Nephrology Billing Services
Nephrology billing involves unique monthly capitated dialysis codes, CKD staging documentation, transplant management, and the interplay between office visits and dialysis facility billing.
Why Nephrology Billing Requires Specialty Expertise
Nephrology uses monthly capitated ESRD codes (90960-90966) based on age and visit frequency, plus hemodialysis procedure codes (90935-90937) and office-based CKD management. The monthly capitation model is unlike any other specialty's billing structure.
Common Nephrology CPT Codes
Our coders handle these nephrology codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Nephrology CPT Codes by State
Medicare reimbursement for nephrologyprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same nephrology CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 9 core nephrologycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Nephrology Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 90935 | Hemodialysis with single evaluation | $63.92 | $61.37 | $64.02 | $65.93 | $61.86 | $63.70 | $60.55 | $61.56 | $59.78 | $61.89 |
| 90937 | Hemodialysis with repeated evaluation | $91.81 | $88.34 | $92.67 | $95.11 | $89.12 | $92.19 | $87.21 | $88.77 | $85.92 | $89.34 |
| 90945 | Dialysis other than hemodialysis | $81.88 | $76.86 | $80.08 | $83.34 | $77.34 | $79.28 | $75.15 | $76.75 | $74.50 | $76.96 |
| 90951 | ESRD services, monthly comprehensive, age 0-1 | $1,251.62 | $1,179.44 | $1,231.01 | $1,277.98 | $1,187.39 | $1,219.61 | $1,154.88 | $1,179.05 | $1,143.61 | $1,183.11 |
| 90960 | ESRD services, monthly focused, age 12-19 | $398.52 | $370.93 | $386.79 | $403.93 | $373.07 | $382.17 | $361.36 | $369.84 | $358.71 | $370.54 |
| 36800 | Vascular catheter insertion for hemodialysis | $109.81 | $107.05 | $116.15 | $116.79 | $108.49 | $115.39 | $105.94 | $108.55 | $103.00 | $110.05 |
| 36901 | Diagnostic angiography of dialysis fistula | $785.12 | $677.10 | $704.38 | $762.42 | $677.08 | $683.40 | $637.82 | $664.15 | $642.73 | $659.18 |
| 99213 | Established patient office visit, low MDM | $104.31 | $94.46 | $98.20 | $103.97 | $94.79 | $96.44 | $90.97 | $93.60 | $90.84 | $93.44 |
| 99214 | Established patient office visit, moderate MDM | $148.01 | $134.59 | $140.26 | $148.05 | $135.13 | $137.84 | $129.83 | $133.55 | $129.44 | $133.44 |
Full Nephrology fee detail by state
2026 Medicare allowables for nephrology CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 90935 | Hemodialysis with single evaluation | $63.92 | $63.92 |
| 90937 | Hemodialysis with repeated evaluation | $91.81 | $91.81 |
| 90945 | Dialysis other than hemodialysis | $81.88 | $81.88 |
| 90951 | ESRD services, monthly comprehensive, age 0-1 | $1,251.62 | $1,251.62 |
| 90960 | ESRD services, monthly focused, age 12-19 | $398.52 | $398.52 |
| 36800 | Vascular catheter insertion for hemodialysis | $109.81 | $109.81 |
| 36901 | Diagnostic angiography of dialysis fistula | $785.12 | $147.22 |
| 99213 | Established patient office visit, low MDM | $104.31 | $59.65 |
| 99214 | Established patient office visit, moderate MDM | $148.01 | $87.54 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Nephrology Billing Challenges We Solve
Common billing problems in nephrology and how our team handles them.
Monthly ESRD Codes
90960-90966 are based on patient age and number of physician contacts per month.
Dialysis Facility Coordination
Billing must coordinate between nephrologist professional fees and facility charges.
CKD Staging
Proper staging documentation affects code selection and payer coverage.
Transplant Management
Pre- and post-transplant billing has specific code ranges and documentation requirements.
Common Nephrology Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Nephrology Practices Miss
Payer-Specific Nephrology Billing Tips
Nephrology Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Nephrology Billing Support
Free billing assessment for your nephrology practice. See where revenue is leaking.
What We Handle for Nephrology Practices
Why Choose Go Medical Billing for Nephrology
Nephrology's monthly capitation model is unique. Our team handles ESRD codes, dialysis coordination, and CKD staging with the precision this specialty requires.
We serve nephrology practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Nephrology Billing by State
We handle nephrology billing in all 50 states. The 2026 Medicare allowables for nephrology CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Nephrology Billing Support
Stop losing revenue to nephrology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.