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NEPHROLOGY BILLING • CKD • ESRD MONTHLY SERVICES • DIALYSIS ROUNDS
We help nephrology practices bill ESRD monthly services count dialysis visits right code CKD stages correctly handle Medicare ESRD rules clear aging renal A/R
Kidney Care Is Ongoing. Your Billing Should Keep Up Every Month.
ESRD monthly capitation services, dialysis visits, CKD office care, hospital rounds and transplant follow-up each follow different rules. SkyLine MB provides nephrology billing services that handle coding review, claims, coordination of benefits, denials and A/R.
LET'S TALK
Get a Free Nephrology Billing Review
Tell us about your nephrology practice and the claims you’d like reviewed.
Please do not include patient names, diagnoses or protected health information.
EVERY MONTH IS COUNTED
90960 • 90966 • N18.6 • Z99.2
Visits, age group, setting and payer order checked together.
NEPHROLOGY BILLING, EXPLAINED
Nephrology billing services — also called nephrology medical billing — manage insurance claims and reimbursement for chronic kidney disease (CKD) care, end-stage renal disease (ESRD) monthly services, dialysis rounding, home dialysis supervision, hospital consultations and kidney transplant follow-up.
Much of nephrology revenue is monthly. ESRD-related services for dialysis patients are reported once per month with codes that depend on the patient’s age and the number of face-to-face visits during the month, while home dialysis patients are billed under separate monthly codes. Partial months, hospitalizations and transfers between physicians change what can be billed.
Coverage adds its own complexity: Medicare ESRD entitlement, waiting periods and the coordination period with employer group health plans decide which payer is primary. SkyLine MB reviews the records that connect visits, coding, payer order and payment.
Reviewed by the SkyLine MB billing & coding team · Last updated October 2026
Every month has a billing checklist
Connecting dialysis visits, patient status, payer order and payment follow-up.
NEPHROLOGY REVENUE SUPPORT
One dialysis patient was seen four times this month. Another was hospitalized for ten days. A third started home dialysis training. A fourth changed from an employer plan to Medicare. Each situation changes the monthly code, the payer or both.
Nephrology billing also covers CKD office visits, hospital rounds and transplant care, where the diagnosis must reflect the CKD stage and related conditions such as hypertension or diabetes with the right combination codes.
SkyLine MB reviews visit logs, dialysis unit schedules, hospital census, eligibility, claims, remittances and denials. With 10 years of medical billing experience, we also flag repeating issues by payer so your team can fix the cause.
Monthly kidney care shouldn’t turn into monthly billing surprises.
SPECIALTY REVENUE CYCLE SERVICES
Nine connected nephrology billing services, from eligibility checks to monthly payment follow-up.
01
Confirm who pays before the month starts.
We check coverage, ESRD Medicare status, secondary plans and coordination periods.
02
Some plans need approvals for kidney care.
We coordinate referrals and authorizations for visits, procedures and selected services.
03
The month should support the monthly code.
We review visit counts, age groups, partial months and CKD diagnoses — see the nephrology code table.
04
Monthly claims, sent on time.
We prepare ESRD monthly, office and hospital claims with the right dates and diagnosis linkage.
05
Find the reason before resubmitting.
We work duplicate-month, payer-order, eligibility and coding denials with corrections or appeals.
06
Small monthly balances add up.
We monitor open claims and report A/R by payer, service type and aging bucket.
07
Primary, secondary and patient balances posted correctly.
We post payments and route balances to the next payer in order.
08
Keep providers billable at every unit and hospital.
We assist with payer enrollment, CAQH updates and adding new providers.
09
Clear statements and clear monthly numbers.
We support statements and reports by dialysis unit, payer and provider.
NEPHROLOGY CODING REFERENCE
ESRD monthly codes depend on age and visit count; CKD claims depend on stage and related conditions.
| CPT / ICD-10-CM | Representative service or condition | Billing consideration |
|---|---|---|
| 90960 | ESRD monthly services, age 20+, 4 or more face-to-face visits | Visit count documented for the month |
| 90961 | ESRD monthly services, age 20+, 2–3 face-to-face visits | Visit count and dates |
| 90962 | ESRD monthly services, age 20+, 1 face-to-face visit | At least one documented visit |
| 90951–90959 | ESRD monthly services for patients under 20, by age and visits | Age band and visit count |
| 90966 | Home dialysis monthly services, age 20+ | Home dialysis status for the full month |
| 90963–90965 | Home dialysis monthly services, under age 20 | Age band and full-month status |
| 90967–90970 | ESRD services, less than a full month, per day | Partial-month reasons and day count |
| 90935 | Hemodialysis with single evaluation | Usually outside the monthly service or for acute care |
| 90937 | Hemodialysis requiring repeated evaluations | Documentation of repeat evaluations |
| 90945 | Dialysis other than hemodialysis, single evaluation | Peritoneal or other dialysis type |
| 99202–99215 | Office or outpatient E/M visits | CKD care, MDM or time |
| 99221–99233 | Hospital inpatient and observation care | Initial vs. subsequent visits |
| N18.1–N18.6 | Chronic kidney disease, stage 1 through ESRD | Stage documented; N18.30–N18.32 for stage 3 |
| I12.0 / I13.x | Hypertensive CKD and heart and CKD | Combination codes presumed by ICD-10-CM guidelines |
| Z99.2 | Dependence on renal dialysis | Reported with ESRD when dialysis is ongoing |
Descriptions are abbreviated. Monthly ESRD codes are reported once per patient per month by the physician managing ESRD care, and visit and setting rules apply. Always check current CPT®, ICD-10-CM guidelines and payer policy. CPT® is a registered trademark of the American Medical Association.
ESRD MONTHLY BILLING RULES
Visits, setting and payer order decide what the month is worth — and who pays it.
For in-center dialysis patients age 20 and older, the monthly code changes with one, two to three, or four or more face-to-face visits.
Each visit should be documented with a date and the provider who saw the patient.
Home dialysis patients are billed under separate monthly codes (90963–90966).
Medicare allows home dialysis monthly assessments by telehealth, with required in-person visits during the first three months and at least every three months after.
Medicare ESRD entitlement usually begins after a waiting period, and for patients with an employer group health plan there is a 30-month coordination period in which that plan pays first.
Getting payer order wrong leads to denials and refunds.
Based on CPT® ESRD service guidelines, the Medicare Claims Processing Manual for ESRD physician services, Medicare Secondary Payer rules and ICD-10-CM guidelines. Commercial payer policies vary.
MODIFIER & SERVICE REPORTING
Nephrology uses fewer procedure modifiers than surgical specialties, but the ones it uses — for hospital roles, telehealth and same-day services — directly affect payment. Each must reflect the documentation and payer rules.
| Modifier | Typical purpose | What requires review |
|---|---|---|
| 25 | Separately identifiable E/M on the same day as another service | Work beyond the other billed service |
| 24 | Unrelated E/M during a postoperative period | Unrelated condition, such as CKD care after access surgery |
| 57 | Decision for major surgery | E/M that resulted in the decision to operate |
| AI | Principal physician of record (Medicare inpatient) | Admitting or attending role |
| 95 | Synchronous telehealth service | Payer telehealth rules and allowed codes |
| 93 | Audio-only telehealth | Payer acceptance and documentation |
| GC | Service performed with a resident under a teaching physician | Teaching physician presence rules |
| KX | Specific coverage requirements met | Only where a payer policy requires it |
NEPHROLOGY PRACTICES WE SUPPORT
We organize billing around the kidney care your practice actually delivers:
Treating stones or other urologic conditions too? See our urology billing services.
COMMON NEPHROLOGY BILLING PROBLEMS
Each one has a different root cause — and a different fix.
The visit tier billed was higher than the visits documented.
Two physicians or two units billed the same patient’s month.
A partial month or inpatient stay changed what could be billed.
Medicare was billed first during an employer plan coordination period.
Claims missed the CKD stage or hypertension combination code.
Monthly secondary and patient balances quietly age.
MONTHLY CLAIM READINESS
A nephrology monthly claim should connect three sets of information:
Practices rounding across several dialysis units benefit from a monthly visit reconciliation before billing. When the same payer keeps denying monthly claims, our denial management services investigate the cause and support eligible corrections or appeals.
ESRD monthly billing tracker
ILLUSTRATIVE
OUR PROCESS
Built around visit logs, dialysis schedules and payer rules.
01
We review providers, dialysis units, hospitals, payers and open A/R.
02
We confirm how visit notes, unit schedules and hospital census reach billing.
03
Visit counts, age bands, home status and partial months are checked before submission.
04
Payments are reconciled, secondary claims sent and denials worked.
05
Monthly reports by dialysis unit, payer, provider and service type.
WHY SKYLINE MB
Structured revenue cycle support for recurring-care specialties.
Visit tiers checked against documented visits.
ESRD entitlement and coordination periods verified.
Stages and combination codes applied correctly.
Office, unit, home and hospital services in one workflow.
Denials and A/R by unit, payer and provider.
NEPHROLOGY BILLING SUPPORT COMPARISON
Many nephrology practices have dedicated billing staff.
The question is whether that team — or a general vendor rather than a dedicated nephrology billing company — has time to reconcile visits across dialysis units, track coordination periods and work every small monthly balance.
| Billing priority | In-house team | General billing provider | SkyLine MB nephrology support |
|---|---|---|---|
| ESRD monthly claims | Visit logs from many units | General coding support | Visit count and age-band review |
| Home dialysis | Separate monthly codes | Varies by expertise | Home status and telehealth rule review |
| Partial months | Easy to miss | Depends on workflow | Hospitalization and transfer review |
| Payer order | MSP rules are complex | May need specialist support | ESRD entitlement and COB checks |
| CKD coding | Stage often omitted | Depends on coder | Stage and combination code review |
| Denials and A/R | Competes with daily work | Depends on agreement | Denial investigation and payer follow-up |
PAYERS, COMPLIANCE & SOFTWARE
Medicare ESRD entitlement generally begins after a waiting period, with earlier entitlement for patients who start home dialysis training. When a patient also has an employer group health plan, that plan is primary during a 30-month coordination period. Medicare Advantage and Medicaid plans set their own referral, authorization and visit rules. Dialysis facility claims are billed separately from the physician’s professional services.
Claims are billed only for services actually performed and documented; questions about visits or diagnoses go back to the treating nephrologist. SkyLine MB follows applicable HIPAA requirements, signs a Business Associate Agreement and uses role-based access.
Works inside your EHR & PM system
Are ESRD monthly or CKD claims coming back denied?
Request a free nephrology billing review. We’ll look at visit counts, payer order, partial months, CKD coding and aged A/R.
SPECIALTY REVENUE REPORTING
Reporting by dialysis unit, payer, provider and service type.
Patients whose month isn't billed yet, and why.
Claims accepted without rejection, and the preventable errors behind the rest.
Share of 1, 2–3 and 4+ visit months by unit and provider.
Denials linked to coordination of benefits and eligibility.
Unpaid claims and aging by insurer, unit and provider.
Collected vs. collectible under payer agreements and adjustments.
NEPHROLOGY BILLING FAQS
Nephrology billing services manage insurance claims for CKD office care, ESRD monthly services, dialysis rounding, home dialysis supervision, hospital consultations and transplant follow-up. They typically include eligibility checks, coding review, claim submission, coordination of benefits, denial management and A/R follow-up.
ESRD-related services for dialysis patients are reported once per month. For in-center patients age 20 and older, CPT 90960 applies with four or more face-to-face visits, 90961 with two or three visits and 90962 with one visit. Separate code ranges apply to younger patients.
Physician services for home dialysis patients are reported monthly with 90963–90966 based on age. Medicare allows these monthly assessments by telehealth, with required face-to-face visits during the first three months of home dialysis and at least once every three consecutive months after that.
When a full month of services isn’t provided, for example because of certain hospitalizations, transplant or a change of physician, the per-day codes 90967–90970 may apply depending on the circumstances and payer rules.
CKD is coded with N18.1–N18.6 by stage, with N18.30–N18.32 for stage 3 subtypes. ICD-10-CM presumes a link between hypertension and CKD, so combination codes such as I12.0 or I13.x are used when both are present. Z99.2 reports dependence on dialysis.
It depends on entitlement and other coverage. When an ESRD patient has an employer group health plan, that plan pays first during a 30-month coordination period, after which Medicare becomes primary. We verify payer order before billing.
Generally only one physician or practice managing the patient’s ESRD care bills the monthly service. When care changes hands mid-month, partial-month rules and coordination between the practices matter.
Inpatient hospital visits and consultations are generally billed with hospital E/M codes, and certain hospitalizations affect how the monthly ESRD service is reported. Rules vary, so each case is reviewed.
Yes. We support pre-transplant evaluations, post-transplant office visits and related diagnosis coding, coordinated with the patient’s coverage.
Yes. We work inside your existing systems wherever possible and confirm how rounding logs and visit notes reach billing during onboarding.
Yes. We review aging monthly claims, correct payer-order and coding issues, and pursue eligible balances within filing and appeal limits.
Pricing depends on provider count, number of dialysis patients and units, claim volume, payers and the scope of support. Contact SkyLine MB for a free consultation and a customized proposal.
RELATED SERVICES
ESRD status and payer order.
Monthly and COB denials.
Visit tiers and CKD coding.
Primary and secondary balances.
Small balances worked monthly.
Nephrologist enrollment.
Related specialties:
GET STARTED
Your nephrologists see dialysis patients every month, follow CKD patients for years and coordinate care across units, hospitals and homes. Your billing process needs that same consistency.
Whether your practice focuses on dialysis rounding, home dialysis, CKD care or transplant follow-up, SkyLine MB can reconcile monthly visits, verify payer order, investigate denials and monitor outstanding reimbursement.
Ongoing care deserves ongoing billing accuracy.
