Billing Tips for Nephrologists and Dialysis Centers in 2025

Billing Tips for Nephrologists and Dialysis Centers in 2025

As 2025 brings evolving regulations and payer expectations, nephrologists and dialysis centers must adapt their billing strategies to maintain financial stability. Accurate coding, compliant documentation, and up-to-date knowledge of policy changes are more than just operational best practices. They’re essential for ensuring full and timely reimbursement.
Dialysis care providers already navigate one of the most complex billing environments in healthcare, with frequent patient visits, bundled payment models, overlapping conditions, and payer-specific rules. From outpatient hemodialysis to monthly ESRD visits, each service comes with its own coding, timing, and documentation nuances. In this blog, we’ll break down the most important billing tips for nephrologists and dialysis centers in 2025, focusing on how to improve claim accuracy, avoid denials, and optimize collections while staying fully compliant with CMS and commercial payer requirements.

Stay Updated on 2025 CMS and Payer Policy Changes

The Centers for Medicare & Medicaid Services (CMS) continues to refine its policies for end-stage renal disease (ESRD) care under the ESRD Prospective Payment System (PPS). In 2025, there is a stronger emphasis on documentation that supports the medical necessity of services, clear coding for comorbid conditions, and distinctions between ESRD and acute kidney injury (AKI).
Telehealth services for nephrology care are still allowed but under stricter conditions than during the public health emergency. Some services now require prior authorization, and documentation must support the use of telehealth, especially when billing for MCP (Monthly Capitated Payment) visits via remote platforms.
It’s essential for billing teams to regularly monitor CMS updates, payer bulletins, and MAC (Medicare Administrative Contractor) guidelines to ensure alignment with the latest documentation and coding rules. Even a small lapse in compliance, particularly when it comes to bundled billing, can lead to widespread denials or delays in receiving reimbursement.
Stay Updated on 2025 CMS and Payer Policy Changes

Use the Correct CPT and ICD-10 Codes for Dialysis Services

Nephrology billing heavily depends on accurate CPT and ICD-10 coding. Each dialysis session or monthly encounter must be coded correctly based on service type, location, and physician involvement. Misuse of codes or coding combinations can easily trigger denials or post-payment audits.

For hemodialysis and peritoneal dialysis, commonly used CPT codes include:
CPT Code Description
90935 Hemodialysis with a single physician evaluation
90937 Hemodialysis with repeated evaluations
90945 Peritoneal dialysis, including evaluation
90947 Peritoneal dialysis with multiple evaluations
For ESRD-related MCP billing, nephrologists use a range of codes from 90951 to 90970, depending on the patient’s age and the number of required visits within the calendar month. Each of these codes carries its documentation requirements regarding frequency and type of encounters.
ICD-10 codes must also align precisely with the clinical picture. For example:
ICD-10 Codes Description
N18.6 End-stage renal disease
N18.5 Chronic kidney disease. stage 5
N17.9 Acute kidney failure, unspecified
Always ensure that diagnosis codes support the CPT codes billed and are updated as needed to reflect the patient’s disease progression or complications.

READ HERE: What is the ICD-10 Medical Coding System?

Prioritize Complete and Compliant Documentation

In dialysis and nephrology billing, having proper documentation is more than just a requirement; it’s essential for staying compliant and ensuring you receive the payments you deserve. Incomplete or vague notes are among the most common reasons for denied claims. To ensure full payment, nephrologists and dialysis centers must document the following consistently:
  • The date and time of each encounter
  • Type of dialysis session (hemodialysis or peritoneal)
  • Any evaluation and management (E/M) service provided during the session
  • Complications addressed, medication changes, or care plan updates
  • For monthly MCP visits, the number of face-to-face encounters and the content of those interactions
Home dialysis supervision should be well-documented, especially for training sessions, supply orders, and remote monitoring. If billing for AKI-related dialysis in patients who are not ESRD-eligible, documentation should differentiate the condition and provide a rationale for treatment.
Using EHR templates customized for nephrology can streamline compliance and reduce the likelihood of missed documentation elements.

Apply the Correct Place of Service (POS) Codes and Modifiers

Correct use of place-of-service codes and modifiers is essential for ensuring your claim reflects the true care setting and provider involvement. Payers frequently flag incorrect combinations, which can result in automatic rejections.

For dialysis services, the following POS codes are commonly used:

POS Code Description
11 Physician’s Office
21 Inpatient Hospital
22 Outpatient Hospital
65 ESRD Treatment Facility
Modifiers help clarify the circumstances around the billed service. In nephrology billing, common modifiers include:
Modifier Description
GC Indicates services performed by a resident under supervision
25 For separate and significant E/M services on the same day
KX Indicates requirements for medical necessity have been met
The documentation must support every modifier. Avoid using modifiers as a default; they should only be used when they accurately reflect the care provided.

Prevent Denials by Strengthening Front-End Processes

Most revenue loss in dialysis billing can be traced to front-end failures. From insurance eligibility issues to incorrect patient demographics, early errors in the billing process can compound throughout a patient’s treatment.
Ensure your administrative and billing staff are following these front-end best practices:
  • Verify patient insurance eligibility and ESRD coverage every month, especially for new or transitioning patients
  • Capture all services provided, including separately billable lab tests or complications treated during dialysis
  • Validate payer authorization requirements, particularly for telehealth nephrology visits or inpatient dialysis sessions
  • Track the number of monthly visits for accurate use of MCP codes
  • Ensure consistent communication between providers and billing staff, particularly when treatment plans change
Automation tools like eligibility checkers and coding assistants can help reduce human error and flag potential issues before claims are submitted.
Prevent Denials by Strengthening Front-End Processes

READ HERE: Best Practices for Denials Management in Healthcare

Optimize Reimbursement With Data and RCM Support

Enhancing your dialysis billing process goes beyond simply submitting accurate claims. It’s about creating a streamlined system that accelerates reimbursements, minimizes denials, and offers complete transparency into your financial health. This approach helps your practice operate more efficiently and confidently.
Nephrologists and dialysis centers should regularly monitor:
  • Claim rejection patterns by payer and service type
  • Days in A/R by claim category
  • Top denial reasons and root cause analysis
  • Revenue leakage due to underbilling or incorrect bundling
  • Missed billing opportunities, such as non-dialysis-related E/M services
Optimize Reimbursement With Data and RCM Support

BOOK A FREE NEPHROLOGY PRACTICE AUDIT

Partnering with a dedicated revenue cycle management (RCM) expert like MaxRemind can make a real difference for dialysis centers. It helps streamline claim submissions, guarantees accurate coding, and keeps you informed about reimbursement trends, making your billing process smoother and more efficient. MaxRemind’s nephrology billing experts stay ahead of CMS updates and payer policy changes so you don’t have to.

Final Thoughts

Dialysis and nephrology billing in 2025 demands precision, adaptability, and a deep understanding of regulatory shifts. As reimbursement models evolve and documentation expectations rise, nephrologists and dialysis centers must refine their billing processes to stay competitive and financially secure.

Whether you’re billing for routine ESRD services, acute dialysis cases, or complex transplant-related care, the margin for error is shrinking. By having the right tools, proper training, and support from partners like MaxRemind, you can better manage your billing process, minimize denials, and unlock the full financial potential of your nephrology practice.

Want unlock the full financial potential of your nephrology practice?

Reach out to MaxRemind for a free consultation. Let’s optimize your revenue cycle.
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FAQs
What are the new billing rules for dialysis centers in 2025?

CMS has reinforced its ESRD PPS framework, requiring clearer documentation of monthly visits, stricter guidelines for telehealth implementation, and more detailed reporting of comorbid conditions. Providers must track bundled vs. separately billable services more carefully.

How do you bill outpatient dialysis services correctly?

Outpatient dialysis billing depends on the type of dialysis and physician engagement. Use CPT codes 90935, 90937, 90945, or 90947, and ensure documentation reflects the actual services performed, patient condition, and any physician evaluation during the session.

What CPT codes are used for monthly nephrology visits?

CPT codes 90951–90970 are used for Monthly Capitated Payments (MCP) based on the patient’s age and number of face-to-face visits within a calendar month. Documentation must support each encounter and be available for audit if requested.

How can nephrologists reduce claim denials?

Claim denials can be significantly reduced by documenting thoroughly, verifying insurance coverage each month, using the correct CPT/ICD codes, and ensuring modifiers and POS codes match the setting and service.

Are dialysis services still under bundled payment rules?

Medicare continues to use the ESRD PPS model, which includes routine dialysis, labs, medications, and supplies. Proper tracking of what’s included in the bundle—and what qualifies as separately billable—is crucial for accurate reimbursement.