Nephrology billing
Nephrology billing services
We handle billing for nephrology practices, from monthly ESRD dialysis services to hospital dialysis visits and CKD office care. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and pricing starts at 2.5% of collections.
- Monthly ESRD codes (90951–90970) by age and visit count
- Inpatient dialysis and hospital E/M billed correctly together
- Medicare and ESRD coordination of benefits tracked
Why nephrology billing is different
Nephrology is billed by the month, the visit and the setting
Dialysis care is paid as a monthly service, while CKD and hospital care are paid by the visit. Mixing the two up is where most nephrology revenue leaks.
Monthly ESRD services
Outpatient dialysis management is billed once per month (90951–90962) based on the patient’s age and the number of face-to-face visits. Four or more visits pays more than two or three, so visit counts have to be tracked all month.
Home dialysis
Patients on home hemodialysis or peritoneal dialysis are billed with a monthly home dialysis code by age (90963–90966), with different documentation expectations than in-center patients.
Partial months
When a patient is hospitalized, changes facility, starts dialysis or dies mid-month, a full-month code may not apply. Payers expect per-day codes (90967–90970) or other rules in those cases.
Hospital dialysis visits
Inpatient dialysis is reported with 90935/90937 (hemodialysis) or 90945/90947 (other dialysis). An E/M on the same day needs a separate, documented reason and usually modifier 25.
Medicare and ESRD coordination
ESRD patients often have Medicare plus an employer plan. During the coordination period the employer plan pays first. Billing the wrong payer first leads to denials and recoupments.
Chronic care and transitions
CKD patients may qualify for care management and transitional care services. These have their own time, consent and documentation rules that payers check.
Common codes
Nephrology codes we review on every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 90951–90962 | Monthly outpatient ESRD services, by age and number of visits | Visit count for the month and the patient’s age group |
| 90963–90966 | Monthly home dialysis services, by age | Home dialysis status and monthly documentation |
| 90967–90970 | ESRD services billed per day for a partial month | Used only when a full month does not apply |
| 90935 / 90937 | Hemodialysis with one evaluation / repeated evaluations | Setting and any same-day E/M with modifier 25 |
| 90945 / 90947 | Dialysis other than hemodialysis (such as peritoneal) | Same evaluation rules as hemodialysis |
| 99221–99233 | Initial and subsequent hospital visits | Not billed for the same dialysis work reported with 90935–90947 |
| 99202–99215 | Office visits for CKD and hypertension | Level supported by medical decision making or total time |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Nephrology denials we stop before they happen
Nephrology denials usually come from monthly counting errors, payer order and same-day conflicts. We check each before the claim goes out.
- Monthly ESRD code that does not match the documented visit count
- Full-month code billed when the patient was hospitalized or transferred mid-month
- Wrong primary payer during the ESRD coordination period
- Hospital E/M billed on a dialysis day without separate documentation
- Duplicate monthly claims when two nephrologists in a group round on the same patient
- Care management billed without the required consent or time on record
What we handle
Everything between the rounding list and the payment
- Insurance eligibility and benefits checks, including Medicare and secondary coverage
- Charge entry and coding review of monthly, per-day and hospital codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing, including hospital and dialysis facility locations
- Patient statements and balance tracking
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for nephrology practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing.
Common questions
How do you track visit counts for monthly ESRD codes?
We match each month’s documented face-to-face visits to the patient’s age group before choosing the code. If your rounding sheets or EHR show fewer visits than the claim needs, we flag it before submission.
What happens when a dialysis patient is hospitalized mid-month?
A full-month code may no longer apply. Depending on the payer, the month may be billed with per-day codes (90967–90970) or under other partial-month rules. We check the payer’s current policy for each case.
Can you bill a hospital visit and inpatient dialysis on the same day?
Yes, when the E/M addresses a separate problem and is documented separately. It is usually billed with modifier 25. Routine dialysis evaluation is part of 90935–90947.
Do you handle Medicare coordination for ESRD patients with employer coverage?
Yes. We confirm which plan is primary during the coordination period and bill in the right order, which avoids denials and later recoupments.
Do you bill care management for CKD patients?
Yes, when your team provides and documents it. We check consent, time and the payer’s rules for the care management codes before billing.
Is nephrology your main specialty?
No. Our core focus is behavioral health, and we bill nephrology and other specialties with the same team, the same promises and CPB-certified billers on the team.
Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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