Specialty billing

Medical billing services, specialty by specialty

Coding rules, payer requirements and coverage limits differ by specialty, and so do the reasons claims get denied. Each page below covers the codes, modifiers and payer rules for one specialty. Search yours, or browse A–Z.

51 specialties A dedicated coding playbook for eachOne accountable team

A 4

Allergy & ImmunologyEvery antigen dose, testing unit, and biologic — paid the first time. AmbulanceThe claim is built in the field, mid-emergency, by a crew who will never see the remittance. Ambulatory Surgical CenterAn ASC claim looks like an ordinary outpatient claim and behaves like nothing of the sort. AnesthesiaEvery base unit, time unit, and care-team modifier — captured.

B 1

Behavioral HealthThe diagnosis doesn't decide the claim. The entity that adjudicates it does.

C 3

CardiologyOne CPT bills three ways. The split can't be guessed. ChiropracticThe same adjustment is covered while it produces improvement — and non-covered the moment the patient plateaus. Community Behavioral HealthThere is no single claim in this specialty.

D 3

DentalThe benefit plan decides the check, not the diagnosis. DermatologyAn excision is sized by a formula, not by the lesion. DMENothing ships until the file that pays for it is complete.

E 1

Emergency RoomAlmost every encounter spawns two claims at once — and each is leveled under its own rulebook.

F 1

Family PracticeOne practice, every age — and every age has its own rulebook.

G 2

GastroenterologyA colonoscopy that starts as a screening and ends with a polypectomy is not the screening the schedule promised. General SurgeryGet paid for the full operation you performed.

H 3

HealthcareRevenue is rarely lost to one big break. It's lost in the seams. Home HealthThe assessment sets the price. We make the claim match it. HospitalTwo payment systems, one claim form, no room for a generalist.

M 1

Mental HealthA therapy session is not an office visit. It's paid by the clock.

N 3

NephrologyNephrology payment is assembled, not read off a single fee. NeurologyThree unrelated payment systems. One patient. One week. Nutrition as Therapy"Nutrition therapy" hides four separate benefits a payer treats as four different products.

O 5

OB/GYNTwo specialties sharing one tax ID. Each paid a different way. OncologyThe drug line is the economic engine. We bill it that way. OptometryOne encounter. Two different insurers. Why they came decides. OrthopedicWhether the next visit is billable turns on the modifier, not the calendar. Otolaryngology (ENT)Sinus surgery is billed per sinus and per side — not as one operation.

P 11

Pain ManagementCoverage rules settle payment before the claim is even built. PathologyNot per container. Not per block. Per specimen. PediatricA pediatric visit is not a shorter adult visit. PharmacyThe only part of the revenue cycle that runs on two entirely separate rails at once. Physical TherapyTherapy revenue is decided in fifteen-minute blocks. PhysicianEvery provider is a revenue channel. It has to be switched on before it can pay. Plastic SurgeryNo other surgical specialty forces the same decision on every case. PodiatryA clinically correct service and a payable claim are two different things. Primary CareNo single six-figure claim. A hundred small increments a week. PsychiatricOne appointment. Two billable services. Bill both. PulmonologyFour rulebooks, colliding on one date of service.

R 4

Radiation OncologyThe equipment time, physicist hours, and physician oversight are already spent before most of the money comes back. RadiologyEvery study is two payable pieces. We bill both, correctly. RheumatologyOne of the few office specialties that runs a small pharmacy inside the exam suite. Rural Health (RHC)The claim carries every code you performed. Exactly one line pays.

S 4

Skilled Nursing (SNF)In an SNF the clinical record is the invoice. Sleep DisorderA study, a titration, a read — then months of equipment claims. Sports MedicineAn encounter almost never resolves to a single charge. That is exactly where a general biller starts losing your money. Substance Abuse (SUD)The level of care is the master variable. Everything else follows it.

T 2

TelehealthCoded to the current rules, not last year's. TeleradiologyYou never touched the scanner. Don't let the claim say you did.

U 2

Urgent CareA walk-in looks like a single office visit and pays like five separate decisions. UrologyThe office doubles as the operating room. That is exactly where the money slips through.

W 1

Wound CareDebridement pays by tissue depth — not by the wound, and not by the instrument.
Nothing matches that.Try a shorter word, or clear the search to see all 51.

Not sure which page covers your mix?

Most practices bill across several of these. Tell us what you run and we will review your denials and aged A/R against the rules that apply.

Request a Revenue Review Call +1 888-502-0537