ENT billing
ENT billing services for otolaryngology practices
We handle billing for ENT and otolaryngology practices, from office visits with same-day nasal endoscopy to audiology testing, allergy services and sinus procedures. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Same-day E/M and endoscopy coding with modifier 25
- Audiology and allergy testing billed with correct units
- Prior auth checks for balloon dilation and sinus surgery
Why ENT billing is different
Why ENT billing is different
An ENT visit often turns into a procedure on the same day. That means bundling edits, modifiers and global periods decide whether each line on the claim gets paid.
Scopes on the same day as a visit
Diagnostic nasal endoscopy (31231) and flexible laryngoscopy (31575) are often done during an office visit. The E/M only pays when it is significant and separately identifiable, with modifier 25 and notes that show it. A diagnostic scope is generally bundled into a surgical endoscopy in the same session.
Global surgical periods
Sinus, ear and throat procedures carry 0, 10 or 90-day global periods. Follow-up visits inside the global are not paid separately. Unrelated visits need modifier 24, and a return to the OR needs 78 or 79, with the right diagnosis.
Bilateral and laterality rules
Many ear and sinus procedures can be done on one or both sides. Payers differ on modifier 50 versus RT and LT, and on how units are reported. Getting this wrong causes denials or half payments.
Audiology billing
Hearing tests are billed under the rendering audiologist or physician, and some tests bundle together. Medicare generally does not cover routine hearing exams or hearing aids, so an ABN or patient estimate may be needed.
Allergy testing and immunotherapy
Skin tests are billed per test, and antigen preparation is billed per dose. Unit counts, payer caps on the number of tests, and matching the injection code to the extract preparation are common trouble spots.
Prior authorization for procedures
Balloon sinus dilation, functional endoscopic sinus surgery, sinus CT and some sleep procedures often need authorization. Payers may ask for proof of failed medical therapy before they approve.
Common codes
ENT codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 31231 | Diagnostic nasal endoscopy | Modifier 25 on a same-day E/M only when supported; bundled with surgical sinus endoscopy |
| 31575 | Flexible diagnostic laryngoscopy | Separate indication documented; bundling edits with other scopes the same day |
| 69209 / 69210 | Impacted cerumen removal by lavage / by instrumentation | Impaction documented; bilateral reporting rules differ by payer |
| 31295–31298 | Sinus ostial balloon dilation | Prior authorization and failed medical therapy documented |
| 92557 / 92567 | Comprehensive audiometry / tympanometry | Rendering provider, bundling with other audiology tests, Medicare coverage limits |
| 95004 / 95024 | Percutaneous and intradermal allergy tests | Units equal the number of tests; payer caps per year |
| 95165 | Allergen immunotherapy antigen preparation | Units per dose; matches the injection codes (95115 / 95117) |
| 69433 / 69436 | Tympanostomy tube placement (local / general anesthesia) | Global period, laterality and anesthesia type |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
ENT denials we stop before they happen
Most ENT denials come from the same handful of issues. We check for them during coding review, before the claim goes out.
- E/M denied with a same-day scope because modifier 25 was missing or the note did not support a separate service
- Follow-up visits billed inside a global period without modifier 24 or an unrelated diagnosis
- Diagnostic endoscopy billed alongside a surgical endoscopy in the same session
- Bilateral procedures billed with the wrong modifier or unit count for that payer
- Allergy tests or antigen doses billed over the payer’s unit or yearly limit
- Balloon dilation or sinus surgery done without an approved authorization on file
- Hearing tests billed to Medicare as routine screening without an ABN
What we handle
Everything between the visit and the payment
- Insurance eligibility and benefits checks before visits and procedures
- Charge entry and coding review of E/M, scope, audiology and allergy codes
- 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
- Credentialing for physicians, audiologists and advanced practice providers
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Behavioral health is our core focus. We bill ENT and other specialties with the same team, the same promises and CPB-certified billers on the team.
Pricing
Clear pricing for ENT 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 with billing.
Common questions
Can we bill an office visit and a nasal endoscopy on the same day?
Yes, when the visit is significant and separately identifiable from the scope. The E/M is billed with modifier 25, and the note must show work beyond the usual pre-procedure evaluation. If the decision to scope is the whole visit, the E/M usually is not paid.
How do you bill bilateral cerumen removal?
It depends on the payer. Some want modifier 50 on one line, others want RT and LT or a unit count. Impaction has to be documented for 69209 or 69210. We apply each payer’s current rule before submission.
Do you bill audiology services?
Yes. We bill hearing tests under the rendering audiologist or physician and check bundling between tests. Medicare generally does not cover routine hearing exams or hearing aids, so we flag when an ABN or patient estimate is needed.
Do you handle prior authorization for balloon sinus dilation?
Yes. We check whether the payer requires authorization and what documentation it wants, such as failed medical therapy or CT findings. Requirements vary by payer, so we check current policy for each case.
How do you handle allergy testing units?
Skin tests are billed with units equal to the number of tests, and antigen preparation is billed per dose. We check the payer’s yearly limits and make sure injections and extract preparation match.
How much do ENT billing services cost?
Billing starts at 2.5% of collections, with flat monthly fees and dedicated billers also available. No setup fee and no long-term contract.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
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
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
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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