News and Analysis

Every month, kidney care clinics lose thousands of dollars because of billing mistakes. In fact, studies show that about 70% of these mistakes happen due to coding errors and missing documentation. In 2025, billing remains one of the most significant challenges for nephrology practices. Treatments like dialysis occur frequently and require numerous claims to insurance companies, which are constantly changing their rules. This leaves very little room for mistakes. That’s why many clinics now use specialized nephrology medical billing services. Accurate CPT coding for nephrology, along with smooth EHR integration, not only lowers claim denials but also improves cash flow. This lets clinics spend more time focusing on patients instead of paperwork. Want to learn how leading nephrology practices handle billing challenges and keep their finances strong? Keep reading — this blog will guide you through it.

The Unique Challenges of Nephrology Billing in 2025

Nephrology and Its Complicated Billing 

Nephrology is one of the most complicated specialties for medical billing services. Nephrology manages chronic kidney disease (CKD) patients, end-stage renal disease (ESRD) patients, and kidney transplant patients, all of whom require treatment frequently (often 2-3x/week) due to the nature of CKD, ESRD, and post-transplant care. Nephrology medical billing is vital to ensure proper reimbursement. 

Fact: 

In 2023, dialysis treatments cost an average of $72,000 per patient per year in the U.S., so accurate billing or nephrology coding and billing is essential to preserving clinic revenue. Current industry data supports that up to 70% of nephrology claim denials are due to errors in coding or missing necessary documentation.

Dealing with High Patient Volume and Frequent Procedures

Nephrology clinics have a large volume of patients, many of whom require frequent, recurring procedures, and, for example, the average dialysis patient has treatment three times a week.  This results in a large number of claims that require completely accurate coding and billing or risk denials.  

Stat:

In the U.S. in 2024, there were over 785,000 dialysis patients, making it very challenging for clinics to handle billing accurately and submit claims promptly.  

EHR integration in nephrology billing plays a pivotal role in this process, helping clinics streamline documentation associated with claims, reduce potential errors, and speed up claims processing.  It was reported by a nephrology billing solution that clinics using integrated nephrology billing solutions saw an average of 25% reduction in claims denials in the first year.

Growing Regulatory Focus and Billing Risks

Due to the complexity of the costs at hand, Medicare and other payers’ audits and policies have been on the rise. Documentation and billing errors often lead to claim denials or payment delays.

Fact:

In 2023, Medicare identified improper payments in excess of $25 billion, in part due to improper payments across specialties, including nephrology. Research indicates that nephrology-specific CPT coding errors are nearly 20% of all billing denials in kidney care practices in 2024.

Why a Dedicated Nephrology Billing Service is Important

With complicated patient needs, continual claims, and an ever-changing payer landscape, most general billing services simply don’t cut the mustard. Specialized nephrology medical billing services and solutions that understand CPT coding, are compliant with EHRs, and stay on top of changes in regulations and policies, are vital to keeping your financial stability and ensuring continuity of care for patients.

CPT Coding for Nephrology: What to Know

Accuracy in CPT coding for nephrology is critical for correct billing and reimbursement. Nephrology encompasses a variety of complicated procedures, including, but not limited to, dialysis, kidney biopsies, transplant care, and chronic disease management. Accurate coding of claims will greatly increase the chances of the claim getting processed correctly without denial or delay. 

Below is a list of some of the most commonly used CPT codes in nephrology, along with the meanings of what they are:

90935 — Dialysis procedure with single evaluation.When a patient is getting hemodialysis and has a one-time evaluation while receiving treatment. 

90937 — Dialysis procedure with multiple evaluations. When the patient is getting hemodialysis and has more than one evaluation during that treatment session.

90945 — Dialysis procedure for home patient, single evaluation. Used for patients who are receiving dialysis at home and have a one-time evaluation.

90947 — Dialysis procedure for home patient, multiple evaluations. For home dialysis treatments, with multiple evaluations during that session.

50300 — Kidney biopsy. Used when a sample of kidney tissue is collected for diagnostic purposes.

90999 — Unlisted dialysis procedure Unlisted for dialysis – for services that are not described by specific CPT codes and with full documentation. 

90960 — Peritoneal dialysis training (individual) Covers the training sessions that were provided to patients who are starting peritoneal dialysis.

90961 — Peritoneal dialysis training (group). Similar to 9096, but it was group training.

90970 — Hemodialysis procedure with extracorporeal blood perfusion. When the patient is receiving hemodialysis in addition to some form of blood perfusion therapy, also noted on the checklist.

90989 — Hemodialysis procedure with repeated evaluations. For one session of hemodialysis with extended or repeated evaluations.

Why Accurate CPT Coding is Important

Billing for nephrology services involves precision. Incorrect or incomplete CPT coding results in claims being denied or paid incorrectly, which impacts a practice’s cash flow. Beginning in 2025, with enhanced payer scrutiny and tighter regulations, the margin for error will be at a very small percentage.

That is why so many clinics invest in nephrology billing platforms and employ EHR integration in nephrology billing to maximize coding accuracy and ensure complete integration of documentation to billing.

Errors in coding and keeping up with changes and guidelines can be a costly mistake for a nephrology practice. Eventually, practices should focus on the important matter at hand- outcome-driven clinical care.

How EHR Integration Changes Nephrology Billing

In a specialty as detailed as nephrology, every note, lab result, and visit must be correctly aligned with billing documentation. This is the moment that EHR integration in nephrology billing becomes revolutionary.

In situations where electronic health records (EHR) systems are fully integrated into billing systems, they enable medical and financial teams in nephrology to share information easily, which will lessen errors in billing, improve coding accuracy, and speed up claims processing time.

EHR Integration Advantages:

Quick Claim Submission:

Because clinical data is automatically transferred into billing systems, practices can submit their claims quickly—usually within 24–48 hours of the patient visit.

Greater Coding Detail:

EHRs pull diagnosis and treatment details directly into the claim file, and many more CPT codes will not be missed or incorrectly coded; code the way you perform the visit.

Audit-Ready Clinical Documentation:

When a nephrology clinic is audited by Medicare or reviewed by payers, its location-agnostic workflow is seamless because every claim is supported by a specific clinical document designed in the structure of the claim.

Fact:

Our clinics that have fully integrated EHR and billing have as much as a 30% reduction in claim denials due to improved coding and documentation.

Reduced Admin Load:

Staff is spending more of their time providing clinical care to patients rather than performing unnecessary manual data entry and work, which positively impacts their efficiency and level of burnout.

Real-World Impact

A nephrology clinic managing 100 dialysis patients per week can generate over 1,200 claims a month. Without integration, even a 5% error rate can mean 60 denied or delayed claims monthly. With EHR integration, clinics can significantly cut that number, leading to faster payments and less revenue leakage.

Stat: According to a 2024 industry survey, 78% of nephrology practices using EHR-integrated billing systems reported improved cash flow within 6 months of implementation.

With patient volumes rising and documentation demands increasing, nephrology billing solutions must be designed to work hand-in-hand with clinical data systems. In 2025, EHR integration in nephrology billing is no longer just a tech upgrade — it’s a financial necessity.

Deciding on the Optimal Nephrology Billing Partner in 2025

Choosing the correct nephrology medical billing services is crucial now more than ever. In 2025, there will be over 785,000 dialysis patients in the U.S., and the number of Medicare audits continues to climb (up 15% in 2024). Practices must select a partner who truly appreciates the specialty.   

A reputable partner like P3Care understands the specialty and the unique challenges of nephrology, providing expertise and assistance in decreasing denials, improving coding accuracy, and revenue cycle.   

Conclusion

By 2025, the evolution of nephrology medical billing services from a back-office task to an integral part of keeping practice financial viability and legal compliance is undeniable.  With specialist billing solutions that connect with your EHR necessary in light of an increasing volume of kidney patients, a growing number of dialysis episode,s and next-level regulatory scrutiny, the potential partners for your billing team have changed drastically in previous years.

A billing partner dedicated to nephrology medical billing and coding understands the nuances of nephrology medical billing and securely positions your team for the future. P3Care and our revenue cycle management team can help your organization increase business operations and revenues, reduce denials, and improve patient care.

FAQs on Nephrology Medical Billing Services (2025) 

Q1: What are nephrology medical billing services? 

A: These services handle billing and coding for kidney-related treatments like dialysis and CKD care. They ensure accurate CPT coding and documentation to maximize reimbursements and reduce denials. 

Q2: How does EHR integration help nephrology billing? 

A: EHR integration syncs clinical data with billing systems, reducing manual errors, improving coding accuracy, and speeding up claim processing. 

Q3: Why is specialized billing needed for nephrology? 

A: Nephrology has frequent, complex procedures requiring precise codes. Specialized billing services understand these needs, helping reduce denials and improve cash flow.

Q4: Which CPT codes are frequently used in billing for nephrology?

A: Dialysis (e.g., 90935, 90937), vascular access procedures, peritoneal dialysis training, and kidney transplant treatment are all included in the common CPT coding for nephrology. For correct billing, these codes must be used precisely.

Q5: How can I pick the best medical billing service for nephrology?

A: Seek a partner with nephrology coding and billing experience, robust EHR integration, compliance assistance, clear reporting, and a track record of lowering denials and enhancing revenue cycles, and with this and the best track record, P3care is the best partner you are looking for 
The post Nephrology Medical Billing Services: Why It’s a Game-Changer in 2025 appeared first on P3.