Nephrology
Revenue intelligence for Nephrology practices. CKD management programs, dialysis-adjacent billing, and care management opportunities.
$156K
Avg Missed/Year
10K
US Providers
460
Avg Patients
4.0
Avg Chronic Dx
Specialty Overview
Nephrology practices manage the highest-acuity patients in outpatient medicine, with an average HCC risk score of 1.65 and 4.0 chronic conditions per patient. This creates the strongest care management revenue opportunity of any specialty — CKD patients require intensive medication management, dietary coordination, and multi-specialist communication.
Key Insight: Nephrology has the highest per-provider missed revenue ($156K) of any specialty. A single nephrologist with a 200-patient RPM program and full CCM enrollment can add $300K+ in annual revenue.
E&M Coding Distribution
National benchmark for Nephrology E&M code distribution. Compare your practice against these targets to identify coding optimization opportunities.
99213
20%
$92/visit
99214
50%
$130/visit
99215
30%
$176/visit
Revenue Gap Breakdown
CCM (99490)
22% adoption is the highest of any specialty, but 78% of the opportunity remains. CKD patients virtually all qualify for CCM.
RPM (99453-99458)
Blood pressure and weight monitoring for CKD patients is critical and highly reimbursable. 12% adoption.
E&M Coding Gap
Complex medication management and high-risk patients support 99215. Benchmark: 20% 99213 / 50% 99214 / 30% 99215.
AWV (G0438/G0439)
14% AWV rate. CKD patients need comprehensive preventive care planning.
BHI (99484)
18% depression prevalence in CKD patients. Dialysis patients especially benefit from behavioral health support.
Care Management Adoption Rates
CCM
22%
Target: 15%
RPM
12%
Target: 10%
BHI
4%
Target: 10%
AWV
14%
Target: 70%
Common Chronic Conditions
Recommended Billing Guides
Nephrology Provider? See Your Gaps
These are national averages. Scan your NPI to see how your billing compares to Nephrology benchmarks and get a personalized revenue roadmap.
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