Nephrology Billing Cheat Sheet (2026)
The monthly ESRD capitation runs nephrology billing. The code shifts with the patient's age and the number of face-to-face visits that month, so an uncounted visit is a miscoded claim, and inpatient dialysis and vascular access add another layer on top.
Quick reference for nephrology billers. Last updated .
Top Nephrology CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 90935 | Hemodialysis with single evaluation | $61.46 | $61.46 | 1.84 |
| 90937 | Hemodialysis with repeated evaluation | $88.51 | $88.51 | 2.65 |
| 90945 | Dialysis other than hemodialysis | $77.16 | $77.16 | 2.31 |
| 90951 | ESRD services, monthly comprehensive, age 0-1 | $1,183.73 | $1,183.73 | 35.44 |
| 90960 | ESRD services, monthly focused, age 12-19 | $372.75 | $372.75 | 11.16 |
| 36800 | Vascular catheter insertion for hemodialysis | $107.55 | $107.55 | 3.22 |
| 36901 | Diagnostic angiography of dialysis fistula | $686.39 | $147.30 | 20.55 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
| 99214 | Established patient office visit, moderate MDM | $135.61 | $84.50 | 4.06 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Nephrology billing services page.
Modifiers That Prevent Nephrology Denials
A significant, separately identifiable E/M unrelated to the dialysis service on the same day.
A distinct procedure separate from the dialysis or access service that NCCI would otherwise bundle.
Hemodialysis adequacy (Kt/V) reporting designators some payers require on the monthly claim.
Splitting professional and technical components on access imaging such as fistula angiography.
A repeat procedure by the same physician with the medical reason documented.
An item or service not for the treatment of ESRD, billed separately from the bundled ESRD payment.
Top Nephrology Denials → Quick Fix
The monthly capitation code (90951 to 90970) depends on age and the number of face-to-face visits that month. Document each visit date; the count sets the code.
Inpatient hemodialysis (90935, 90937) is billed per session and is separate from the outpatient monthly capitation. Do not bill both for the same service period without documentation.
Append modifier 25 and document an evaluation unrelated to the dialysis service itself; routine dialysis assessment is included.
Bill the professional component with modifier 26 on fistula angiography when the practice reads but does not own the equipment.
Append modifier AY for items and services not related to ESRD treatment so they are paid outside the bundled payment.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 90935 | 0596T | Standards of medical/surgical practice |
| 90935 | 0597T | Standards of medical/surgical practice |
| 90937 | 0596T | Standards of medical/surgical practice |
| 90937 | 0597T | Standards of medical/surgical practice |
| 90945 | 0213T | Standards of medical/surgical practice |
| 90945 | 0216T | Standards of medical/surgical practice |
| 90951 | 0591T | CPT Manual or CMS manual coding instruction |
| 90951 | 0592T | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
The patient age band and every face-to-face visit date in the month, since both set the code.
Each session and whether single or repeated evaluation, billed per session.
The diagnostic versus interventional work and equipment ownership for the component split.
That the evaluation was unrelated to the routine dialysis assessment, supporting modifier 25.
That the service is unrelated to ESRD treatment, supporting modifier AY for separate payment.
Revenue Nephrology Practices Leave on the Table
Billing the wrong monthly capitation tier because visit dates were not counted.
Folding billable non-ESRD services into the bundled payment instead of using modifier AY.
Losing the professional component on access imaging.
Skipping a documented separate E/M that qualified for modifier 25.
Nephrology Billing FAQ
How is the monthly ESRD code chosen?
By the patient's age band and the number of face-to-face visits during the month (90951 to 90970). Every visit date has to be documented because the count moves the code and the payment.
Can I bill inpatient dialysis and the monthly code?
Inpatient hemodialysis (90935, 90937) is per session and separate from the outpatient monthly capitation. Billing both for the same service period without clear documentation is a bundling denial.
What is modifier AY for?
It identifies an item or service not for the treatment of ESRD, so it is paid outside the bundled ESRD payment rather than absorbed into it.
When can I bill an E/M on a dialysis day?
When the evaluation is significant and unrelated to the routine dialysis assessment, with modifier 25 and a distinct note. The routine assessment is part of the dialysis service.
Stop Losing Nephrology Revenue to Preventable Denials
Our AAPC-certified nephrology coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.