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Nephrology Billing

Nephrology Medical Billing Services

Nephrology billing runs on the monthly capitation payment model for dialysis, a system unlike any other specialty. Our certified coders specialize in nephrology and ESRD so your dialysis and clinic revenue is captured in full.

Get a Free Nephrology Billing Audit

We handle nephrology billing end to end, dialysis MCP billing, ESRD care, home dialysis, and inpatient nephrology. Because dialysis reimbursement uses age-based monthly capitation codes with visit requirements, a specialty-trained team is what prevents the denials and lost revenue unique to the field.

Nephrology billing we handle

  • Dialysis MCP codes. Monthly capitation payment (90957 to 90970) by age and visit count.
  • ESRD management. End-stage renal disease care coded to visit and complexity requirements.
  • Home dialysis. Home and self-care dialysis billing.
  • Inpatient nephrology. Hospital visits and consults with correct E/M.
  • AKI & inpatient dialysis. Hospital and acute dialysis (90935 to 90947) for non-ESRD and acute kidney injury.
  • Kidney transplant management. Transplant evaluation and post-transplant care coding.
  • Renal biopsy & procedures. Kidney biopsy and related procedures where performed.
  • Vascular access & procedures. Access-related procedures where performed.
  • CKD clinic visits. Chronic kidney disease office E/M and management.
The MCP visit rule. Monthly capitation dialysis codes depend on the patient's age and the number of face-to-face visits in the month. Bill the wrong tier for the visit count and the claim is denied or underpaid, a common nephrology error we prevent.

Why nephrology practices lose revenue

The usual losses: wrong MCP code for age/visit count, missed visits affecting the capitation tier, CKD clinic visits under-coded, and inpatient consults billed incorrectly. Nephrology-trained coders apply the dialysis rules correctly.

What you get with PRMS

MCP expertise

Monthly capitation dialysis codes billed to the correct age and visit tier.

ESRD accuracy

End-stage renal care coded to meet visit and complexity requirements.

Full capture

Home dialysis, CKD clinic, and inpatient care all billed.

Nephrology billing FAQs

How is dialysis billed in nephrology?

Outpatient dialysis is billed with monthly capitation payment (MCP) codes (90957 to 90970) that vary by the patient's age and the number of face-to-face visits that month. Correct tier selection is essential to full, compliant payment.

Do you handle home dialysis and ESRD?

Yes, home and self-care dialysis billing and end-stage renal disease management, coded to the applicable visit and complexity requirements.

Can you bill inpatient nephrology consults?

Yes, with correct E/M leveling for hospital visits and consults alongside outpatient dialysis and CKD management.

How soon will results show?

Most nephrology practices see cleaner dialysis MCP claims and fewer tier-related denials within the first one to two billing cycles.

Related services & specialties

Explore our full billing, coding & denial management services and provider credentialing, or see other specialties including 25+ more.