Nephrology billing lives or dies on the ESRD monthly capitation package, where 90951-90970 tiers by patient age and visit count, dialysis claims cross facility and professional lines, and AKI versus CKD coding decides medical necessity. MedTaskly manages the full monthly cycle so your practice captures every MCP dollar without denials.
Book Free RCM AuditESRD monthly capitation payments are billed once per month using CPT codes 90951-90970, tiered by patient age and the number of face-to-face visits: four or more, two to three, or one. Bill the code matching the actual visit count, since Medicare pays a lower rate for fewer visits. Home dialysis patients use separate codes, and partial-month scenarios such as transient patients or transplants require daily-rate codes instead.
One miscounted visit or wrong MCP tier repeats the loss monthly.
Nephrology revenue runs on the ESRD monthly capitation payment, billed through CPT 90951-90970 and tiered by patient age and face-to-face visit count. Bill the four-plus visit tier when only two visits are documented and the claim denies or triggers an audit; bill the lower tier by default and you leave the difference on the table every month. Add home dialysis codes, partial-month daily rates for transient or hospitalized patients, and separately billable services that must be carved out of the monthly package, and small errors compound fast.
AKI versus CKD coding creates another leak, since acute kidney injury dialysis is billed per session rather than under capitation, and transplant follow-up shifts patients out of MCP entirely on strict timelines. MedTaskly's AAPC-certified coders handle nephrology billing for practices among our 1,500+ providers across 75+ specialties, tracking visit counts, tier assignments, and modifier rules each month. The result is a 98% clean-claim rate and capitation revenue that arrives in full, on time.