Billing built for nephrology, not generic medical.
Nephrology billing is different. Monthly Capitation Payments, ESRD bundling, transplant coordination, and vascular access procedures all follow rules that trip up general billers. Our certified coders live in dialysis billing every day. Same 4.99% flat rate. Same dedicated manager who knows what an MCP is.
Nephrology CPT codes we handle every day.
Dialysis MCP visit counting, ESRD bundling, and CKD stage documentation. Our nephrology coders know exactly what documentation supports what code.
MCP, 4+ Visits (ESRD, 20+)
Monthly Capitation Payment for full-month management with 4 or more face-to-face visits. Adult patients.
MCP, 2-3 Visits (ESRD, 20+)
Reduced monthly capitation for 2 to 3 visits. Visit documentation must be date-stamped and clear.
Hemodialysis, Single
Per-session billing for hemodialysis with physician evaluation. Alternative to MCP for irregular schedules.
Peritoneal Dialysis
Per-session PD with physician evaluation. Different documentation requirements from hemodialysis.
Dialysis Circuit Angiography
Diagnostic angiography of AV fistula or graft. Bundling with interventions (36902-36906) is strict.
Kidney Allotransplantation
Donor kidney implantation. Global surgery period 90 days with extensive post-transplant follow-up rules.
Where nephrology billing usually breaks.
Three patterns account for most denials in nephrology. Our specialized coders catch these before submission.
MCP Visit Count
Dialysis MCP claims denied for insufficient visit documentation. 90960 requires 4+ face-to-face visits, and the notes must prove it.
Concurrent Hospital Care
Denials when nephrology bills MCP and hospital services in the same period without proper modifiers.
CKD Stage Mismatch
CKD chronic care management denied when documented stage doesn’t match ICD-10 tier billed (N18.3 vs N18.4).
Each nephrology sub-specialty billed differently. We handle all of them.
Coders matched to your sub-specialty. Dialysis MCP billing looks nothing like transplant care, and pediatric nephrology has its own MCP structure.
Hemodialysis
In-center HD, home HD, and nocturnal. MCP billing for full-month, per-session codes when patient falls outside MCP eligibility.
Peritoneal Dialysis
CAPD, CCPD, and home PD training. Documentation of training visits is critical for full reimbursement.
Kidney Transplant
Pre-transplant evaluation, transplant coordination, post-transplant follow-up. Extensive documentation for coordinated care.
Vascular Access
AV fistula creation, angiography, angioplasty of dialysis circuits. NCCI bundling rules are strict for combined procedures.
CKD Management
Chronic kidney disease stages 3-5 pre-dialysis. E/M billing with CCM overlay for eligible patients.
Pediatric Nephrology
MCP codes stratified by age (90963-90966). Growth measurements and nutritional counseling documentation required.
Nephrology-specific rules we track for you.
Nephrology has more Medicare bundling rules than any other outpatient specialty. ESRD PPS, MCP thresholds, and consolidated billing all change annually. We track every update.
Prospective Payment System changes tracked annually
Medicare ESRD PPS bundle pricing, drug add-on adjustments, and low-volume payment adjustments update every year. We stay current so your facility billing aligns with professional billing.
90960-90966 documentation requirements enforced
MCP codes stratified by age and visit count. Miss the 4-visit threshold for 90960 and the whole month reverts to reduced payment. We track visit counts weekly, not at month-end.
N18.1 to N18.6 stage documentation matched to billing
CCM and E/M billing depend on documented CKD stage. Stage 3 (N18.3) has different reimbursement patterns than Stage 4 (N18.4). We ensure ICD-10 codes match documentation before submission.
Global periods and multi-specialty billing coordinated
Kidney transplant has a 90-day global. Post-transplant follow-up overlaps with immunosuppression management billing. We coordinate to avoid duplicate claims while capturing everything billable.
Full-service nephrology billing.
Everything a nephrology practice needs, from dialysis MCP billing to transplant coordination and vascular access.
MCP Visit Tracking
Weekly visit counts per patient with alerts when documentation is missing.
Dialysis Billing
HD and PD, in-center and home. MCP and per-session codes applied correctly.
Vascular Access Coding
Fistula creation and interventions with NCCI-compliant bundling.
Transplant Coordination
Pre- and post-transplant billing coordinated across multi-specialty teams.
CCM for CKD Patients
Chronic care management captured for eligible stage 3-5 CKD patients.
Dedicated Manager
Same person answers when you have MCP questions or need a denial appealed.
“We’re a six-nephrologist practice with three dialysis units. Our previous biller was reverting most of our MCP claims to 90961 because they weren’t tracking visit counts properly. CureMed fixed it in the first month. Sixty-eight thousand dollars a month back on the books.”
Common questions about nephrology billing.
What is nephrology billing?
Nephrology billing covers claims for kidney care services including hemodialysis Monthly Capitation Payments (MCP), CKD management, peritoneal dialysis, kidney transplant care, and vascular access procedures. It requires knowledge of complex ESRD billing rules and Medicare bundling policies.
What are the most common nephrology CPT codes?
Common nephrology CPT codes include 90960-90970 (dialysis MCP codes), 90935 (single hemodialysis), 90945 (peritoneal dialysis), 36901 (dialysis circuit interventions), 50300 (kidney allotransplantation), and 99490 (chronic care management). ESRD billing uses a mix of monthly capitation and per-visit codes.
Why do nephrology claims get denied?
Top reasons include MCP visit count documentation gaps (35%), missing modifier for concurrent hospital care (24%), and CKD stage documentation not matching billing tier (19%). Dialysis facility versus professional billing overlap is another common denial trigger.
Do you handle dialysis facility billing along with professional?
Yes. We coordinate professional MCP billing with facility ESRD PPS billing to prevent duplicate claims while capturing everything billable. This is especially important when nephrologists own or operate the dialysis unit.
How do you track MCP visit counts?
We build a weekly visit tracker per patient inside your PM system. When a patient is approaching month-end without enough documented visits for 90960, the office manager gets an alert to schedule the additional visit before revenue reverts to 90961.
Ready for billing that actually speaks nephrology?
Send us three months of your MCP claims and denials. We’ll deliver a free nephrology-specific audit within a week showing exactly where your revenue is slipping.