Nephrology billing for practices and groups: chronic kidney disease visits, monthly services for patients on in-center and home dialysis, hospital dialysis and visits, kidney disease education, and dialysis access procedures, worked inside the software you already use.
A nephrology practice is paid differently for each kind of patient. Kidney disease visits are coded from the decision making or time in the note, patients on dialysis are billed once a month by age and visit count, hospital dialysis is billed by the day, and Medicare’s kidney failure rules decide which plan pays first.
$212M
in improper Medicare payments to nephrology in CMS’s 2025 review, a 16.6% improper payment rate
22.8%
improper payment rate for 90960, the monthly dialysis code for adults seen four or more times, one of two costly physician services CMS flagged above 20%
Much of a nephrologist’s work is for patients on dialysis, and their care is billed as one service a month rather than visit by visit. The code depends on the patient’s age, where they dialyze and how many times they were seen that month, so a missed visit, a hospital stay or a transplant changes what can be billed. Patients with kidney disease who are not on dialysis are billed with ordinary visits, often with the G2211 add-on.
The visit log and the calendar decide the claim. That is why we count each dialysis patient’s visits and days of service every month before the monthly claim goes out.
Nephrologists see patients in the office, the dialysis unit, the patient’s home and the hospital, often in the same month. Each setting has its own codes. Below is how each one fails, and how we prevent it.
Pays forOffice and telehealth visits for patients with chronic kidney disease, the G2211 add-on, and kidney disease education at stage 4.
Where it breaks
What we do
Pays forThe monthly ESRD-related services for patients on in-center and home dialysis, by age and by the number of visits.
Where it breaks
What we do
Pays forInpatient and observation dialysis, hospital visits for kidney failure, and dialysis access procedures.
Where it breaks
What we do
For patients who dialyze in a center, Medicare pays the managing physician or practitioner one monthly fee for ESRD-related services instead of separate visits. Codes 90951 to 90962 are chosen by the patient’s age (under 2, 2 to 11, 12 to 19, and 20 and over) and by the number of face-to-face visits documented in the month: four or more, two or three, or one. For an adult, that is 90960 for four or more visits, 90961 for two or three and 90962 for one.
Patients who dialyze at home are billed one monthly code by age, 90963 to 90966. The per-day codes, 90967 to 90970, cover less than a full month of service in the situations Medicare lists. Visits can be furnished by telehealth, but in-center patients still need at least one in-person visit a month that examines the vascular access site, and home dialysis patients need in-person visits in each of their first three months and at least once every three months after.
What we do: at the end of each month, we count every dialysis patient’s documented visits, check the in-person visit and any hospital stay, transplant or transfer, and choose the monthly or per-day code before the claim goes out.
Nephrology claims combine visit codes, monthly dialysis codes and a few procedure families. These are the ones we see most, with what payers check on each.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 25 with a same-day procedure only when the visit is separate. |
| G2211 | Add-on for ongoing care | Medicare, for patients whose kidney disease you manage over time. |
| 90951 to 90962 | ESRD-related services per month, in-center dialysis | Patient age and the number of face-to-face visits documented in the month. |
| 90963 to 90966 | ESRD-related services per month, home dialysis | Patient age, and in-person visits on the schedule Medicare requires. |
| 90967 to 90970 | ESRD-related services per day, less than a full month | Only in the partial-month situations Medicare lists. |
| 9093590937 | Hemodialysis with a single or repeated evaluations | Inpatient or observation dialysis; a same-day visit needs a separate problem and modifier 25. |
| 9094590947 | Other dialysis, such as peritoneal dialysis or continuous therapy | Single or repeated evaluations documented. |
| G0420G0421 | Kidney disease education, individual and group | Stage 4 chronic kidney disease, up to six sessions. |
| 36901 to 36909 | Dialysis circuit angiography and interventions | Imaging included; the segments treated and the findings documented. |
| N18.1 to N18.6Z99.2 | Chronic kidney disease by stage, and dependence on dialysis | The stage documented, with combination codes for hypertension or diabetes. |
A visit for a separate problem on the same day as dialysis or a procedure. Modifier 25 explained
Access work on a separate site that edits would otherwise bundle. Our modifier 59 guide
Video visits for plans that ask for it; Medicare uses place of service 02 or 10.
A service furnished in part by a resident or fellow under a teaching physician.
The reading of an access study done on someone else's equipment.
Medicare: a service that may not be covered, with a signed notice.
Sources: Medicare Claims Processing Manual, chapter 8, section 140; Medicare NCCI Policy Manual, chapter V (cardiovascular system) for dialysis circuit codes; ICD-10-CM Official Guidelines, chapter 14. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, monthly dialysis codes against visit counts, kidney disease staging, hospital dialysis and payer order, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list each dialysis unit you round at and where each patient dialyzes, and agree how escalations work. Most practices are live within one to two weeks.
Visits, dialysis months and procedures are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, visit counts, stages and payer order checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Nephrology revenue repeats every month: the same dialysis patients, billed by visit count, plus clinic and hospital work. A fee that is a share of collections means we are paid for getting each of those months right, not for sending the claims.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on how many dialysis patients you manage, how many units and hospitals you cover, your mix of clinic and hospital work and the state of the receivables, which we see in the free account review.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, monthly dialysis codes and visit counts, kidney disease staging, hospital dialysis and payer order, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Drive, Salem, NH 03079
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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