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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.

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300+ Practices
90960ESRD Monthly
90935Hemodialysis
99214Office E/M
50360Transplant

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.

Code
Description
90960
ESRD Monthly
90935
Hemodialysis
99214
Office E/M
50360
Transplant

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.

!
90960-90966 are based on patient age and number of physician contacts per month
!
Billing must coordinate between nephrologist professional fees and facility charges
!
Proper staging documentation affects code selection and payer coverage
!
Pre- and post-transplant billing has specific code ranges and documentation requirements

Revenue Opportunities Most Nephrology Practices Miss

Nephrology revenue optimization centers on ESRD monthly code accuracy and vascular access billing. The monthly ESRD code difference between 2-3 visits (90960) and 1 visit (90962) represents a significant reimbursement drop — approximately $100 to $150 per patient per month. For a nephrology practice managing 100 dialysis patients, ensuring all patients receive the appropriate number of monthly visits and the correct code is assigned can add $120,000 to $180,000 annually. Vascular access procedures and maintenance are high-revenue services. Each AV fistula creation, graft placement, or declotting procedure generates $1,500 to $3,000 in professional fees.

Payer-Specific Nephrology Billing Tips

Medicare covers 80% of most ESRD services, and the monthly capitated codes include most dialysis-related physician services. However, hospital admissions, surgical procedures, and non-ESRD conditions are billed separately. Understanding what's included in the ESRD monthly code and what's separately billable is critical. Commercial payers don't always use the ESRD monthly capitated model. Some pay per-visit instead. We track each payer's nephrology payment methodology and bill accordingly. Medicaid ESRD coverage varies by state.

Nephrology Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

1
Monthly ESRD codes (90960-90966) are based on the patient's age group AND the number of physician face-to-face visits that month. Missing a visit downgrades the monthly code.
2
For hospital-based nephrologists, bill inpatient E/M codes (99221-99223, 99231-99233) during the acute phase, then transition to ESRD monthly codes once the patient is stable on dialysis.
3
Vascular access procedures (36821 AV fistula, 36830 AV graft) and access maintenance (36901-36906) are high-revenue procedures that require separate surgical documentation.
4
CKD staging (N18.1-N18.6) must be documented at the highest confirmed stage — underdocumentation of CKD stage affects risk adjustment and care management code eligibility.

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What We Handle for Nephrology Practices

Monthly ESRD capitated billing
Hemodialysis procedure coding
CKD management billing
Transplant evaluation and management
Vascular access procedure coding
Peritoneal dialysis billing

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. Select your state for location-specific payer details, Medicaid rules, and Medicare MAC policies.

CaliforniaTexasFloridaNew YorkPennsylvaniaIllinoisOhioGeorgiaNorth CarolinaMichiganNew JerseyVirginiaMassachusettsArizonaTennesseeMarylandIndianaMissouriWisconsinColorado
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Related Resources

Medical Billing & Coding ServicesA/R Recovery ServicesCredentialing & ContractingCase Studies & ResultsPricing

Frequently Asked Questions

We track physician contacts per month and assign the correct 90960-90966 code based on age and visit frequency.
Yes. We ensure professional and facility charges are properly separated and billed.

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Stop losing revenue to nephrology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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