Get paid between visits
Chronic care management for nephrology practices
Companian follows your CKD patients every month before dialysis begins, so changes reach you early.
- No new hires. We run outreach, consent and monthly calls.
- One file a month. Nothing is billed until you approve it.
- $0 upfront. Works with your EHR, live in about a week.
$66.13* per patient, every month*Nephrology CCM, CPT 99490 (2026 national rate)
Get your CCM Plan
Works nationwide
Practices nationwide
You bill under your own NPI
Same Care Advocate every month
RNs, NPs, LCSWs and care companions
Monthly file approved by your team
No new hires needed
One Care AdvocateSame person, every month
Your NPI, your claimYou bill Medicare directly
Monthly billing fileYour team approves it
Where a Care Advocate fits in kidney care
Four kinds of between-visit work, each written into your care plan.
CKD stages 3 to 5
Lab draws are tracked against your plan’s schedule and confirmed once done. A missed draw is flagged to your office.
Approaching kidney failure
Dialysis education, vascular access visits and transplant evaluations your team arranged are confirmed with the patient ahead of time.
Diabetes and hypertension
Home blood pressure and glucose numbers are logged on the call against your plan’s targets. Out-of-range values go to your clinicians.
Medicines from other prescribers
Each call asks about new prescriptions and over-the-counter products. Anything your plan names, such as NSAIDs, is routed to your clinicians.
What 120 CKD stage 3 to 5 patients bring in each month
2026 Medicare-allowed amounts, and the diagnosis codes that qualify.
Example panel
$7,936 / month
$95,227 a year · 120 patients × $66.13 (CPT 99490, national)
- CPT 99490 pays $66.13 per patient-month nationally (2026).
- Your locality moves it up or down: $60.71 in Arkansas to $83.76 in Alaska.
- Each extra 20 minutes adds CPT 99439 at $50.44.
| Condition | ICD-10 examples | Program fit |
|---|---|---|
| Chronic kidney disease, stage 3 | N18.31, N18.32 | CCM with diabetes or hypertension |
| Chronic kidney disease, stage 4 to 5 | N18.4, N18.5 | CCM; PCM for CKD alone |
| Diabetes with diabetic CKD | E11.22 | CCM |
| Hypertensive CKD | I12.9 | CCM |
Nephrology PCM, CCM or PIN, and the ESRD cutoff
It depends on the conditions you manage and whether monthly dialysis services started.
| Where the patient is | Program | Codes | CMS condition |
|---|---|---|---|
| CKD is the condition your practice manages; primary care has the rest | PCM (nephrology principal care management) | 99426, 99427 for staff time; 99424, 99425 for the nephrologist | One serious, high-risk condition expected to last at least 3 months, and at least 30 minutes in the month |
| Your practice also manages the hypertension or diabetes | CCM (nephrology CCM) | 99490, 99439; complex 99487, 99489 | Two or more conditions expected to last 12 months or more that put the patient at significant risk |
| Stage 5, with dialysis or transplant decisions ahead | PIN | G0023, G0024 | An initiating E/M visit, staff trained on the condition, consent renewed annually |
| Monthly ESRD services have started | No CCM for that period | 90951 to 90970 billed instead | CMS bars CCM in the same period as ESRD services |
| Code | Service | National 2026 |
|---|---|---|
| 99426 | PCM, clinical staff, first 30 min | $67.80 |
| 99427 | PCM, staff, each additional 30 min | $54.11 |
| 99490 | CCM, clinical staff, first 20 min | $66.13 |
| 99487 | Complex CCM, first 60 min | $144.29 |
| G0023 | PIN, first 60 min | $87.18 |
For the base CCM code’s time and documentation rules, see our CPT 99490 guide.
How chronic care management for nephrology practices runs
Three approvals from your side; the calls and the file from ours.
Pick the CKD patients
Share eligible Medicare patients through EHR access or a short referral form. You decide which stages come first.
Sign off on outreach
You approve the first call once per patient. The Care Advocate explains cost-sharing and documents verbal consent.
Monthly contact
Each patient keeps one Care Advocate. Calls cover your plan’s questions, upcoming labs and dialysis education or access visits.
Billing file review
Before any claim, your billers review each patient’s program, code family, month, minutes by activity, activities and consent date. Complex CCM, for months when the care plan is substantially revised, is covered in our guide to CPT 99487 and 99489.
The ESRD exclusion and other nephrology billing checks
What your billing team watches when kidney patients are in care management.
When dialysis starts
Once your practice bills monthly ESRD services (90951 to 90970), CCM stops for that period. The monthly file lists each patient’s program by month, so billers see the switch before claims go out. Ask your billing team how they apply this to PCM.
Patients shared with cardiology and endocrinology
A CKD patient may also see primary care, a cardiologist and an endocrinologist. Agree which office bills CCM, and count each minute once. For the program basics, see what chronic care management is.
Transport, food and housing
Missed labs and visits can come down to a ride or a grocery budget. Community health integration (G0019, G0022) covers that work after an initiating visit, alongside PCM or CCM with no minute counted twice.
Payment by Medicare locality
Medicare pays by payment locality, set by state and county: 109 localities nationwide. For CPT 99490 the 2026 amount runs from $60.71 in Arkansas to $83.76 in Alaska. See CCM reimbursement by locality.
Chronic care management for nephrology
For nephrology, check billing conflicts before enrollment:
ESRD services
CCM cannot share a service period with CPT 90951 to 90970 (MLN909188). Ask your Medicare Administrative Contractor (MAC) about PCM that month and CCM when another practitioner bills the ESRD codes.
Eligibility
Kidney disease is not named in CMS’s example list, which is not exhaustive. Apply the duration and risk test (MLN909188).
Plan
Use a disease-specific plan for PCM (CY2020 final rule) or an electronic comprehensive plan for CCM. See CCM care plan requirements.
Questions nephrology practices ask
Do patients need a visit before they enroll?
Only if they’re new or not seen in the prior year. Then CMS requires an initiating visit: a comprehensive E/M, annual wellness visit or IPPE.
What does the consent call cover?
Four points: the service is available, cost-sharing may apply, only one practitioner bills CCM monthly, and the patient can stop anytime, effective at month end. Consent is documented once. See CCM consent.
Can the Care Advocate tell a patient to stop an NSAID?
No. The Care Advocate records what the patient reports and routes it to your clinicians, who decide and tell the patient.
Who makes the calls?
Our chronic care management for nephrology practices uses a remote team of registered nurses, nurse practitioners, licensed clinical social workers and care companions. Gloria, our AI assistant, drafts documentation and pre-visit summaries. Lab interpretation and treatment changes stay with your nephrologists.
Who is the supervising practitioner?
The nephrologist or NPP who bills, under general supervision as CMS allows. The services agreement sets the arrangement; confirm it with your counsel.
Who receives the Medicare payment?
Your practice. Claims go out under your own NPI and the payment comes to you. Our fee is covered on the intro call.
Rates & disclosures
National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.
Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.
Care management for other specialty practices
One Care Advocate model, written to each specialty’s patients.
Add care management to your nephrology practice
Fifteen minutes on your pre-dialysis CKD patients. No patient information needed.