Common Endocrinology CPT Codes for 2026: What You Actually Need to Know
- Sirius solutions global
- 2 days ago
- 10 min read
We have been working with endocrinology practices for years, and We can tell you billing for these specialties is a whole different ballgame. Between managing patients with complex diabetes cases, navigating thyroid workups, and dealing with the constant changes in payer requirements, it's easy to feel overwhelmed.
Here is the thing: most endocrinology practices lose money simply because they don't know which codes to use or how to document properly. I have seen practices leave thousands on the table every month just from undercoding routine visits or missing charges for patient education time.
So let's cut through the confusion. This guide walks you through the CPT codes you will actually use day-to-day in 2026, plus some insider tips I have picked up that can make a real difference in your bottom line.
Why Endocrinology Billing Is Trickier Than Most People Think
Look, every specialty has its challenges. But endocrinology? You are dealing with chronic disease management, lengthy patient interactions, tons of lab work, and procedures that range from simple injections to complex ultrasound-guided biopsies.
The problem is that most billing teams even good ones weren't trained specifically on endocrine coding. They might know general E&M codes, but ask them about continuous glucose monitoring billing or parathyroid imaging, and you'll get blank stares.
I have reviewed hundreds of endocrinology charts over the years. Want to know what I see most often? Providers doing the work but not getting paid for it. They spend 20 minutes counseling a newly diagnosed diabetes patient but only bill a level 3 visit. They provide chronic care coordination but never use the CCM codes. It adds up fast.
The good news? Once you nail down the right codes and learn how to document properly, billing becomes way less stressful. And your revenue will reflect all the hard work you're actually doing.
The Bread and Butter: Office Visit Codes
Let's start with what you use every single day evaluation and management codes. These are the backbone of your practice revenue.
New Patient Visits
When someone walks through your door for the first time, you will use one of these:
99202: Pretty straightforward visit, usually 15-29 minutes
99203: Bit more involved, low complexity, 30-44 minutes
99204: This is where most new endocrine patients land moderate complexity, 45-59 minutes
99205: Your complex cases, 60-74 minutes
Here's my advice: don't be afraid to bill what you actually do. New diabetes diagnoses? That's usually a 99204 or 99205. Multiple comorbidities, reviewing outside records, coordinating with primary care? You've earned that higher level code.
Established Patient Follow-Ups
For return visits, you're looking at:
99212: Quick check-ins, 10-19 minutes
99213: Standard follow-up, 20-29 minutes this is your workhorse code
99214: More complex follow-ups, 30-39 minutes
99215: High complexity, 40-54 minutes
Most stable diabetes or thyroid patients doing well? That's probably a 99213. But if you are adjusting multiple medications, reviewing recent labs, and addressing new concerns? Bill the 99214. You earned it.
One thing that's made life easier: time-based billing. Just document your total time including reviewing the chart before the visit, talking with the patient, and wrapping up notes afterward. It's much simpler than trying to justify complexity levels.
Chronic Care Management: The Money You're Probably Missing
This is where we see practices leave the most money on the table. If you are managing patients with diabetes, thyroid disease, or metabolic syndrome between visits, you should be billing for it.
99490 is your basic chronic care management code. If your team spends at least 20 minutes per month on non-face-to-face care think medication refills, reviewing labs, coordinating with other providers, checking in by phone you can bill this. It's worth about $40-60 depending on your payer.
99491 is for complex chronic care management 60 minutes or more per month. Patients with multiple conditions requiring significant coordination? This one's for you.
Here's the catch: you need to track your time. Seriously. Get a system in place where staff document every phone call, every prescription review, every care coordination activity. Without documentation, you can't bill it.
We have helped practices implement CCM programs that brought in an extra $30,000-50,000 annually. That's real money that was already being earned just not captured.
Diabetes Management: More Than Just Office Visits
Diabetes is probably your biggest patient population, so let's talk about the specific codes you need.
Patient Education and Training
A lot of providers don't realize they can bill separately for diabetes education. Here's what's available:
97802: Initial nutrition therapy assessment
97803: Follow-up nutrition sessions (billed per 15 minutes)
98960: Individual diabetes self-management training, first session
98961: Each additional individual training session
98962: Group education (you need 5-8 patients)
The key is documentation. You need to show the physician ordered the training, what was covered, and how long it took. Many payers require the patient to have a fairly recent diagnosis or a change in treatment to cover this.
Continuous Glucose Monitoring
CGM has been a game-changer for diabetes management. The billing? Not quite as simple as it should be.
95249: Setting up the CGM, teaching the patient how to use it
95250: Professional CGM where you place the sensor and interpret the data
95251: Analyzing and reporting on CGM data
Medicare's loosened up coverage for CGM, which is great news. But you still need solid documentation showing medical necessity. Make sure you're documenting why the patient needs CGM uncontrolled blood sugars, history of severe hypoglycemia, whatever the clinical reason is.
And please, verify coverage before ordering. We have seen too many situations where the patient gets stuck with a $500 bill because nobody checked insurance first.
Thyroid Procedures: What Most Practices Do
Thyroid nodules and disorders keep endocrinologists busy. Here are the codes you will use regularly.
Fine Needle Aspiration Biopsy
If you are doing thyroid FNAs in your office (and most endocrinologists do), you need these codes:
10006: FNA with ultrasound guidance, first lesion
10007: Each additional lesion with ultrasound guidance
10004: FNA without imaging, first lesion
10005: Each additional lesion without imaging
Real talk: always use ultrasound guidance when you can. It's better medicine, and it pays better too. The guidance codes reimburse significantly more than blind FNAs.
Document how many needle passes you made, whether you got adequate samples, and any complications. Some payers want to see this level of detail.
Thyroid Ultrasound
76536 is your go-to code for thyroid ultrasound. Make sure your medical necessity is clear palpable nodule, abnormal thyroid function tests, following up on a known nodule. Whatever it is, document it.
Bone Density Scanning for Osteoporosis
A lot of endocrinologists manage osteoporosis, especially in post-menopausal women and patients on long-term steroids.
77080 is your standard DEXA scan code for central skeleton measurements hip and spine. Medicare covers this every two years for qualifying patients.
77081 adds vertebral fracture assessment, which you should consider in patients with height loss or kyphosis.
Document risk factors clearly. Previous fractures, steroid use, family history, low body weight whatever applies to your patient. This supports medical necessity and keeps auditors happy.
Injections and Infusions: Don't Leave These Behind
If you're giving injections in your office testosterone, B12, osteoporosis medications you need to bill for both the drug and the administration.
Injection Administration
96372: Subcutaneous or intramuscular injection
96374: IV push, single substance
96413: Chemotherapy administration (for certain cancer-related hormone therapies)
Then you bill the drug separately with a J-code. For example:
Testosterone cypionate is J1071
Vitamin B12 is J3420
Denosumab (Prolia) is J0897
Common mistake I see: billing the injection code but forgetting the drug code, or vice versa. You need both to get full reimbursement.
Infusion Therapy
Some endocrinology practices offer IV hydration or infusion therapy:
96360: First hour of IV hydration
96365: First hour of therapeutic infusion
These come up less frequently in endocrinology than in some other specialties, but when you do them, make sure you're capturing the charges.
Lab Testing: The Foundation of Endocrine Care
You order labs all day long. Here are the most common codes you'll need:
83036: Hemoglobin A1c you are billing this constantly
84443: TSH another daily code
84439: Free T4
84481: T3 or Free T3
82947: Blood glucose
84402: Testosterone, free
84144: Progesterone
82670: Estradiol
80053: Comprehensive metabolic panel
Medicare simplified lab billing by eliminating the need for Modifier QW on most tests. Just make sure your lab is CLIA-certified and you're documenting why each test was necessary.
Here's something to watch: payers are getting pickier about "routine" lab orders. If you're ordering the same panel on every patient every visit without clinical justification, expect to see some denied claims. Tie your lab orders to specific diagnoses or clinical decisions.
Specialized Testing and Procedures
Beyond the basics, you've got some more specialized codes that come up regularly.
Parathyroid Evaluation
When you're working up hyperparathyroidism:
78070: Parathyroid imaging, basic
78071: With SPECT
78072: With SPECT and CT
Adrenal Function Tests
82528: Cortisol level
82533: 24-hour urine free cortisol
80400: ACTH stimulation panel
These adrenal tests get audited fairly often, so your documentation needs to be rock solid. Why are you suspecting adrenal dysfunction? What were the clinical findings? Spell it out.
Mistakes That Cost You Money (And How to Avoid Them)
We have seen the same billing mistakes over and over. Let me save you the headache.
Undercoding visits: This is huge. A lot of providers bill 99213 for everything because it's "safe." But if you spent 35 minutes managing a complex patient with multiple medication adjustments, that's a 99214. Bill what you did.
Forgetting Modifier 25: When you do a procedure and an E&M on the same day, you need Modifier 25 on the E&M code. Without it, the E&M gets denied as bundled. I see this missed constantly with FNAs or injections.
Poor documentation: Your notes have to support your code. If you bill a 99215 but your note looks like a 99213, you're going to lose that appeal. Document thoroughly.
Not tracking time: If you're using time for E&M coding, document it. "Total time: 32 minutes" in your note protects you and supports your code choice.
Missing charges: Small things add up. That injection you gave? The patient education? The care coordination? If you don't capture it in real-time, it's lost revenue.
How Documentation Makes or Breaks Your Reimbursement
We can't stress this enough: documentation is everything. Good coding means nothing if your notes don't back it up.
For time-based billing, just write the total time in your note. "Total time spent today: 38 minutes including reviewing labs from 2/1, face-to-face exam and discussion, and calling endocrine surgery regarding referral." Done. That supports your 99214.
For chronic care management, keep a running log. Date, time spent, what was done. "2/5/26 - 8 minutes, medication refill and pharmacy coordination for insulin." Stack those up to 20 minutes in a month, and you have got a billable service.
Medical necessity is your best friend. For every test, every procedure, every service your note should make it obvious why it was necessary. Don't make auditors guess.
What's Different with Various Insurance Companies
Not all payers play by the same rules. Here's what you need to know for 2026.
Medicare: They've expanded CGM coverage for insulin users, which is great. But they're also cracking down on medical necessity documentation across the board. Do your documentation right the first time.
Commercial payers: Prior authorization requirements are getting more aggressive. Growth hormone, testosterone therapy, expensive osteoporosis drugs expect to jump through hoops. Start the PA process early.
Medicaid: Coverage varies wildly by state. What's covered in California might not be covered in Texas. Always verify before providing services.
Top Endocrinology Medical Billing Companies in 2026
Specialized partners handle complex coding and denials effectively:
Sirius Solutions Global — Leads with deep endocrinology expertise, strong denial reduction (60-80%), and compliance focus on CGM and thyroid procedures.
Coronis Health
CureMD
MedCare MSO
Quest MBS
BellMedEx
Why Practices Choose to Work with Sirius Solutions Global
Here's the reality: billing takes time away from patient care. And unless you've got a really strong in-house team with endocrinology-specific experience, you're probably not capturing everything you should.
We've worked with endocrinology practices for years. What we've learned is that every practice has the same challenges keeping up with code changes, managing denials, ensuring proper documentation, dealing with prior authorizations.
Our team knows endocrinology inside and out. We catch coding errors before claims go out. We appeal denials aggressively and we win most of them. We help implement chronic care management programs that actually generate revenue instead of just adding paperwork.
Most practices we work with see their collections increase by 15-25% in the first six months. Not because we're doing anything shady just because we're capturing revenue they were already earning but not billing for.
We handle CGM billing (which is complicated), prior authorizations (which are annoying), and the day-to-day claim management so your team can focus on patients.
Interested in seeing what we could do for your practice?
We offer a free billing analysis. We'll review your current performance and show you specifically where revenue is being left on the table. No obligation, just information. Reach out to our team whenever you're ready.
Staying Out of Trouble: Compliance Basics
Nobody wants to deal with an audit. Here's how to stay safe.
Run internal audits quarterly. Pull 10-15 charts randomly and review them. Are the codes supported? Is the documentation adequate? Catch problems before payers do.
Train your staff regularly. CPT codes change every January. Payer policies change throughout the year. Keep everyone current.
Have written policies for your common scenarios. "How we code new diabetes visits." "Our policy for billing chronic care management." When questions come up, you've got answers.
Consider a basic compliance program even if you're a small practice. It doesn't have to be complicated just some written policies, regular training, and periodic audits.
Wrapping This Up
Endocrinology billing doesn't have to be a nightmare. Once you know which codes to use, how to document properly, and what payers are looking for, it gets a lot easier.
The practices that do well financially are the ones that treat billing as seriously as they treat clinical care. They invest in good systems, train their staff, and don't leave money on the table.
Whether you handle billing in-house or work with a partner, the key is staying current and being thorough. Use the right codes, document well, and follow up on denials. Do that consistently, and your revenue cycle will be in good shape.
If you're struggling with billing or just want to make sure you're not missing anything, that's exactly what we help practices with every day. Sirius Solutions Global specializes in endocrinology revenue cycle management from daily claim submission to complete billing optimization.
Want to talk about your specific situation? Schedule a free consultation with our team. We will look at your practice's numbers, identify opportunities, and show you exactly how we can help. No pressure, just practical solutions from people who genuinely understand endocrinology billing.
Your practice works hard. Your billing should work just as hard for you.
