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Endocrinology Billing Guidelines for 2026: Complete CPT, ICD-10, CMS & Reimbursement Guide

Doctor examining a woman's throat in a clinical setting. Blue and white presentation slide reads "Endocrinology Billing Guidelines for 2026."




Endocrinology has always been a documentation-heavy specialty. But in 2026, it’s no longer just about diagnosing diabetes or managing thyroid disorders it’s about navigating CMS policy updates, payer scrutiny, risk-adjusted coding, and value-based care models that directly impact reimbursement.


Across the U.S., endocrinology practices are facing:

  • Increased claim denials for E/M services

  • Downcoding due to insufficient MDM documentation

  • Missed revenue from chronic care management (CCM) and RPM

  • Heightened audit risk tied to diabetes complexity coding


At Sirius Solutions Global, we work with endocrinology practices every day solo clinics, hospital-based groups, and multi-location specialty practices. What we see consistently is this: excellent clinical care does not automatically translate into correct reimbursement.




Before diving into codes, it’s critical to understand the billing environment endocrinologists are operating in this year.

Key Endocrinology Billing Changes in 2026

  • E/M leveling continues to rely heavily on Medical Decision Making (MDM)

  • Time-based billing audits are increasing, especially for diabetes management visits

  • Risk Adjustment Factor (RAF) accuracy is now closely reviewed for endocrine diagnoses

  • Expansion of Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) reimbursement

  • Stricter documentation expectations for complex diabetes, thyroid cancer, and adrenal disorders

These shifts mean billing teams must think beyond CPT selection and focus on clinical storytelling through documentation.





Endocrinology billing revolves around a combination of E/M services, procedural codes, and chronic care management codes.


Common Endocrinology E/M Codes


2026 Reminder: History and exam are no longer the drivers of E/M level selection MDM or total time is what matters.


Endocrinology-Specific CPT Codes

  • 95249 / 95250 / 95251 – Continuous Glucose Monitoring (CGM)

  • 83036 – Hemoglobin A1c testing

  • 36415 – Venipuncture

  • 78012–78014 – Thyroid uptake studies

  • 60210–60252 – Thyroid procedures (global billing considerations apply)

Correct modifier usage and documentation are essential to prevent bundling denials.


ICD-10 Coding Updates That Impact Endocrinology in 2026

Diagnosis coding accuracy has become one of the largest revenue drivers in endocrinology.

High-Impact Endocrinology ICD-10 Codes

  • E11.9 – Type 2 diabetes mellitus without complications

  • E11.65 – Type 2 diabetes with hyperglycemia

  • E10.65 – Type 1 diabetes with hyperglycemia

  • E03.9 – Hypothyroidism, unspecified

  • E05.90 – Hyperthyroidism, unspecified

  • E66.9 – Obesity, unspecified

Important: Coding “unspecified” diagnoses without clinical justification increases audit risk and lowers risk-adjusted reimbursement.




Endocrinology visits often qualify for moderate or high MDM, but many practices undercode because documentation doesn’t clearly reflect complexity.

What Payers Look for in Endocrinology MDM

  • Management of multiple chronic conditions

  • Medication adjustments (insulin, GLP-1s, thyroid hormone)

  • Review of labs and CGM data

  • Risk of complications (hypoglycemia, cardiovascular disease)

  • Coordination with primary care or specialists

When documented correctly, many routine diabetes follow-ups legitimately qualify for 99214 or 99215.






Few specialties are better suited for CCM than endocrinology yet it remains one of the most underutilized revenue streams.

Common CCM Codes

  • 99490 – Standard CCM (20 minutes)

  • 99439 – Each additional 20 minutes

  • 99491 / 99437 – Physician-provided CCM

Patients with diabetes, thyroid disorders, osteoporosis, or adrenal disease often qualify automatically.

At Sirius Solutions Global, we routinely uncover $2,000–$5,000/month in missed CCM revenue during endocrinology audits.





With CGMs and connected devices becoming standard, RPM billing is a major opportunity in 2026.

Key RPM Codes

  • 99453 – Device setup & patient education

  • 99454 – Device supply & data transmission

  • 99457 / 99458 – Treatment management services

Proper consent, data thresholds, and time tracking are critical for compliance.





Across hundreds of claims, the same problems appear repeatedly:

  • Under-coding E/M visits

  • Missing documentation for time-based billing

  • Incorrect CGM code selection

  • Failure to capture RAF-eligible diagnoses

  • No billing for CCM or RPM despite eligibility

These are process problems, not clinical ones and they’re fixable.





Endocrinology billing is not generic internal medicine billing. It requires:

  • Specialty-specific CPT & ICD-10 expertise

  • Understanding of diabetes complexity

  • Knowledge of payer behavior across states

  • Audit-safe documentation workflows

Practices often compare us with:

  • MedBillMD

  • Kareo Billing

  • R1 RCM

  • BellMedEx

  • AdvancedMD Billing

They choose Sirius Solutions Global because we combine automation, specialty knowledge, and human oversight not cookie-cutter billing. We leads with innovative, results-driven services. Explore our Endocrinology billing expertise today.


Final Thoughts: Endocrinology Billing Success in 2026

Endocrinology practices that thrive in 2026 are not the ones seeing more patient they are the ones billing smarter, documenting better, and using data to drive decisions.

With the right billing partner, endocrinology doesn’t have to be high-risk or unpredictable.

Sirius Solutions Global helps practices turn complex endocrine care into consistent, compliant revenue.



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