Nephrology Medical Billing Services That Get MCP, Dialysis, and CKD Claims Paid the First Time
Nephrology medical billing covers every claim a kidney practice files: monthly ESRD capitation (CPT 90951 to 90970), dialysis procedures, CKD office visits, kidney biopsies, access work, and transplant follow up. Medicotech runs that full cycle for nephrology groups in all 50 states. Our CPC certified coders count your MCP visits, confirm which payer comes first, and chase every denial, so your physicians collect for the care they already delivered.
What is nephrology medical billing?
Nephrology medical billing is the process of turning kidney care into paid claims. It spans eligibility checks, ICD-10 and CPT coding, claim submission, payment posting, denial appeals, and patient statements for services such as CKD management, in center hemodialysis, home dialysis, acute kidney injury treatment, and transplant care. Two things set it apart from general physician billing. Medicare pays most dialysis related physician work through one monthly capitation payment, and most ESRD patients carry Medicare plus a second payer.
The patient base keeps growing. CDC’s March 2026 kidney disease fact sheet estimates that 14 percent of US adults (about 37 million people) have CKD, and roughly 831,000 Americans live with end stage kidney disease. About two thirds of them dialyze. For your practice, that means more monthly capitation claims, more coordination of benefits questions, and more room for small errors to compound.
Nephrology is one specialty inside our broader medical billing services for US practices, and it’s one of the most rule heavy.
Why do payers deny nephrology claims more often than other specialties?
Nephrology claims fail for reasons that rarely touch other specialties: miscounted MCP visits, Medicare secondary payer mistakes, unspecified CKD staging, and services that payers treat as part of the monthly capitation or the dialysis facility's bundle. Sound familiar? Here's what we find in almost every nephrology audit.
Visit Count Mismatch
The claim says 90960, but the clinical notes only support three visits, causing immediate audit flags and claim reconciliation errors.
Wrong Primary Payer
During the 30-month coordination period, the group health plan pays first. Send the claim to Medicare first and you'll trigger CO-22 denials.
Unspecified Codes
Reporting N18.9 or N18.30 when the GFR in the note clearly supports N18.32 leads to rapid rejections from commercial payers and Medicare Advantage.
Missing Dialysis Status
Submitting N18.6 without the accompanying Z99.2 status code on a patient who dialyzes three times a week causes automated rejections.
Overlapping Claims
Submitting separate claims for routine work that the monthly capitation payment (MCP) already covers invariably results in payer CO-97 denials.
Reconciliation Gaps
Failing to reconcile inpatient dialysis days against the monthly billing claim leads to uncaptured revenue or severe overpayment clawbacks.
Blame the workflow. Your nephrologists round at three or four dialysis units, a nurse practitioner covers some of the visits, and the visit log lives in a different system than the billing software. By the last day of the month, nobody holds one clean count. What does that cost? Here’s a quick illustration. MGMA has long estimated about 25 dollars of staff time to rework one denied claim. If your group files 900 claims a month and 15 percent bounce, that’s 135 reworks and roughly 3,375 dollars in labor every month, before you count the claims nobody appeals. Undercoded MCP months never appear as denials at all. They just pay less
Miscounted MCP visits and payer order mistakes drain nephrology revenue every month, and most of that loss never shows up on a denial report.
How does the ESRD Monthly Capitation Payment (MCP) work in 2026?
Medicare pays the nephrologist who manages a dialysis patient one monthly amount for ESRD related physician services. For in center patients, the code depends on the patient’s age and the number of face to face visits that month. For home dialysis patients, the code depends on age alone. ESRD monthly capitation codes at a glance (CPT 2026)
| CPT Code | Patient Age | Setting & What Drives the Code |
|---|---|---|
| 90951, 90952, 90953 | Under 2 | In center, full month; driven by 4 or more visits, 2 to 3 visits, or 1 visit |
| 90954, 90955, 90956 | 2 to 11 | In center, full month; driven by 4 or more visits, 2 to 3 visits, or 1 visit |
| 90957, 90958, 90959 | 12 to 19 | In center, full month; driven by 4 or more visits, 2 to 3 visits, or 1 visit |
| 90960 | 20 and older | In center, full month; driven by 4 or more face to face visits |
| 90961 | 20 and older | In center, full month; driven by 2 to 3 face to face visits |
| 90962 | 20 and older | In center, full month; driven by 1 face to face visit |
| 90963 to 90966 | By age band (90966 is 20 and older) | Home dialysis, full month; age only, with at least one face to face visit |
| 90967 to 90970 | By age band (90970 is 20 and older) | Any setting, partial month; one unit per day under your care |
Five rules decide whether these claims pay.
- Medicare allows one MCP code per patient per calendar month, no matter how many physicians share the care.
- The physician or practitioner who performs the complete assessment and sets the plan of care files the claim. Visits by partner physicians, nurse practitioners, and PAs count toward the monthly total.
- Most MACs want dates of service that span the full calendar month. First Coast, for one, rejects a 90966 claim that lists only the last day of the month.
- Home dialysis still needs at least one face to face visit each month, and your notes must show it.
- Partial months call for the per day codes. Think of a transient patient, a transplant on the 12th, or a home patient who enters the hospital. Seven days under your care equals seven units of 90970.
Picture a four physician group in Tampa that rounds at three dialysis units. The managing nephrologist sees a patient twice in March. A partner covers one Tuesday, and the NP covers another. The biller only finds the managing physician’s two notes, so the claim goes out as 90961. The chart supports 90960. Repeat that across 40 patient months a year and you’ve found real money. AAPC’s walkthrough of pro fee MCP coding covers more edge cases if your coders want a second reference.
Outsource Nephrology Medical Billing & Credentialing to Medicotech
We handle the full cycle for nephrology practices, from the eligibility check before the first visit to the last dollar of patient balance. Hand us everything, or only the pieces that hurt most.
Eligibility & Benefits
Our team checks eligibility and benefits before every visit and again at the start of each dialysis month, tracking Medicare entitlement and 30-month coordination periods.
Nephrology Coding & Charge Capture
Our certified medical coding team codes every encounter to the highest specificity, including CKD stages, diabetic combinations, and checking when the G2211 add on code applies.
Claims & Payment Posting
We submit professional CMS-1500 claims electronically, post ERAs and EOBs as they arrive, compare every payment against contracted rates, and rework underpayments promptly.
Denial Management & Appeals
Our denial management services tackle CO-97, CO-22, CO-50, CO-16, and CO-29 denials, attaching clinical notes and feeding patterns back to your front desk and coders.
A/R Follow Up & Reporting
We work aging claims starting past 30 days and deliver comprehensive KPI reports showing denial rates, days in A/R, and net collection rates broken out by payer and physician.
Credentialing & Payer Enrollment
We manage credentialing for new nephrologists, including Medicare PECOS enrollment, CAQH upkeep, commercial applications, and hospital privileging paperwork.
Full Cycle RCM & Internal Medicine Support
Our full cycle revenue management covers every step under a single agreement. We also support hospital patients through how we bill for internal medicine groups.
Which nephrology CPT, HCPCS, and ICD-10 codes matter most?
A short list of codes drives most nephrology revenue: the MCP series, dialysis procedure codes, E/M visits, a handful of procedures, and the N17 to N18 diagnosis family. Here’s our working reference, checked against CPT 2026 and the ICD-10-CM code set in effect through September 30, 2026.
Common nephrology CPT and HCPCS codes
| Code | What It Covers | Billing Note |
|---|---|---|
| 99202 to 99215 | Office visits for CKD, hypertension, and electrolyte disorders | Select the level by medical decision making or total time. Check G2211 for ongoing CKD care. |
| 99221 to 99233 | Hospital inpatient and observation care | Common for AKI consults and admitted dialysis patients. |
| 90935 | Hemodialysis with one physician evaluation | Inpatient and AKI encounters. Routine outpatient ESRD months belong under the MCP. |
| 90937 | Hemodialysis with repeated evaluations | The note must explain why the patient needed more than one evaluation. |
| 90945, 90947 | Dialysis other than hemodialysis (peritoneal, CRRT), single or repeated evaluation | Same logic as 90935 and 90937. |
| 90951 to 90970 | ESRD monthly and per day services | See the MCP table above. |
| 90989, 90993 | Dialysis training, completed course or per session | Report apart from the monthly MCP code. |
| 50200 | Percutaneous renal biopsy | Report imaging guidance separately when you perform and document it. |
| 36556, 36558 | Central venous catheter placement, temporary or tunneled, age 5 and older | Confirm the catheter type in the procedure note. |
| 36901 to 36909 | Dialysis circuit angiography, angioplasty, stent, and thrombectomy | Choose one base code per session (36901 to 36906). The family follows a hierarchy. |
| 93990 | Duplex scan of hemodialysis access | Requires an order and a separate interpretation. |
| 76770, 76775 | Retroperitoneal ultrasound, complete or limited | A complete study must document every required element. |
| G0420, G0421 | Kidney disease education, individual or group | Stage 4 CKD, physician referral, six sessions per lifetime. |
| G0491, G0492 | AKI dialysis in an ESRD facility or at home | Facility codes. The nephrologist bills professional services separately. |
Common nephrology ICD-10-CM codes
| Code | Diagnosis | Coding Note |
|---|---|---|
| N18.1 to N18.5 | CKD stages 1 through 5 | Stage 3 splits into N18.30, N18.31 (3a), and N18.32 (3b). Code from the documented GFR. |
| N18.6 | End stage renal disease | Add Z99.2 when the patient dialyzes. |
| N18.9 | CKD, unspecified | Avoid it whenever the note documents a stage. |
| N17.0 to N17.9 | Acute kidney failure | N17.9 is the unspecified option. AKI never pairs with MCP codes. |
| I12.0, I12.9 | Hypertensive chronic kidney disease | ICD-10 presumes the link. Add the N18 stage code. |
| I13.0 to I13.2 | Hypertensive heart and chronic kidney disease | Add codes for the heart failure type and the CKD stage. |
| E11.22 | Type 2 diabetes with diabetic CKD | Add the N18 stage code. |
| D63.1 | Anemia in chronic kidney disease | Sequence the CKD code first. |
| N25.81 | Secondary hyperparathyroidism of renal origin | Supports PTH labs and related treatment. |
| E87.1, E87.5 | Hyponatremia and hyperkalemia | Frequent reasons for inpatient nephrology consults. |
| Z99.2 | Dependence on renal dialysis | Status code. Never the primary diagnosis on an MCP claim. |
| Z94.0 | Kidney transplant status | Use T86.10 to T86.19 when a complication exists. |
| Z91.15 | Noncompliance with renal dialysis | Explains missed treatments and supports medical necessity for extra care. |
One date to circle. The FY 2027 ICD-10-CM set takes effect on October 1, 2026, with 190 new, 30 deleted, and 4 revised codes across all chapters, according to CMS’s ICD-10 code files. We update your templates and superbills before the first October claim leaves.
How do we bill ESRD, home dialysis, AKI, and transplant care differently?
Each care setting follows its own code set and its own trap. This comparison shows the professional side of the claim, which is the side your nephrologists own. Nephrology billing by care scenario
| Scenario | Physician Codes | The Rule That Trips Practices Up |
|---|---|---|
| In center ESRD, full month | 90960, 90961, 90962 (adults) | The visit count on the claim must match the chart. One MCP per patient per month. |
| Home dialysis, full month | 90963 to 90966 | One face to face visit every month. Medicare allows telehealth for some monthly assessments, but it requires in person visits monthly for the first three months and then at least once every three months. |
| Partial month | 90967 to 90970 | Units equal the days under your outpatient care. |
| AKI dialysis | 90935, 90937, or E/M by site of service | No MCP codes. The facility reports G0491 or G0492 at the ESRD PPS base rate ($281.71 in 2026). |
| Inpatient dialysis | 90935, 90937, 90945, 90947 | The dialysis code includes the related evaluation that day. A separate E/M needs a distinct problem and modifier 25. |
| Transplant follow up | E/M with Z94.0, plus T86 codes for complications | MCP billing stops at transplant. Per day codes cover the days before surgery that month. |
Common nephrology ICD-10-CM codes
ESRD PPS Base Rate
CMS raised the base rate to $281.71 per treatment on January 1, 2026, up $7.89 from $273.82, per the CY 2026 ESRD PPS final rule fact sheet. The AKI dialysis rate matches it.
ETC Model Termination
CMS used the same rule to terminate the ESRD Treatment Choices Model. If your group sat in an ETC region, check that your 2026 remits no longer carry those adjustments.
Two Conversion Factors
The CY 2026 Physician Fee Schedule final rule set $33.57 for qualifying APM participants and $33.40 for everyone else, both up from $32.35. Nephrologists who qualify through an advanced APM such as Kidney Care Choices receive the higher factor.
Efficiency Adjustment
CMS cut work RVUs by 2.5 percent for services that aren't time-based. That trims procedures such as renal biopsy and catheter placement. CMS exempted time-based codes and services on the Medicare telehealth list.
ICD-10-CM FY 2027
New diagnosis codes apply to every encounter on or after October 1, 2026. Ensure your coding team and EHR templates are updated to reflect the latest specificity requirements.
Looking ahead, CMS has proposed a CY 2027 ESRD PPS base rate of 299.55 dollars, which includes 15.96 dollars to fold phosphate binders into the bundle. CMS usually finalizes that rule in November. We’ll update this page when it does.
In house or outsourced nephrology billing: which fits your practice?
In house billing works when you employ two or more experienced nephrology billers and a backup plan. One biller plus hope doesn’t count. If your group manages more than 100 dialysis patients a month, this comparison applies to you more than most.
In house versus outsourced nephrology billing
| Factor | In House Team | Medicotech |
|---|---|---|
| Cost structure | Salaries, benefits, software, clearinghouse fees, and training | A percentage of collections. No setup fees. |
| MCP visit reconciliation | Often one person's spreadsheet | Monthly reconciliation across every dialysis unit before claims go out |
| Coverage when a biller leaves | Claims stall while you hire and train | A team covers your account, so work continues |
| Coding and rule updates | Staff learn on their own time | CPC certified coders apply CPT, ICD-10, and CMS changes on the effective date |
| Reporting | Whatever your PM system exports | KPI reports by payer and physician: denial rate, days in A/R, net collection rate |
| Control | Full | You keep your EHR, your fee schedule, and your bank account |
How does onboarding work for nephrology medical billing solutions?
Onboarding runs in five steps, and you keep billing through your current process until the go live date.
A billing specialist reviews your last 90 days of claims, denials, and MCP months, then walks you through the findings.
We sign a business associate agreement, and you grant role based access to your EHR and clearinghouse.
We file EDI and ERA enrollments and confirm each provider's credentialing status with every payer.
We map your dialysis units, build the monthly MCP reconciliation sheet, and load your fee schedules.
We start filing claims, work the agreed share of old A/R, and send your first KPI report.
Do our nephrology billing solutions work with your EHR ?
Yes. We work inside your existing EHR and practice management system. No forced migration. No disruption to the way your physicians chart.
Systems our billers work in include Epic, Oracle Health (Cerner), Meditech, athenahealth, eClinicalWorks, NextGen, AdvancedMD, Kareo (Tebra), DrChrono, Practice Fusion, Greenway Health, and Modernizing Medicine. Running a nephrology specific platform? Tell us which one during your audit and we’ll confirm access and workflow before you commit to anything.
How much do nephrology billing services cost?
We charge a percentage of your monthly collections, typically 4 to 8 percent depending on claim volume, payer mix, and the services you hand us. No setup fees. No long term contract. We earn our fee only after payers pay you, so our revenue rises only when yours does.
Every engagement starts with a free audit of your last 90 days of claims. You see the gaps before you decide anything.
Every month of undercounted visits and unworked denials represents revenue your nephrologists already earned. Medicotech's nephrology medical billing services pair CPC certified coders with a 96 percent clean claim rate
Frequently Asked Questions
What does a nephrology billing company do?
A nephrology billing company manages the revenue cycle for kidney care practices. It verifies eligibility, codes CKD visits and dialysis services, files monthly capitation claims, posts payments, appeals denials, and sends patient statements. Medicotech also reconciles MCP visit counts across every dialysis unit your physicians cover and tracks Medicare secondary payer status, two tasks that general billing companies often skip.
Which CPT codes do nephrologists use for monthly dialysis care?
Nephrologists report ESRD monthly capitation with CPT 90951 to 90970. For adults who dialyze in center, 90960 covers four or more face to face visits in the month, 90961 covers two to three, and 90962 covers one. Home dialysis patients aged 20 and older fall under 90966 for a full month. Partial months use the per day codes, 90967 to 90970, with one unit per day.
Can a nephrologist bill an office visit in the same month as an MCP code?
Yes, when the visit addresses a problem unrelated to ESRD and dialysis. The MCP covers routine dialysis related management, so a separate E/M claim for that work draws a CO-97 denial. A visit for an unrelated condition can stand on its own with a distinct diagnosis and clear documentation. We review these claims one by one before they go out, because payers audit them closely.
How do you bill dialysis for acute kidney injury patients?
AKI patients don’t have ESRD, so the MCP codes never apply. The nephrologist bills each encounter, usually with 90935, 90937, or an E/M code that fits the site of service, plus an N17 diagnosis. The dialysis facility reports G0491 or G0492, and Medicare pays it the ESRD PPS base rate, which is 281.71 dollars per treatment in 2026. Your documentation must show that the kidney failure is acute.
What is the 30 month coordination period for ESRD patients?
The 30 month coordination period is the window when a patient’s employer group health plan pays first and Medicare pays second, even though the patient qualifies for Medicare because of ESRD. The clock starts with Medicare eligibility, whether or not the patient has enrolled. Bill Medicare as primary during that window and the claim denies, typically with CO-22. We track the start and end date for every ESRD patient on your panel.
How do you bill home dialysis when a patient spends part of the month in the hospital?
Switch from the full month code to the per day codes. If an adult home dialysis patient spends seven days under your outpatient care and the rest of the month admitted, you report seven units of 90970 for those days. Inpatient dialysis work during the stay goes out separately under 90935, 90937, 90945, or 90947. We build this split into the monthly reconciliation so it doesn’t depend on anyone’s memory.
Does Medicare pay for kidney disease education?
Yes. Medicare Part B covers up to six kidney disease education sessions in a patient’s lifetime for people with stage 4 CKD, when the physician managing the kidney condition refers them. Report G0420 for an individual session and G0421 for a group session. Each session runs about an hour. Many nephrology practices deliver this teaching and never bill it, which leaves legitimate revenue on the table.
Which denial codes hit nephrology practices most often?
Five codes show up again and again: CO-97 (the payer considers the service part of the MCP or another bundle), CO-22 (another payer should pay first), CO-50 (medical necessity, common on labs and injections), CO-16 (missing or invalid claim information), and CO-29 (timely filing). Each one traces back to a fixable workflow gap. We log every denial by code and payer so patterns surface within a month.
How much do nephrology billing services cost?
Medicotech charges a percentage of your monthly collections, typically 4 to 8 percent depending on claim volume, payer mix, and scope. We charge no setup fees and don’t require a long term contract. We earn our fee only after payers pay you. Every engagement starts with a free audit of your last 90 days of claims, so you see real numbers before you sign anything.
How long does it take to switch nephrology billing companies?
Plan for a few weeks, and most of that time belongs to the payers. EDI and ERA enrollments need payer approval before we can submit claims and receive remittances on your behalf. While those applications process, we build your MCP reconciliation sheet, load fee schedules, and map your dialysis units. Your old A/R stays covered. We agree in writing who works the claims your previous team filed before the go live date.
Is Medicotech HIPAA compliant, and do you work in our EHR?
Yes to both. Medicotech is HIPAA compliant and signs a business associate agreement before anyone touches your data. We work inside your current EHR and practice management system, including Epic, athenahealth, eClinicalWorks, NextGen, AdvancedMD, and Kareo (Tebra), with role based access that you control. You keep your software, your data, and your bank account. We never ask you to migrate.