Nephrology CPT Codes and Common Modifiers Explained
Nephrology billing is one of the nonsurgical medical specialties that often face denials due to documentation errors, coding issues, or missing prior authorizations.
According to recent industry research, 20% to 30% of denials happened in 2026 due to coding errors and documentation issues, which hurts nephrology centers’ and practices’ revenue cycles.
To overcome this, you need to understand nephrology CPT codes, how to apply them, and documentation requirements — so you can submit clean claims and streamline the billing process.
In this blog, we discuss common CPT codes for nephrology billing, how to use them, common errors to avoid, and how to fix them to boost cash flow and prevent denials.
What Are Nephrology CPT Codes, and Why Are They Important?
Nephrology CPT codes are Current Procedural Terminology (CPT) codes established and maintained by the American Medical Association (AMA). These codes indicate the services, procedures, or treatments performed for patient care.
If these codes don’t align perfectly with what your documentation shows, health insurance companies deny the claims. From kidney transplants and biopsies to dialysis and ESRD, each procedure has its own CPT code, and even a minor mistake can cost you revenue.
Common Nephrology CPT Codes in 2026
Let’s discuss the common nephrology CPT codes by procedure type used in 2026, with examples;
Evaluation & Management (E/M) CPT Codes
The nephrology E/M codes used by nephrologists, physicians, and practices when performing evaluation and management services include;
CPT Codes 99202-99205: These codes are used for nephrology E/M services delivered to new patients, cover/spend 30-60 minutes or more, or involve a straightforward to high level of medical decision-making.
CPT Codes 99211-99215: These are used for established patients, covering 10-40 minutes, or involve a straightforward to high level of medical decision-making.
Hemodialysis CPT Codes
Hemodialysis CPT codes report the inpatient or outpatient services based on the physician’s evaluation frequency and whether it is end-stage renal dialysis or acute kidney dialysis.
Common hemodialysis CPT codes include;
CPT Code 90935 indicates hemodialysis performed by the physician or healthcare professional, along with a single evaluation on the same day and session.
CPT Code 90937 indicates hemodialysis performed by the physician or healthcare professional, along with a repeated evaluation on the same day and session.
Peritoneal Dialysis CPT Codes
CPT Code 90945 indicates the provider evaluates the patient and performs any type of dialysis except hemodialysis.
CPT Code 90947 indicates peritoneal dialysis performed to treat the patient, and the procedure requires repeated physician evaluations with or without substantial revision of a dialysis.
ESRD Monthly Management CPT Codes
CPT Code 90951 indicates face-to-face visits for a younger-than-2-year-old ESRD patient, up to 4 times in one month.
CPT Code 90952 indicates face-to-face visits for a younger-than-2-year-old ESRD patient, up to 3 times in one month
CPT Code 90953 indicates face-to-face visits for a younger-than-2-year-old ESRD patient, up to 1 time in one month
CPT Code 90954 indicates face-to-face visits for a 2- to 11-year-old ESRD patient, at least four times in a month.
CPT Code 90955 indicates face-to-face visits for a 2- to 11-year-old ESRD patient, at least three times in a month.
CPT Code 90956 indicates face-to-face visits for a 2- to 11-year-old ESRD patient, at least once a month.
CPT Code 90957 is for face-to-face visits for a 12- to 19-year-old ESRD patient, at least four times or more per month.
CPT Code 90958 is for face-to-face visits for a 12- to 19-year-old ESRD patient, at least two to three times per month.
CPT Code 90959 is for face-to-face visits for a 12- to 19-year-old ESRD patient, at least once per month.
CPT Code 90960 refers to face-to-face visits four or more times per month for a 20-year-or-older ESRD patient.
CPT Code 90961 refers to face-to-face visits two to three times per month for a patient with ESRD aged 20 or older.
CPT Code 90962 refers to face-to-face visits once per month for a patient with ESRD aged 20 or older.
CPT Code 90963 refers to full-month home dialysis care for a patient younger than two years old with ESRD.
CPT Code 90964 refers to full-month home dialysis care for a patient younger than 2 to 11 years old with ESRD.
CPT Code 90965 refers to full-month home dialysis care for a patient younger than 12 to 19 years old with ESRD.
CPT Code 90966 refers to full-month home dialysis care for a patient younger than 20 years or older with ESRD.
CPT Code 90967 refers to less than a full month of all the daily services associated with the dialysis care for a patient younger than 2 years old with ESRD.
CPT Code 90968 refers to less than a full month of all the daily services associated with dialysis care for a patient younger than 2 to 11 years old with ESRD.
CPT Code 90969 refers to less than a full month of all the daily services associated with dialysis care for a patient younger than 12 to 19 years old with ESRD.
CPT Code 90970 refers to less than a full month of all the daily services associated with dialysis care for a patient younger than 20 years or older with ESRD.
Vascular Access Procedure CPT Codes
CPT Code 36818-36921 indicates the arteriovenous anastomosis procedure for a patient with kidney failure receiving hemodialysis treatment.
CPT Code 36825 indicates the AV fistula creation using a graft.
CPT Code 36832 indicates an open treatment of AV fistula to revise the connection, without thrombectomy.
CPT Code 36833 indicates an open treatment of AV fistula to revise the connection, with thrombectomy.
Renal Imaging & Diagnostic CPT Codes
CPT Code 75831 indicates an X-ray of one kidney to identify the location and degree of blood clot.
CPT Code 75833 indicates an X-ray of both kidneys to identify the location and degree of blood clot.
CPT Code 76770 indicates a retroperitoneal ultrasound of the kidney with real-time image documentation.
CPT Code 76775 indicates a limited retroperitoneal ultrasound of the kidney, such as the renal, aorta, or nodes, with real-time image documentation.
CPT Code 76776 refers to the ultrasound of transplanted kidney(s).
CPT Code 71045 refers to the single radiological view of the chest.
CPT Code 71046 refers to at least two radiological views of the chest.
CPT Code 71047 refers to at least three radiological views of the chest.
CPT Code 71048 refers to at least three radiological views of the chest.
Kidney Transplant Related CPT Codes
CPT Code 50360 refers to the kidney and ureter transplant from a cadaver or living donor, without nephrectomy.
CPT Code 50365 refers to the kidney and ureter transplant from a cadaver or living donor, with nephrectomy.
CPT Code 50370 refers to the removal of a previously transplanted donor kidney from the recipient.
CPT Code 50380 refers to removing the patient’s kidney from its normal anatomic location and reimplanting it into a new site.
Common Modifiers Used in Nephrology Billing
Modifiers in nephrology billing add context to the services/procedures performed to treat the patient’s health. They help insurers understand procedures performed on the same date of service in the same session, bundle or unbundle services, and accurately determine reimbursement rates.
Common modifiers nephrology practices use include modifier 25, 50, 59, RT/LT, 22, 26, 95, 91, and 76, which indicate distinct services on the same day by the same physician, anatomical site, laterality, repeated tests or procedures, and more.
| Modifier | Description | Application |
|---|---|---|
|
22 |
Increased Procedural Services |
Indicates additional work during a procedure. |
|
25 |
Separate E/M Service |
Identifies a separate E/M service performed on the same day. |
|
26 |
Professional Component |
Identifies the interpretation and reporting portion of a service. |
|
50 |
Bilateral Procedure |
Indicates a procedure performed on both sides. |
|
59 |
Distinct Procedural Service |
Identifies a separate, distinct service. |
|
RT |
Right Side |
Indicates a procedure on the right side. |
|
LT |
Left Side |
Indicates a procedure on the left side. |
|
76 |
Repeat Procedure |
Indicates a repeated procedure by the same provider. |
|
91 |
Repeat Laboratory Test |
Identifies a medically necessary repeat lab test. |
|
95 |
Telemedicine Service |
Identifies qualifying real-time audio-video services. |
Common Nephrology Coding Mistakes to Avoid
Here are some common nephrology coding mistakes you should avoid;
Nephrology practices handle complex kidney conditions, CKD staging, and dialysis services. Incorrect coding can lead to claim denials, delayed reimbursements, and revenue loss. Common coding mistakes include:
- Reporting the wrong CKD stage or using an unspecified code when documentation supports a specific stage.
- Using incorrect CPT codes or billing for dialysis services that do not match the documented treatments.
- Confusing acute kidney injury (AKI) with chronic kidney disease (CKD) or reporting unsupported diagnoses.
- Failing to report associated conditions, such as diabetes with CKD (E11.22), along with the appropriate CKD stage code.
- Missing or incorrectly applying modifiers such as 25, 26, TC, and 59.
- Missing CKD stages, dialysis records, laboratory findings, or medical necessity details.
- Failing to follow ICD-10-CM guidelines when coding hypertension, diabetes, and CKD together.
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Frequently Asked Questions
What are the most commonly used CPT codes in nephrology?
Common nephrology CPT codes include 99202–99215 for office visits, 90935 and 90937 for hemodialysis services, and 90960–90962 for monthly end-stage renal disease (ESRD) services.
What ICD-10 codes are used for chronic kidney disease (CKD)?
CKD diagnosis codes fall under category N18. These include N18.1 (Stage 1), N18.2 (Stage 2), N18.3 (Stage 3), N18.4 (Stage 4), and N18.5 (Stage 5).
What causes claim denials in nephrology billing?
Common causes include incorrect CKD staging, missing dialysis documentation, coding errors, incorrect modifiers, lack of medical necessity, and failure to follow payer-specific billing guidelines.
Do Nephrology Billing Companies handle CPT and ICD-10 coding?
Yes. Most specialized Nephrology Billing Companies offer CPT and ICD-10 coding support for kidney-related services, including dialysis, chronic kidney disease (CKD), kidney transplants, and vascular access procedures. They also help ensure that diagnosis codes, procedure codes, and modifiers match the medical documentation.
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