PCM · Nephrology
PCM Qualifying Diagnoses
for Nephrology.
20 ICD-10 codes qualify nephrology patients for Principal Care Management (PCM).
Qualifying Codes
ICD-10 codes for nephrology.
Autoimmune
1 codeSystemic lupus erythematosus, unspecified
Systemic lupus erythematosus, unspecified
Cancer
1 codeMalignant neoplasm of kidney, unspecified
Malignant neoplasm of kidney, unspecified
Chronic Kidney Disease
6 codesChronic kidney disease, stage 3 unspecified
BP + weight monitoring; fluid management critical
Chronic kidney disease, stage 3 unspecified
BP + weight monitoring; fluid management critical
Chronic kidney disease, stage 3a
Chronic kidney disease, stage 3a
Chronic kidney disease, stage 3b
Chronic kidney disease, stage 3b
Chronic kidney disease, stage 4 (severe)
Pre-dialysis monitoring; aggressive BP and fluid control
Chronic kidney disease, stage 4 (severe)
Pre-dialysis monitoring; aggressive BP and fluid control
Chronic kidney disease, stage 5
ESRD pre-dialysis or post-transplant monitoring
Chronic kidney disease, stage 5
ESRD pre-dialysis or post-transplant monitoring
End stage renal disease
End stage renal disease
Hypertension
5 codesEssential (primary) hypertension
Most common RPM diagnosis; twice-daily BP monitoring recommended
Essential (primary) hypertension
Most common RPM diagnosis; twice-daily BP monitoring recommended
Hypertensive chronic kidney disease, stage 1–4/unspecified
Hypertensive chronic kidney disease, stage 1–4/unspecified
Hypertensive heart and CKD without heart failure, stage 1–4/unspecified
Hypertensive heart and CKD without heart failure, stage 1–4/unspecified
Renovascular hypertension
Renovascular hypertension
Other secondary hypertension
Other secondary hypertension
Other Renal
2 codesNephrotic syndrome, unspecified
Nephrotic syndrome, unspecified
Unspecified nephritic syndrome, unspecified
Unspecified nephritic syndrome, unspecified
Type 1 Diabetes
2 codesType 1 diabetes mellitus with diabetic nephropathy
Type 1 diabetes mellitus with diabetic nephropathy
Type 1 diabetes mellitus with diabetic chronic kidney disease
Type 1 diabetes mellitus with diabetic chronic kidney disease
Type 2 Diabetes
3 codesType 2 diabetes mellitus with diabetic nephropathy
Type 2 diabetes mellitus with diabetic nephropathy
Type 2 diabetes mellitus with diabetic chronic kidney disease
Type 2 diabetes mellitus with diabetic chronic kidney disease
Type 2 diabetes mellitus with other diabetic kidney complication
Type 2 diabetes mellitus with other diabetic kidney complication
Clinical Context
Why nephrology practices benefit from PCM.
Nephrology practices can leverage PCM to improve patient outcomes through structured care management, generating $97–$220+ per patient per month in Medicare reimbursement while reducing avoidable hospitalizations.
Related Conditions
Condition monitoring guides.
FAQ
Common questions.
What ICD-10 codes qualify nephrology patients for PCM?
There are 20 ICD-10 codes that qualify nephrology patients for Principal Care Management (PCM). These include codes across 7 diagnosis categories: Autoimmune, Cancer, Chronic Kidney Disease, Hypertension, Other Renal, Type 1 Diabetes, Type 2 Diabetes.
How does CCN Health support nephrology practices with PCM?
CCN Health provides turnkey PCM services for nephrology practices — including patient eligibility identification, enrollment documentation, device provisioning, clinical monitoring, and full Medicare billing support. Most practices are fully operational within 1 week.
What is the revenue potential for PCM in nephrology?
PCM generates $68–149 per patient per month in Medicare reimbursement. Nephrology practices with a high prevalence of qualifying conditions can scale rapidly, especially when PCM is stacked with other eligible programs like RPM and BHI.