Billing built for endocrinology, not generic medical.
Endocrinology is chronic care and complex E/M billing on almost every visit. CGM interpretation codes, insulin pump prior auths, thyroid ultrasound frequency rules, and diabetes complexity documentation all trip up general billers. Our endocrinology coders catch what general billers miss. Same 4.99% flat rate. Same dedicated manager.
Endocrinology CPT codes we handle every day.
CGM interpretation, thyroid procedures, and complex diabetes E/M coding. Our endocrinology coders know exactly what documentation supports what code.
CGM Interpretation
Continuous glucose monitor analysis and interpretation. Requires 72+ hours of data and physician review documentation.
CGM Start with Training
Patient-owned CGM start-up with training. Bundled with training documentation, one-time use per device.
Thyroid Biopsy
Percutaneous needle biopsy. Ultrasound guidance (76942) billed separately when performed.
Thyroid Ultrasound
Complete real-time ultrasound. Requires documented indication and interpretation report.
Level 4 Established Visit
Complex diabetes or multi-endocrine visits. Time-based (30-39 min) or MDM-based coding accepted.
Chronic Care Management
20+ minutes of non-face-to-face management per month for 2+ chronic conditions. Massively under-billed.
Where endocrinology billing usually breaks.
Three patterns account for most denials in endocrinology. Our specialized coders catch these before submission.
CGM Medical Necessity
CGM interpretation and pump claims denied for insufficient documentation of Type 1 diabetes, insulin regimen, or frequency of glucose testing.
E/M Level Downgrades
99214 and 99215 downgraded to 99213 when time or medical decision-making documentation is missing.
Prior Authorization
Insulin pumps, GLP-1 agonists, and specialty thyroid medications denied for missing or expired prior auth.
Each endocrine sub-specialty billed differently. We handle all of them.
Coders matched to your sub-specialty. Diabetes management billing looks nothing like thyroid procedure billing, and pediatric endocrinology has its own coding conventions.
Diabetes Management
Type 1 and Type 2 diabetes with insulin management, CGM interpretation, and complex E/M visits. Highest volume in most practices.
Thyroid Disorders
Hypothyroidism, hyperthyroidism, thyroid nodules, cancer surveillance. Biopsy and ultrasound heavy sub-specialty.
Adrenal & Pituitary
Cushing’s, Addison’s, hyperaldosteronism, pituitary adenomas. Complex hormone panels and MRI interpretation.
Pediatric Endocrinology
Growth disorders, precocious puberty, Type 1 diabetes in children. Growth hormone billing requires strict documentation.
Reproductive Endocrinology
PCOS, hypogonadism, fertility hormone panels. Overlap with OB-GYN billing for female patients.
Metabolic & Bone
Osteoporosis, calcium disorders, obesity management. DEXA scans and bone density monitoring frequency-limited by payer.
Endocrinology-specific rules we track for you.
CGM coverage rules change annually. Insulin pump PA requirements vary by payer. Chronic care management is under-billed by most endocrinology practices. We track every rule that affects your revenue.
Medicare and commercial CGM rules tracked monthly
CMS updated Medicare CGM coverage rules to include Type 2 patients on insulin in 2023. Commercial payers have their own criteria. We track updates from every major payer so your CGM billing stays clean.
99490 and 99491 rules applied for diabetes patients
CCM codes are massively under-billed by endocrinology practices managing Type 2 diabetes with 2+ chronic conditions. Most practices see $40K to $100K a year in previously-missed CCM revenue after we set up the workflow.
Pump and pump supply PA rules current per payer
Insulin pump prior auth requirements vary by payer, patient age, and diabetes type. We maintain a live rulebook and initiate PAs at prescription so pumps aren’t stuck at the DME supplier.
Payer-specific TSH monitoring and ultrasound rules tracked
Most payers cover thyroid ultrasound annually for nodules and every 6 months for cancer surveillance. Additional scans need documented indication. We track allowed frequency per patient per payer.
Full-service endocrinology billing.
Everything an endocrinology practice needs, from diabetes management to thyroid procedures and specialty pharmacy coordination.
CGM & Pump Billing
Interpretation, training, and pump supply billing with proper documentation.
Complex E/M Coding
Level 4 and 5 visits captured with time or MDM documentation.
Chronic Care Management
CCM codes captured for eligible diabetes and multi-endocrine patients.
Thyroid Procedures
Biopsies, ultrasounds, RAI treatment coordination with proper coding.
Prior Auth Management
Every pump, GLP-1, and specialty medication pre-authorized before dispense.
Dedicated Manager
Same person answers when you have CGM coding questions or need an appeal filed.
“We’re a three-endocrinologist practice heavy on Type 2 diabetes with cardiac and kidney complications. Our previous biller never billed chronic care management. CureMed set up the workflow in a month and we’re now capturing seventy-four thousand a year in CCM alone. Feels almost unfair how much was being left behind.”
Common questions about endocrinology billing.
What is endocrinology billing?
Endocrinology billing covers claims for hormone and metabolic disorder care including diabetes management, thyroid disease, adrenal disorders, continuous glucose monitor (CGM) training and interpretation, insulin pump management, and complex chronic disease E/M visits.
What are the most common endocrinology CPT codes?
Common endocrinology CPT codes include 95251 (CGM interpretation), 95249 (CGM start with training), 60100 (thyroid biopsy), 76536 (thyroid ultrasound), 99490 (chronic care management), and level 4-5 E/M codes (99214, 99215) for complex diabetes and multi-endocrine visits.
Why do endocrinology claims get denied?
Top reasons include CGM medical necessity documentation gaps (33%), E/M level downgrades from missing time or complexity documentation (25%), and prior authorization issues for insulin pumps and specialty drugs (18%).
Do you bill chronic care management (CCM) for us?
Yes, and this is often the largest revenue opportunity for endocrinology practices. We identify eligible diabetes and multi-endocrine patients, get consent, and build the billing workflow around your existing follow-up cadence. Most practices see $40K to $100K a year in previously-missed CCM revenue.
How do you handle insulin pump prior authorizations?
We initiate PAs at prescription, not after the pump is stuck at the DME supplier. Our team maintains a live payer rulebook for pump PA requirements and follows up daily until approval or exhaustion.
Ready for billing that actually speaks endocrinology?
Send us three months of your claims and CGM documentation. We’ll deliver a free endocrinology-specific audit within a week showing exactly where your revenue is slipping and how much CCM you’ve been missing.