Pulmonology Medical Billing Services
Pulmonology medical billing is specialty billing and revenue cycle work built for pulmonary practices where a pulmonary function test billed without its professional/technical split, a pulmonary rehab session billed past the covered limit, or a bronchoscopy coded without its distinct components is the difference between full payment and a denial.
EverCure Billing handles the complete revenue cycle for pulmonologists and pulmonary-care groups across the United States: eligibility and benefit checks, prior authorizations, pulmonary coding, claim submission, denial appeals, and aged A/R recovery. Your team treats the lungs. We make sure the testing, bronchoscopy, rehab, and sleep work you already performed actually gets paid and holds up if a payer looks.
What Is Pulmonology Medical Billing?
Pulmonology medical billing covers every financial step between a patient booking a visit and that money landing in your practice account.
For a pulmonary practice specifically, that includes verifying benefits and coverage for testing and procedures, obtaining prior authorization for advanced procedures and pulmonary rehab, coding pulmonary function tests with the correct professional and technical components, tracking session limits on pulmonary rehab, coding bronchoscopy and EBUS to their distinct components, handling home-oxygen documentation, submitting a clean claim, posting the payment, appealing the denial, and chasing the balance until it clears.
General billing bills a procedure. Pulmonology billing runs on PFT component splits, session-limited rehab, procedure-specific documentation, and prior-authorization-heavy advanced services and those rules make pulmonology one of the more denial-prone and under-collected specialties in medicine.
Why Do Pulmonology Practices Lose More Revenue Than They Should?
Because pulmonary revenue runs on PFT component billing, session-limited pulmonary rehab, procedure-specific coding, and prior-authorization-heavy advanced services and each is easy to get wrong. These are the specific leaks we see when we run audits on pulmonary practices:
PFT professional/technical split errors
Spirometry, DLCO, and lung-volume tests are often split between the interpretation (professional) and the equipment (technical) components. Bill the wrong component for the setting and the claim under-collects or denies.
Pulmonary rehab session-limit errors
Pulmonary rehabilitation carries regulatory session limits. Bill past the covered limit or without meeting the documentation requirements and the extra sessions deny.
Bronchoscopy and EBUS coding errors
Diagnostic bronchoscopy, transbronchial biopsy, BAL, and EBUS each have distinct codes and can be billed together when documented. Miss the distinct components and value is lost to bundling.
Prior-authorization delays and gaps
Advanced procedures, EBUS, rehab, and home oxygen frequently require authorization first. Deliver the service before the auth and the claim denies with no easy path.
Home-oxygen documentation gaps
Home oxygen therapy has strict documentation and qualifying-criteria requirements. Weak documentation turns a covered service into a denial.
High denial rates on complex procedures
Pulmonology carries an elevated denial rate because coding errors on DLCO, lung biopsy, and advanced tests are common and unworked denials become write-offs.
We build the workflow around these six failure points, because they are where pulmonary revenue actually disappears.
What Pulmonology Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
We verify active coverage, deductible and coinsurance status, and coverage for testing and procedures before the visit.
Prior authorization support
We prepare and submit authorization requests for advanced procedures, EBUS, pulmonary rehab, sleep studies, and home oxygen, attach the clinical documentation, and follow up with the payer until a decision is issued.
Pulmonology coding
Our coders work from your notes to assign the correct CPT, ICD-10-CM, and modifiers splitting PFTs into professional and technical components correctly, coding bronchoscopy and EBUS to their distinct components, and tracking rehab session limits. Coding and billing are handled together, so coding errors are caught before the claim goes out.
Charge entry and claim scrubbing
Every claim runs through a pre-submission check for PFT component logic, procedure-specific modifiers, rehab session limits, home-oxygen documentation, and diagnosis linkage before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the documentation the payer is actually asking for including the clinical notes for rehab, oxygen, and advanced-procedure denials. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar bronchoscopy, EBUS, and biopsy claims and anything approaching a timely filing deadline.
Patient billing and support
Clear patient statements, balance explanations, and a support line so your front desk isn't fielding coverage questions all day.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS so a new pulmonologist isn't sitting idle waiting on a panel.
Billing audits and compliance review
Periodic internal review of PFT component billing, rehab session limits, and home-oxygen documentation to reduce audit exposure before a payer finds it first.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, and payer performance in plain language, not a data dump.
Which Pulmonology Services
Do You Bill?
Pulmonary function testing (PFT) spirometry, lung volumes, and full PFT panels, with professional and technical components handled correctly.
Spirometry with bronchodilator pre- and post-bronchodilator testing coded to the correct code.
Diffusion capacity (DLCO) testing coded and billed with the correct component split.
Diagnostic bronchoscopy with biopsy, BAL, and therapeutic interventions coded to their distinct components.
Endobronchial ultrasound (EBUS) diagnostic and sampling procedures.
Thoracentesis and lung biopsy transbronchial or needle, coded to the procedure performed.
Arterial blood gas analysis coded for the setting.
Pulmonary rehabilitation coded with session-limit tracking and documentation.
Sleep studies (polysomnography) in-lab and home studies coded to the correct code.
Home oxygen therapy documentation and billing that meets qualifying criteria.
Which Pulmonology CPT and ICD-10 Codes
Do You Work With?
| Code / Range | What It Covers |
|---|---|
| 94010 | Spirometry |
| 94060 | Spirometry with bronchodilator |
| 94726 / 94727 / 94728 | Lung volume / plethysmography measurement |
| 94729 | Diffusing capacity (DLCO) |
| 94760 / 94761 | Pulse oximetry (single / multiple) |
| 31622 | Diagnostic bronchoscopy |
| 31628 | Bronchoscopy with transbronchial lung biopsy |
| 31652 / 31653 | Endobronchial ultrasound (EBUS) |
| 32554 / 32555 | Thoracentesis |
| 94618 | Pulmonary stress / rehab testing |
| G0424 | Pulmonary rehabilitation (session-limited) |
| J44.- / J45.- | COPD / asthma |
| J96.- | Respiratory failure |
| G47.33 | Obstructive sleep apnea |
Code sets update annually, and payer rules especially rehab session limits and home-oxygen criteria shift over time. Keeping current on both is part of the service, not an extra.
Which Modifiers and Codes Actually Decide
Whether a Pulmonology Claim Gets Paid?
The theme in pulmonology is that PFT component accuracy, rehab session-limit discipline, and procedure-specific documentation decide payment far more than any single code. That's exactly what we scrub before submission.
Professional / technical component. The defining modifier pair in pulmonology: PFTs, DLCO, and imaging are frequently split between the interpretation and the equipment. Getting the component wrong for the setting denies or underpays the claim.
Distinct procedural service. Used to correctly separate legitimately distinct bronchoscopy and EBUS components under bundling edits.
Reduced services. Where a test or procedure is partially reduced from its full description.
Not a modifier, but the biggest quiet lever on pulmonary rehab billing within the covered session count is what keeps rehab claims paid.
The qualifying criteria and documentation, not a modifier, decide whether home oxygen is covered.
Advanced tests require the diagnosis to support them we link them before submission.
How Does Compliance Work in Pulmonology Billing?
PFT component discipline
Professional/technical splits are only defensible when they match the setting. We set the component to what actually happened so PFTs aren't under- or double-billed.
Rehab session-limit discipline
Pulmonary rehab session limits are a compliance and revenue question at once. We track the covered count and documentation so rehab claims are supported.
Home-oxygen criteria
Home oxygen carries strict qualifying-criteria and documentation requirements. We hold each claim to those requirements so covered oxygen is paid.
Medical necessity
Advanced tests and procedures carry medical-necessity expectations. We link the diagnosis to the service so claims aren't submitted unsupported.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does the
Onboarding Process Work?
Free billing audit
We review a sample of recent claims, denials, and your aged A/R to identify where revenue is being lost and how much is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your testing and procedure mix, rehab and sleep-study volume, top payers, and current denial patterns, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, CareCloud, Epic, and Cerner.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide.
What Does Pulmonology Billing Cost?
Our pulmonology billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on testing and procedure mix, claim volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the Business Assessment is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Pulmonology Billing?
We code and bill together.
In pulmonology, most lost revenue is a coding decision the wrong PFT component, a rehab session past the limit, a bronchoscopy that bundled. Handling coding and billing in one workflow means those errors are caught before the claim drops.
We handle the whole pulmonary tangle, not just easy claims.
PFT component splits, session-limited rehab, home-oxygen documentation, and prior-authorization-heavy procedures take real attention. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your service mix.
Direct access to leadership.
When something goes wrong, you're not escalating through four layers.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, and collections every month.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Pulmonology Practice Leaving Money on the Table?
Most pulmonary practices don't know their real denial rate, how many PFTs are billed with the wrong component, or how much of their aged A/R is still collectible until someone actually looks.
That's what the Business Assessment is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Pulmonology Billing
Yes. We set the professional or technical component to match the setting so spirometry, DLCO, and lung-volume tests aren't under- or double-billed.
Yes. We track the covered session count and documentation so rehab claims are billed within the limit and supported.
Yes. We code diagnostic bronchoscopy, biopsy, BAL, and EBUS to their distinct components so value isn't lost to bundling.
Yes. We hold each home-oxygen claim to the qualifying criteria and documentation requirements so covered oxygen is paid.
Yes. We handle both together, which is how coding errors get caught before submission rather than in an audit.
Yes. We prepare and submit the request, attach the documentation, and follow up until a decision is issued.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available.
Yes. We log into your current system and work inside it. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Pulmonology Revenue Cycle?
Every miscoded test and every aged account is money your practice already earned. Let's go get it.