical management for patients receiving chronic renal replacement therapy or conservative management of ESRD. Proper use of this code affects care continuity, clinical oversight, and reimbursement for monthly complex chronic care services.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent and service setting, an overview of common modifiers used with this service (provided separately), and context on how 90961 fits into ESRD outpatient care workflows. The publication clarifies the service expectations tied to the code, outlines typical sites of service, and summarizes the policy relevance of documenting multiple monthly face-to-face encounters. Data not available in the input for payer-specific rates, ICD-10 pairings, and related codes are noted as unavailable where applicable.