Our Endocrinology Billing Services
We build a program tailored to your workflows and payer mix. Typical services include:
Insurance & Eligibility
-
Real-time eligibility & benefit verification at scheduling and check-in.
-
Identification of medical necessity and prior-auth requirements for devices, biologics and DME.
Charge Capture & Coding (Endocrinology-trained coders)
-
Accurate CPT/HCPCS/ICD-10 mapping for CGM, insulin pumps, DME, DSMT/DSMS, RPM/RTM (e.g., CPT 95251, 99457 types, G-codes where applicable).
-
Proper modifier & laterality handling; split-visit/E&M + procedure audits.
Device, DME & Pharmacy Reconciliation
PDAC/PDL/HCPCS validation for CGMs and insulin pumps; supplier enrollment and invoice-to-claim reconciliation so device claims don’t fail.
Prior-auth automation for high-cost endocrine meds and biologics.
DSMT/DSMS/CCM & Chronic Care Billing
Ensure DSMT program accreditation requirements are met and session codes (G0108/G0109 or equivalent) are billed correctly.
Chronic Care Management (CCM) support and documentation for CPTs like 99490/99491 when applicable.
RPM / RTM Integration
Device onboarding, adherence to monitoring data thresholds (e.g., required days/data points), correct time-based reporting and documentation for CPTs 99457/99458 and other monitoring codes.
Imaging & Ancillary Procedure Billing
-
DEXA, thyroid ultrasound, pathology and lab claim reconciliation with procedural attachments where required.
-
Claim Scrubbing & Submission
-
Specialty scrubs tuned for endocrine patterns (device codes, DSMT, RPM, biologics) before submission to improve first-pass acceptance.
Denial Management & Appeals
Root-cause analytics to stop recurrent denials; evidence-based appeals with chart excerpts, lab trends and device logs.
Patient Billing & Consumer Experience
-
Empathy-first financial conversations, payment plans, transparent statements that explain device costs vs. medical charges.
Reporting & Advisory
-
Monthly dashboards (net collection rate, denial reasons, A/R days, device capture rate) and quarterly strategy calls.
Big Picture Outcomes You Should See
When an endocrine practice moves to a specialty RCM partner, realistic improvements include:
· Faster payments and reduced A/R days through prioritized follow-up.
· Fewer denials for device, RPM/RTM, and DSMT claims through specialty scrubs and human appeals.
· Recovered missed device and vaccine/DME revenue via reconciliation.
· Better patient financial experience with clear, empathy-first outreach.
Those gains come from a mix of automation (AI that finds patterns) and humans who close the loop on complex decisions.
Why endocrinology billing needs a specialist approach
Endocrinology isn’t “just” office visits. You bill for device services (CGM downloads and interpretation), diabetes self-management and nutrition education, remote monitoring, infusion or drug therapy oversight, bone density testing, and complex follow-ups. Each of these areas has payer-specific rules that change often so a specialist billing workflow prevents missed revenue and reduces audit risk. For example, continuous glucose monitor (CGM) coverage and coding requirements are governed by specific Medicare policy and PDAC device listings; billing CGM incorrectly is a frequent source of denials.
Endocrinology Billing Services
Automation-powered streamlined billing solutions for endocrinology clinics aided by artificial intelligence
Endocrinology blends routine chronic care with high-complexity technology and device billing. From CGMs and insulin pumps to DSMT/DSMS programs, RPM/RTM, DEXA scans and specialty biologics endocrinology billing requires both clinical nuance and billing precision. At Sirius Solutions Global, we pair endocrinology-trained coders with AI-augmented workflows and human review to make sure your practice captures every appropriate dollar while protecting patient trust and payer compliance.
Benefits of Partnering with Sirius Solutions Global
Quicker payments come from streamlined billing processes. Certified coders reduce claim mistakes. Release your team for patient care by lowering administrative load. Customized services for solo practitioners, team practices, and multi-specialty clinics. Comprehensive reports to increase operational efficiency.
Endocrinology Medical Billing, Explained
Endocrinology billing centers on the whole revenue cycle for endocrine practices diabetes care, thyroid disease, and hormone therapies, among others. Specialized teams manage insurance checks, accurate coding, claim submission, denial follow-ups, and payment posting so practices are suitably compensated and may concentrate on patient care. Firms like I-Med Claims, CureMD, and PCH Global offer these services for the complex world of endocrine diagnoses and tests.
What Is Endocrinology Billing?
It offers billing specifically designed to meet the requirements of diabetes, thyroid conditions, and hormone imbalances that of the endocrine system. The objective is correct: uniform compensation for thyroid treatments and hormone treatment.
Specialized Focus
Deep familiarity with endocrine conditions ensures the right codes and documentation are used for complex cases.
Key services we optimize for endocrinology
-
Proper HCPCS/CPT mapping ensures that the equipment complies with PDAC listing through CGM configuration, download, and analysis (CPT/HCPCS management).
-
Diabetes self-management education and training (DSMT/DSMS/DSMT) is defined by accreditation, appropriate usage of Medicare DSMT codes G0108 / G0109, and staffing and credential requirements.
-
Remote physiological monitoring (RPM) and remote therapeutic monitoring (RTM) are defined by the correct use of 99457/99458, the device against treatment-management instructions, and data demands for compensation.
-
Medicare/Medicaid Medical Nutrition Therapy (MNT) and correct G-codes.
-
DEXA (bone density), pathological reconciliations, and thyroid ultrasound tests are among endocrine system and imaging reconciliations.
-
Anti-resorptives for osteoporosis, biologics, or certain diabetic drugs needing permission are among complex pharmaceuticals and previous approval protocols.
-
Audio-only telehealth appointments are observed with payer-specific modifiers and consent where allowed.
Choosing the Right Partner
-
Experienced with endocrine abnormalities and the pertinent billing codes, specialized knowledge.
-
Tailored workflows: Processes that suit your emphasis—diabetes care, thyroid health, or pediatric endocrinology.
-
Comprehensive RCM: One coordinated team spanning every stage of the revenue cycle.
10-Point Endocrinology Billing Audit
Use this as a checklist you can run or share with us for a free baseline review.
1. Are CGM device and supplier HCPCS/PDAC/PCL codes validated before billing? (include UDI where required)
2. Is your DSMT/DSMS program accredited, and are session codes and attendance documented correctly? (G0108/G0109 or payer equivalents)
3. Are RPM/RTM services meeting device-specific data/time thresholds and documented for the required time periods?
4. Is telehealth modality and patient consent documented per current payer rules (audio-only where allowed)?
5. Are prior authorizations triggered automatically for specialty endocrine meds and biologics at order time?
6. Are DEXA and pathology attachments reconciled and correctly attached to the procedural claim?
7. Is split-visit logic (E/M + procedure) audited and are modifiers (25, 59/XS) applied correctly?
8. Are denials root-caused and are process changes tracked monthly to prevent recurrence?
9. Are patient outreach scripts empathy-first with payment plan options and clear device/medical separation?
10. Are detailed audit trails kept (who edited the claim, when and why) and are all edits logged?
7 Actions That Protect Revenue
1. Device compliance & CGM coding verification (PDAC/HCPCS checks).
2. Accredited DSMT/DSMS billing and attendance reconciliation.
3. RPM/RTM integration with device onboarding and data thresholds.
4. Prior-auth automation for specialty meds with medical record attachments.
5. Telehealth readiness & consent capture.
6. Pre-submission scrubs tuned to endocrine patterns.
7. Human-in-the-loop appeals (AI drafts, humans submit).
How AI Changes the Game
AI speeds the repetitive work and surfaces risks always with human review.
What our AI does
-
Automated OCR & chart parsing: extracts lab trends, CGM downloads and medication titrations to pre-populate claim fields and appeal packets.
-
Predictive denial scoring: flags claims with high denial probability so coders prioritize them.
-
Smart prior-auth builders: assemble required documents (labs, images, device logs) into a ready packet to speed approvals.
-
Continuous learning: scrub rules evolve with resolved appeal outcomes so the system learns which clinical phrases win appeals.
Where humans step in
Every critical decision prior authorization submission, medical-necessity narrative, or appeal sign-off is reviewed and finalized by a trained endocrinology coder or clinician. AI suggests; people decide.
The Hard Problems Endocrine Practices Face
Problem: Device & CGM Claim Failures
Why it happens: CGM and pump claims are rejected when PDAC/HCPCS codes don’t match supplier listings, UDIs are missing, or clinical documentation doesn’t support the device use.
How we fix it: We validate device and supplier codes against PDAC/PCL before billing, reconcile invoices to claims, and follow a documented supplier-path billing flow so device claims pass eligibility and coverage checks. This reduces rejections and lost device revenue.
Problem: DSMT/DSMS Program Billing Errors
Why it happens: DSMT/DSMS billing requires accredited programs, session tracking, proper codes (G0108/G0109 historically, plus payer variants) and attendance documentation. Without audit trails, payers often deny.
How we fix it: We verify accreditation, implement session-level documentation templates, ensure the correct code variants are used, and build audit packets for payers.
Problem: RPM/RTM Time & Data Requirements
Why it happens: RPM/RTM codes require meeting specific data collection thresholds and documentation of time spent. Misinterpretation causes denials.
How we fix it: Our RPM workflows enforce data thresholds and automate time logs; our coders and auditors verify claims meet clinical criteria before submission.
Problem: Prior Auths for Specialty Drugs & Biologics
Why it happens: High-cost endocrine meds and biologics often need authorization plus clinical attachments (labs, prior trials). Delays or missing documentation cause claims to deny or be delayed.
How we fix it: We automate prior-auth triggers at order time, collect needed records (labs, dosing history), and build appeal packages when payers push back.
Problem: Close Link Between Clinical Data and Medical Necessity
Why it happens: Endocrine decisions (dose titration, lab trends, CGM downloads) must be clearly documented to support services billed. When charts are sparse, payers deny.
How we fix it: We use OCR and chart parsing to extract lab trends and device data into appeal packets and claims, and we build documentation templates clinicians can use to capture necessary elements quickly.
Partner with the Endocrinology Billing Experts
Endocrinology calls for regular and correct billing assistance from first patient visits through long-term treatment programs. Your reliable partner in reaching enhanced cash flow, fewer denials, and total compliance is Sirius Solutions Global. Today, call us to find out how we might improve your endocrinology billing income and speed.