Nephro
Nephrology
ESRD monthly capitation drives outpatient nephrology revenue (MCP, 90951-90970), plus CKD E/M, vascular access procedures, and home dialysis training. MCP coding is age-stratified and visit-frequency stratified.
Top billed codes
The codes that drive revenue in this specialty. Click any code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 99214 | Office o/p est mod 30 min The workhorse code. Two or more chronic problems with progression/treatment changes, OR one undiagnosed new problem with uncertain prognosis, OR prescription drug management. | 1.92 | 4.06 | $136 | Details → |
| 99215 | Office o/p est hi 40 min Severe exacerbation, decompensated chronic illness, decision regarding hospitalization, or extensive comorbidity management requiring high-risk decision-making. | 2.80 | 5.76 | $192 | Details → |
| 90951 | ESRD service mo 0-1 yrs full month Pediatric ESRD <2 years, 4+ face-to-face dialysis visits in the calendar month. | 7.21 | 9.92 | $331 | Details → |
| 90954 | ESRD MCP, 2-11yr, 4+ visits/mo Pediatric ESRD ages 2-11, 4+ face-to-face dialysis visits in the calendar month. | 4.36 | 7.75 | $259 | Details → |
| 90957 | ESRD MCP, 12-19yr, 4+ visits/mo Adolescent ESRD ages 12-19, 4+ face-to-face dialysis visits in the calendar month. | 4.13 | 7.28 | $243 | Details → |
| 90960 | ESRD service mo adult 4 visits Adult ESRD patient on chronic dialysis, 4+ face-to-face visits in the calendar month. | 4.30 | 6.01 | $201 | Details → |
| 90961 | ESRD service mo adult 2-3 visits Adult ESRD with 2-3 face-to-face dialysis visits in the calendar month. | 3.47 | 4.85 | $162 | Details → |
| 90962 | ESRD service mo adult 1 visit Adult ESRD with exactly 1 face-to-face dialysis visit in the calendar month. | 1.74 | 2.43 | $81 | Details → |
| 90963 | ESRD home dialysis, <2yr Home dialysis monthly cap for pediatric patients under 2 years. | 4.39 | 8.10 | $271 | Details → |
| 90970 | ESRD MCP per diem, 20+yr Per-diem ESRD billing when patient is not on chronic dialysis for the full month (e.g. transplant, hospitalization, death). | 0.10 | 0.18 | $6 | Details → |
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Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.