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Nephrology billing

Nephrology Billing Services

Monthly ESRD capitation, dialysis access procedures and hospital rounding make nephrology billing uniquely complex. Specialist billers keep every patient-month paid.

  • ESRD monthly services billed by age and visit count
  • Dialysis access and vascular procedures coded correctly
  • Hospital, dialysis unit and office charges reconciled

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97%
Clean-claim rate target
100%
ESRD patient-months reconciled
< 35
Days in A/R goal
Overview

What makes nephrology billing complex

Nephrologists caring for patients on dialysis bill monthly ESRD-related services instead of individual visits. The code depends on the patient’s age and the number of face-to-face visits in the month, with special rules for partial months, home dialysis patients and transient patients.

Practices also round in hospitals, see CKD patients in clinics, and in many cases perform dialysis access interventions, angioplasty, stenting and thrombectomy of the dialysis circuit, that are coded with bundled code families introduced in recent years. Each care setting generates different claims.

Because ESRD patients usually have Medicare as primary after the coordination period, often with Medicaid or a commercial secondary, billing teams must manage coordination of benefits closely. A nephrology billing partner reconciles dialysis-unit census with billed patient-months and catches every missing charge.

Why it's hard

Common nephrology billing challenges

01

Monthly ESRD code selection

Codes 90951–90962 depend on age and documented visits per month.

02

Partial months and transfers

Hospitalizations, transfers and deaths require daily-rate codes instead of monthly codes.

03

ESRD coordination of benefits

The 30-month coordination period changes who pays primary for commercially insured patients.

04

Dialysis circuit procedures

Bundled codes 36901–36909 replaced older combinations and are often coded incorrectly.

05

Multi-site charge capture

Rounds at dialysis units, hospitals and clinics create charges that are easy to miss.

06

Transplant and CKD care

Pre-transplant evaluations and CKD education services have specific billing rules.

What's included

What a nephrology billing partner should handle

  • Monthly dialysis census reconciliation
  • ESRD monthly and daily service coding
  • Home dialysis and transient patient billing
  • Dialysis access intervention coding
  • Hospital and inpatient rounding charge capture
  • Coordination of benefits for ESRD patients
  • CKD education and care management billing
  • Denial management and appeals
  • Patient statements and secondary claims
  • Monthly nephrology KPI reports
Coding focus

Key codes in nephrology billing

Code(s)What it covers
90951–90962ESRD-related services per full month, by patient age and number of visits.
90963–90966ESRD services for home dialysis patients per full month, by age.
90967–90970ESRD services for less than a full month, billed per day.
90935 / 90937Hemodialysis procedure with single / repeated evaluation.
36901–36909Dialysis circuit interventions including angiography, angioplasty, stenting and thrombectomy.
G0420 / G0421Kidney disease education, individual and group sessions.

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Visit documentation each month

Monthly ESRD codes require documented face-to-face visits. Keep a visit log per patient per month and make sure at least one visit is a complete assessment, so the code billed matches the visits provided.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven nephrology experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their nephrology experience.

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5.0 5 reviews

Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
No reviews yet

GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
Pricing

How much does nephrology billing cost?

Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.

Percentage of collections
4% - 7%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Nephrology billing FAQs

With ESRD-related service codes 90951–90962 once per month, chosen by patient age and the number of face-to-face visits documented that month.

If a full month of services was not provided, daily codes 90967–90970 are used for the days the patient received outpatient ESRD services.

For patients with employer group health plans, the plan pays primary during a 30-month coordination period, after which Medicare becomes primary.

Yes, using bundled dialysis circuit codes 36901–36909 and related codes based on documented interventions.

Yes. Monthly census lists are compared to billed patient-months to make sure no patient is missed.

Usually 4% to 7% of collections.

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