Endocrinology billing
Endocrinology billing services
We handle billing for endocrinology practices, from diabetes and thyroid visits to continuous glucose monitoring, thyroid ultrasound and biopsy, and bone density testing. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and pricing starts at 2.5% of collections.
- Continuous glucose monitoring codes (95249, 95250, 95251)
- Thyroid ultrasound, fine needle aspiration and DXA coding
- Benefit and prior authorization checks for tests and devices
Why endocrinology billing is different
Chronic conditions, devices and frequency limits
Endocrinology patients are seen again and again for diabetes, thyroid and bone disease. Much of the billable work is data review and in-office testing, and payers limit how often each can be paid.
Continuous glucose monitoring
CGM has separate codes for starting a patient-owned device (95249), placing and training on a clinic-owned sensor (95250) and interpreting the data (95251). Each has its own documentation and frequency rules.
Thyroid nodules
A thyroid ultrasound and an ultrasound-guided fine needle aspiration are coded separately. The biopsy codes change with the imaging used and how many lesions were sampled.
Bone density testing
DXA scans are covered at set intervals, often every 2 years under Medicare unless the patient meets a condition that allows more. A scan done too early is denied.
Diabetes education and nutrition
Diabetes self-management training and medical nutrition therapy use their own codes, need a referral or order, and may require an accredited program or a registered dietitian.
Prior authorizations
CGM devices, insulin pumps and many newer diabetes and weight-related drugs need payer approval. Supplies often go through pharmacy or DME benefits, not the office claim.
Diagnosis specificity
Diabetes codes carry the type, complications and whether insulin is used. Payers use them to decide coverage for CGM and tests, and risk-adjusted plans use them to set payment.
Common codes
Endocrinology codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 99202–99215, G2211 | Office visits; add-on for ongoing care of a complex condition | Level supported by decision making or time; payer acceptance of G2211 |
| 95249 / 95250 | CGM start-up: patient-owned device; clinic-owned sensor placement and training | Minimum recording time and payer limits on how often |
| 95251 | CGM data analysis and interpretation | Report in the chart; limited to once per 30 days by most payers |
| 76536 | Ultrasound of the soft tissues of the head and neck, including thyroid | Separate from biopsy guidance; diagnosis supports the study |
| 10005 / 10006 | Fine needle aspiration biopsy with ultrasound guidance, first and each added lesion | Guidance included in the code; lesion count matches the note |
| 77080 | DXA bone density scan, axial skeleton | Frequency limits and qualifying diagnosis |
| G0108 / G0109, 97802–97804 | Diabetes self-management training; medical nutrition therapy | Order on file, program or provider requirements, annual hour limits |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Endocrinology denials we stop before they happen
Endocrinology denials usually come from frequency limits, missing approvals and diagnosis codes that do not meet coverage rules. We check these before the claim goes out.
- CGM interpretation billed more often than the payer allows
- CGM start-up billed without enough recorded data or a qualifying diagnosis
- DXA repeated before the covered interval without a qualifying reason
- Thyroid biopsy guidance billed separately when it is already included
- Diabetes education billed without an order or by a provider type the payer does not accept
- Services and devices done without the required prior authorization
- Unspecified diabetes or thyroid diagnosis codes that do not support the service
What we handle
Everything between the visit and the payment
- Insurance eligibility, benefits and prior authorization checks
- Charge entry and coding review of visits, CGM, ultrasound and biopsy services
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for endocrinologists and APPs
- Patient statements and balance tracking
- Monthly reporting on collections, denials and A/R
Our billing team does not call your patients. Patient calls stay with your practice, or with an optional RevenueCTRL virtual assistant.
Pricing
Clear pricing for endocrinology practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing.
Our core focus is behavioral health. We bill endocrinology and other specialties with the same team, the same CPB-certified billers and the same service promises.
Common questions
How do you bill continuous glucose monitoring?
We bill 95249 or 95250 to start a patient on CGM, depending on who owns the device, and 95251 when the provider reviews and interprets the data. We check the recording time, the diagnosis and each payer’s frequency limit first. Rules vary by payer; we check current policy.
Can we bill a thyroid ultrasound and a biopsy on the same day?
Often yes, when the diagnostic ultrasound is a separate, documented study from the guidance used for the biopsy. The biopsy code already includes ultrasound guidance, so guidance is not billed again. Some payers bundle these, so we check their policy.
Do you handle prior authorizations for CGM and diabetes drugs?
We check benefits and flag when a service needs approval before it is done. Device supplies and many medications are covered under pharmacy or DME benefits, which your practice or the supplier submits, and we help track what the office claim needs.
Can you bill diabetes self-management training?
Yes, when your program and providers meet the payer’s requirements, such as accreditation under Medicare, and there is an order on file. We track each patient’s covered hours so claims stay inside the limits.
Is endocrinology your main specialty?
No. Our core focus is behavioral health. We bill endocrinology with the same team and the same promises: claims within 24 hours, denials worked within 5 business days, and a reply within 1 hour during business hours.
How much does endocrinology billing cost?
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. We give you an exact quote after a free review of your claims.
Guides from our team
Learn more before you decide
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Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
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Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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