Monthly Capitation Code Selection
ESRD monthly capitation codes (90960-90962) depend on the number of face-to-face evaluations per month (4+, 2-3, or 1). Selecting the wrong tier directly reduces reimbursement by $50 to $150 per patient per month.
Nephrology Billing Experts
Nephrology Medical Billing Services
Billing support for nephrology practices handling dialysis billing, monthly capitation codes, and transplant follow-up management.
180+
Nephrology Practices
98.0%
Clean Claim Rate
$4.1M
Revenue Recovered
Monthly
Cycle Billing
Overview
The Monthly Billing Cycle of Nephrology
Nephrology billing follows a monthly cycle that differs from every other specialty. Dialysis patients are billed using monthly capitation codes based on the number of face-to-face evaluations. ESRD-related services bundle differently than acute kidney injury management. And the transition between pre-dialysis CKD management and active dialysis changes the entire billing framework.
We build nephrology billing workflows around these monthly cycles. From MCP code selection to dialysis access procedure billing, our team handles the specialty-specific rules that general billers consistently get wrong.
Challenges
Common Nephrology billing Challenges We Solve
Every Nephrology billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
Dialysis Modality Billing Differences
Hemodialysis, peritoneal dialysis, and home dialysis each have distinct billing codes, training codes, and monthly management expectations. Practices managing multiple modalities need billing systems that handle each correctly.
CKD to ESRD Transition Billing
When a patient transitions from CKD management (standard E/M) to ESRD dialysis (monthly capitation), the billing framework changes completely. The transition month requires careful coding to avoid underbilling or overbilling.
Dialysis Access Procedure Coding
Fistula creation, graft placement, catheter insertion, and access revision each have CPT codes with specific documentation requirements. Bundling rules for access procedures performed alongside dialysis sessions add complexity.
Services
Complete Nephrology billing Services
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
ESRD monthly capitation billing (90960-90970)
Hemodialysis, peritoneal, and home dialysis billing
CKD stage-based management and transition coding
Dialysis access procedure coding and bundling compliance
Transplant pre-evaluation and post-transplant management billing
Medicare ESRD program compliance and reporting
Coverage
Serving Nephrology billing Teams Nationwide
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
Guide
The Complete Guide to Nephrology billing
Nephrology billing follows a monthly cycle that differs from every other specialty. Dialysis patients are billed using monthly capitation codes based on the number of face-to-face evaluations. ESRD-related services bundle differently than acute kidney injury management. And the transition between pre-dialysis CKD management and active dialysis changes the entire billing framework.
We build nephrology billing workflows around these monthly cycles. From MCP code selection to dialysis access procedure billing, our team handles the specialty-specific rules that general billers consistently get wrong.
Common Questions
Frequently Asked Questions About Nephrology billing
Answers to the questions practice owners and managers ask most often before switching billing partners.
How does monthly capitation billing work for dialysis patients?
Nephrologists bill a single monthly code based on face-to-face evaluations: 90960 (4+ visits), 90961 (2-3 visits), and 90962 (1 visit). The code covers all dialysis-related E/M services for that month. We track visit counts and select the highest justified tier to maximize reimbursement.
What is the difference between billing for hemodialysis and peritoneal dialysis?
Hemodialysis uses the standard MCP codes (90960-90962) with separate billing for in-center dialysis procedures. Peritoneal dialysis uses the same MCP codes but includes home dialysis training codes (90989, 90993) during the initial setup period. We manage both modalities under one workflow.
How do you handle the CKD to ESRD billing transition?
During the transition month, we bill standard E/M codes for CKD management until dialysis begins, then switch to the monthly capitation code. If the patient starts dialysis mid-month, we prorate accordingly using the appropriate codes to capture both pre-dialysis and dialysis management.
Can you bill for dialysis access procedures?
Yes. We code fistula creation (36818-36821), graft placement (36825-36830), and catheter procedures (36555-36569) with proper documentation of the access type, location, and any complications. We also manage the post-procedure global period billing restrictions.
What Medicare rules apply to nephrology ESRD billing?
Medicare is the primary payer for most ESRD patients after a 90-day coordination period. We manage the Medicare Secondary Payer rules during the first 30 months of ESRD, track the transition to Medicare primary status, and ensure claims are submitted to the correct payer throughout.
Do you handle transplant nephrology billing?
Yes. Pre-transplant evaluation billing, post-transplant management codes (90951-90970 during the transition), and long-term immunosuppression monitoring visits all follow specific coding rules. We coordinate with transplant centers to ensure complete billing coverage.
Comparison
How We Compare for Nephrology billing
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
Criteria
My Medical Bill Solution
Typical Provider
Specialty-specific billing workflows
Included
Often generic
Dedicated account ownership
Yes
Shared queue
Denial root-cause reporting
Weekly
Ad hoc
Claim submission speed
Within 24 hours
Varies
Communication cadence
Planned check-ins
Reactive only
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