Billing for nephrology groups that round at dialysis units, hospital-based kidney specialists, transplant nephrology programs and interventional nephrology centers.
Nephrology revenue is decided one patient month at a time. A fourth dialysis visit left off the charge turns a 90960 worth $372.75 into a 90961 worth $310.63, and across 120 dialysis patients that is $7,454 a month. Employer plan patients billed to Medicare inside the 30-month coordination period get recouped, and hospital rounds go unbilled. Luxen runs full-service medical billing for nephrology practices inside the EHR you already use, with certified coders and no migration.
On this page
Nephrology billing services code and submit claims for monthly ESRD dialysis care, hospital dialysis and rounds, CKD office visits, kidney disease education and vascular access procedures, then work every denial. Monthly codes drive revenue: Medicare pays $372.75 in 2026 for a dialysis patient 20 or older seen 4 or more times a month.
We bill for nephrology practices of every size. The codes overlap, but where the money leaks depends on the practice type.
Service lines we bill: in-center and home dialysis monthly services, per-day partial months, inpatient and AKI dialysis, office and hospital E/M visits, kidney disease education, telehealth and vascular access procedures.
Nephrology claims repeat every month for the same patients, so one error compounds. Our denial and AR recovery team finds these patterns most often. Dollar figures are 2026 Medicare national payments.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Fourth monthly visit left off the charge | 90960 vs 90961 | Visit documented at the dialysis unit, but only 3 counted | $62.12 per patient month | Monthly dialysis visit counts were miscoded on 8% of capitated claims (Luxen claim audit) |
| Employer plan patient in the first 30 months | 90960 | Medicare billed as primary, then recouped | $372.75 per patient month | ESRD patients still inside the 30-month coordination period were billed to Medicare as primary on 7% of monthly capitation claims, across 4,900 nephrology claims (Luxen claim audit) |
| Hospital rounds never charged | 99232, 99233 | Signed hospital note with no charge in the practice system | $70.48 to $106.88 per visit | Inpatient nephrology visits were entered as charges a median of 9 days after the date of service (Luxen billing reviews) |
| Hospital case billed as an office procedure | 36902 | Place of service 11 used for a hospital outpatient case | $980.65 overpaid and recouped | Coding and modifier errors caused 21% of denials (Luxen claim audit) |
| Education billed for the wrong CKD stage | G0420 with N18.32 | Kidney disease education billed for a patient who is not stage 4 | $113.56 per session | Eligibility and coverage errors caused 24% of denials (Luxen claim audit) |
Monthly ESRD codes pay one amount per patient per month, set by the patient age, the dialysis setting and the number of face-to-face visits. Rates are 2026 Medicare national payments at the $33.4009 conversion factor.
| Code | Setting and visits | Age | 2026 Medicare rate |
|---|---|---|---|
| 90960 | In-center, 4 or more visits a month | 20 and older | $372.75 |
| 90961 | In-center, 2 or 3 visits | 20 and older | $310.63 |
| 90962 | In-center, 1 visit | 20 and older | $215.10 |
| 90966 | Home dialysis, full month | 20 and older | $310.29 |
| 90970 | Less than a full month, per day | 20 and older | $10.02 |
| 90957 | In-center, 4 or more visits | 12 to 19 | $796.95 |
| 90954 | In-center, 4 or more visits | 2 to 11 | $1,034.43 |
| 90951 | In-center, 4 or more visits | Under 2 | $1,183.73 |
Per-day codes 90967 to 90970 cover home patients for less than a full month, transient patients, a permanent change of monthly physician, and visits without a complete assessment before an admission, transplant or death. If the complete assessment was done, bill the full-month code for the visits furnished. Example: a patient 20 or older with a complete assessment and 2 visits before admission on the 16th is billed as 90961 at $310.63. Without the assessment, 15 days of 90970 pay $150.30. If you bill inpatient services separately, the monthly payment is reduced for the hospital days under 42 CFR 414.314.
Home patients are billed on 90963 to 90966 by age. The monthly assessment can be done by telehealth from home, but an in-person assessment is required monthly for the first 3 months of home dialysis and at least once every 3 consecutive months after that, a permanent rule in Social Security Act section 1881(b)(3)(B).
Hospital work is billed per session and per day, not per month, and every visit has to travel from the hospital chart to the practice charge report. Rates are 2026 Medicare national payments.
| Code | What it reports | 2026 Medicare rate |
|---|---|---|
| 90935 | Hemodialysis with a single evaluation | $61.46 |
| 90937 | Hemodialysis with repeated evaluations | $88.51 |
| 90945 | Dialysis other than hemodialysis (peritoneal dialysis, hemofiltration, continuous therapies), single evaluation | $77.16 |
| 99232 | Subsequent hospital or observation visit, moderate | $70.48 |
| 99233 | Subsequent hospital or observation visit, high | $106.88 |
Codes 90935, 90937, 90945 and 90947 include E/M services related to the dialysis and the renal failure. A visit for an unrelated problem that cannot be handled during the session can be reported with modifier 25; the NCCI manual lists 99202 to 99215, 99221 to 99223, 99238 to 99239 and 99291 to 99292 for this (NCCI Policy Manual, Chapter XI). Split rounding only pays when every physician, NP and PA is enrolled with each payer, which our credentialing team tracks.
Since January 1, 2017, ESRD facilities can dialyze patients with acute kidney injury and bill G0491, paid at the same $281.71 base rate as ESRD treatments in 2026. The nephrologist bills separately with the per-session dialysis codes, because an AKI patient does not have ESRD and the monthly codes do not apply.
Dialysis circuit procedures pay very differently in an office-based lab and a hospital: 36901 pays $686.39 in the office and $147.30 in a facility, 36902 pays $1,190.74 and $210.09, and 36905 pays $2,205.13 and $385.78.
G0420 (individual, $113.56) and G0421 (group of 2 to 20, $27.39) cover education for stage 4 CKD only, with a lifetime limit of 6 sessions of at least 31 minutes each. Physicians, PAs, NPs and clinical nurse specialists can furnish it; dialysis facilities cannot.
Diagnosis codes decide whether a monthly ESRD claim, an education session or a transplant visit is paid, so the stage on the claim has to match the stage in the note. Stage 3 CKD has separate 3a and 3b codes, which leaves little reason to send N18.30. Our certified medical coders check every stage code before the claim goes out.
| Code | Meaning | When it applies |
|---|---|---|
| N18.31, N18.32 | CKD stage 3a, stage 3b | Use the documented subtype instead of N18.30 |
| N18.4 | CKD stage 4 (severe) | Required for kidney disease education |
| N18.5 | CKD stage 5 | Stage 5 not documented as ESRD |
| N18.6 | End stage renal disease | Monthly ESRD services |
| Z99.2 | Dependence on renal dialysis | Add for patients on dialysis |
| I12.0, I12.9 | Hypertensive CKD with stage 5 or ESRD; with stage 1 to 4 or unspecified | Hypertension and CKD both documented |
| E11.22 | Type 2 diabetes with diabetic CKD | Pair with the N18 stage code |
| Z94.0 | Kidney transplant status | Transplant patient with CKD and no complication |
ICD-10-CM presumes a causal link between hypertension and kidney involvement, so hypertension with CKD goes to category I12 with an N18 code as a secondary code for the stage (FY2026 ICD-10-CM Official Guidelines, section I.C.9.a.2). Only code them separately when the provider documents that the CKD is not related to the hypertension. When heart disease is also present, use I13: I13.0 with heart failure and stage 1 to 4, I13.10 and I13.11 without heart failure, and I13.2 with heart failure and stage 5 or ESRD.
If a note documents both a CKD stage and ESRD, assign N18.6 only. CKD in a transplant recipient is not a transplant complication by itself: code the N18 stage with Z94.0, and use T86.1x codes such as T86.11 rejection or T86.12 failure only when the provider documents the complication.
Telehealth can cover visits for the 2 to 3 and 4 or more visit codes, but one visit a month must be in person to examine the vascular access site (CMS Transmittal 1456). Cost: the full $372.75 for a 90960 is at risk on review. Coding and modifier errors caused 21% of denials (Luxen claim audit).
With a complete assessment before the admission, bill the age-appropriate monthly code for the visits furnished (CMS Transmittal 1456). Cost: $160.33 per patient month when a 90961 is billed as 15 days of 90970. Monthly dialysis visit counts were miscoded on 8% of capitated claims (Luxen claim audit).
For patients with employer group health coverage, Medicare is secondary for a 30-month coordination period (CMS ESRD coordination of benefits). Cost: every month is recoverable, $11,182.50 for one patient billed 90960 for all 30 months. Eligibility and coverage errors caused 24% of denials (Luxen claim audit).
Dialysis codes include E/M services related to the dialysis and renal failure; modifier 25 is only for an unrelated problem (NCCI Policy Manual, Chapter XI). Cost: $106.88 for each recouped 99233. Resubmitting without the fix adds a second denial: Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting (Luxen claim audit).
A patient with ESRD is coded N18.6, with Z99.2 for dialysis dependence, and if a note lists both a stage and ESRD only N18.6 is assigned (FY2026 ICD-10-CM Official Guidelines, section I.C.14.a). Cost: a monthly ESRD claim that does not report ESRD puts $372.75 at risk of a medical necessity denial. The top three denial reasons accounted for 58% of denied dollars in the average practice (Luxen billing reviews).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Nephrology billing depends on records spread across the office, the dialysis unit and the hospital. We work inside the systems you already run, with no migration:
Each month we match every patient on the dialysis unit census to a signed visit count before the 90951 to 90970 charges go out.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen claim audit (61,400 claims audited, Jan 2025 to Jun 2026), Luxen billing reviews (410 practice billing reviews, Jan 2025 to Jun 2026) and Luxen client data (38 client practices, Jan 2024 to Jun 2026):
Dialysis treatment logs and monthly billing records lived in separate systems. Luxen reconciled every patient month, identified 96 incomplete billing cycles, and recovered $84,200 during the first quarter.
Practice Administrator, nephrology and dialysis group
Inpatient rounds were documented at the hospital, but some encounters never reached our office charge report. Luxen matched the census to signed notes and captured 121 missed visits worth $46,600.
Billing Director, hospital-based nephrology practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Coverage order decides who pays a nephrology claim before any code is checked. Our eligibility team checks these rules before the first monthly claim.
Medicare based on ESRD usually starts the first day of the fourth month of dialysis, or the first month when the patient enters a home dialysis training program in the first 3 months. Form CMS-2728 is the primary evidence of ESRD. Coverage ends 12 months after dialysis stops or 36 months after a kidney transplant.
For patients with employer group health coverage, the group plan pays first and Medicare second for 30 months, regardless of employer size (CMS ESRD coordination of benefits). In Marietta Memorial Hospital v. DaVita (2022), the Supreme Court held that a plan can limit outpatient dialysis coverage when the terms apply uniformly to all members, so plan terms need checking too.
People with ESRD have been able to join Medicare Advantage plans since January 1, 2021, which adds plan-level authorization and contract rules to monthly billing. Since January 1, 2023, qualifying patients whose ESRD Medicare ends 36 months after a transplant can keep Part B coverage for immunosuppressive drugs, at a standard premium of $121.60 a month in 2026. Our patient billing team handles the coinsurance statements that follow.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month with 30 days notice, and no setup or exit fee. Example: a nephrology group collecting $150,000 a month.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% | In-house at 7.9% |
|---|---|---|---|---|
| Monthly ESRD dialysis services | $60,000 | $1,800 | $3,600 | $4,740 |
| Hospital rounds and inpatient dialysis | $36,000 | $1,080 | $2,160 | $2,844 |
| Office visits and kidney disease education | $39,000 | $1,170 | $2,340 | $3,081 |
| Vascular access procedures | $15,000 | $450 | $900 | $1,185 |
| Total | $150,000 | $4,500 | $9,000 | $11,850 |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews). That is $142,200 a year here, against $54,000 to $108,000 with Luxen. Your rate within the range depends on dialysis census, hospital volume and payer mix. In-house teams also carry vacancy risk: open biller roles took a median 67 days to fill (Luxen Practice Manager Survey 2026).
Most nephrology billing losses come from monthly visit counts, coverage order and hospital charge capture, so test any partner on those first.
That last question matters: 44% could not name the fee basis in their current billing contract, and 52% of practices that switched billing vendors cited missing denial reporting as the main reason (Luxen Practice Manager Survey 2026). To see how options stack up, compare medical billing companies.
| Partner type | Monthly ESRD code accuracy | Hospital charge capture | Cost basis | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Relies on notes reaching the office | Salaries, benefits and software | Employment |
| Generalist billing company | Broad, rarely nephrology specific | Varies | Percentage of collections | Varies |
| Specialty billing company | Strong on specialty codes | Usually dedicated | Percentage of collections | Varies |
| EHR vendor RCM | Tied to the software | Varies | Percentage plus software fees | Tied to the EHR contract |
| Luxen | Certified coders who match visits to the census monthly | Hospital census checked against signed notes | 3% to 6% of collections | Month to month, 30 days notice |
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
The nephrologist bills one monthly ESRD code per outpatient dialysis patient: 90951 to 90962 for in-center patients by age and visits, 90963 to 90966 for home patients, and 90967 to 90970 per day for partial months. Hospital dialysis is billed per session with 90935, 90937, 90945 or 90947. The dialysis facility bills separately under the ESRD prospective payment system, at a 2026 base rate of $281.71 per treatment.
Luxen charges 3% to 6% of collections, month to month with no setup or exit fee. For a nephrology group collecting $150,000 a month, that is $4,500 to $9,000 a month. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews), which would be $11,850 a month at that size.
About 2 weeks from signed BAA to working claims, and first recovered payments arrive in about 3 weeks. The BAA is signed before we access any patient data. We start with the oldest open monthly ESRD claims and unbilled hospital rounds, then move the current month onto a census-matched monthly close.
Yes. We work inside Acumen nEHR, Falcon EHR, Epic, Oracle Health, athenaOne, eClinicalWorks and NextGen, with no migration. Each month we match the dialysis unit census to signed visits before the 90960, 90961 and 90962 charges go out.
If a complete assessment was furnished before the admission, CMS instructs billing the age-appropriate monthly code for the visits furnished, such as 90961 at $310.63 for 2 or 3 visits. Without it, bill the per-day code for the days outside the hospital, such as 15 days of 90970 at $10.02 a day. When inpatient services are billed separately, 42 CFR 414.314 reduces the monthly payment for the hospital days.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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