Billing for more medical specialties
Beyond our main specialty pages, we bill for a wide range of practices and care settings. Here is a short look at the codes and payer rules we handle in each.
Every specialty has a handful of rules that cause most of its denials. In orthopedics it is fracture care globals and joint injection drugs. In hospice it is notice of election deadlines and benefit periods. In ABA therapy it is authorization units and technician credentials. Our coders learn those rules before they touch your claims.
SFA Solutions works inside your existing EHR or PM system, aims to submit most clean claims within 24 hours of final review. Claims are reviewed against applicable billing, coding and payer-specific rules (10,000+ in our workflow) before submission to help identify preventable errors. If your specialty is listed below, or is not listed at all, a free practice audit is the easiest first step. We review your billing and walk you through where revenue may be slipping.
Orthopedics billing
Fracture care codes include the cast or splint and 90 days of routine follow-up, so separate casting codes are not billed with the initial treatment. Joint injections (20610 without ultrasound, 20611 with ultrasound) are billed with the drug J-code, and visit-plus-injection days need modifier 25. RT and LT, and modifier 57 for decision-for-surgery visits, are checked on each claim.
Pain Management billing
Epidural steroid injections (62321, 62323, 64483) and facet joint injections (64490 to 64495) include imaging guidance in the code. Medicare LCDs on facet interventions require two medial branch blocks with documented relief before radiofrequency ablation (64635, 64636), along with frequency limits. Urine drug testing uses 80305 to 80307 for presumptive and G0480 to G0483 for definitive testing with Medicare.
Nephrology billing
Monthly ESRD services are billed once per month with 90960 to 90962 for patients 20 and older, based on the number of face-to-face visits, and with 90966 for home dialysis. Hemodialysis procedure codes 90935 and 90937 are used for AKI and other non-ESRD situations. CKD stage must be coded with N18 codes that match the documentation.
Endocrinology billing
Continuous glucose monitor start-up is billed with 95249 or 95250 and interpretation with 95251 no more than once every 30 days. Thyroid ultrasound (76536) and ultrasound-guided fine needle aspiration (10005) are common office services. Diabetes self-management training (G0108, G0109) requires an accredited program.
Rheumatology billing
Biologic infusions are billed with therapeutic infusion codes (96365, 96366) and the drug J-code or biosimilar Q-code, such as Q5103 for an infliximab biosimilar. Payers often require a preferred biosimilar and step therapy. Medicare requires modifier JZ or JW on single-dose vial drugs.
Infectious Disease billing
Medicare does not pay consultation codes, so inpatient consults are billed with initial hospital care codes 99221 to 99223. Outpatient IV antibiotic therapy is billed with infusion codes and drug J-codes when given in the office. HIV screening for Medicare uses G0475.
Allergy and Immunology billing
Percutaneous testing (95004) and intradermal testing (95024) are billed per test, so units equal the number of allergens tested. Antigen preparation (95165) is billed per dose, and Medicare counts a dose as up to 1 cc from a multidose vial. Injections use 95115 for one and 95117 for two or more.
Sleep Medicine billing
In-lab polysomnography (95810) and split-night studies (95811) usually need prior authorization, and many payers require a home sleep test first (95800, 95806 or G0399). Medicare covers CPAP after a qualifying study and requires use of at least 4 hours a night on 70% of nights during a 30-day period in the first 3 months.
Wound Care billing
Selective debridement (97597, 97598) and surgical debridement (11042 to 11047) are coded by surface area and the deepest tissue removed, with measurements documented every visit. Skin substitute application (15271 to 15278) is billed by wound size and location along with the product code. Medicare changed how skin substitute products are paid in 2026, so current rates need checking for each product.
Hospitalist billing
Since 2023, inpatient and observation care share the same codes: 99221 to 99223 for initial care, 99231 to 99233 for subsequent care and 99238 or 99239 for discharge. Split or shared visits between physicians and APPs need modifier FS. Medicare uses G0316 for prolonged inpatient services instead of CPT 99418.
Vascular Surgery billing
Endovenous ablation is billed with 36475 for radiofrequency or 36478 for laser on the first vein and add-on codes for more veins. Most payers require documented reflux on duplex ultrasound (93970 or 93971) and a failed trial of compression therapy first. CPT 2026 deleted lower-extremity revascularization codes 37220 through 37235 and replaced them with 46 codes, 37254 through 37299. The new codes are grouped by territory (iliac, femoral and popliteal, tibial and peroneal, and inframalleolar) and by straightforward stenosis versus complex occlusion. Checked against the American College of Surgeons January 2026 Bulletin, printed page 16, on 12 October 2026 (ACS Bulletin PDF). This page does not name a person as the reviewer.
Plastic Surgery billing
The line between cosmetic and reconstructive decides coverage. Upper eyelid blepharoplasty (15823) usually needs visual field testing and photos showing functional loss, and breast reduction (19318) needs documentation of symptoms and tissue weight under payer policy. Breast reconstruction after mastectomy is covered under the Women's Health and Cancer Rights Act.
Ambulatory Surgery Centers billing
ASC facility fees are paid only for procedures on Medicare's ASC covered procedures list, billed on the 837P with the ASC's own NPI. Multiple procedures are paid at 100% for the highest and 50% for others in most cases. Discontinued procedures use modifiers 73 or 74, while surgeons use modifier 53.
Clinical Laboratory billing
Every lab needs a CLIA certificate that covers the complexity of tests performed, and waived tests often need modifier QW. Medicare pays from the Clinical Laboratory Fee Schedule and limits frequency on tests like lipid panels (80061), so ABNs matter. Molecular tests in many MAC regions require registration in the MolDX program.
DME billing
Durable medical equipment is billed to the DME MAC for the patient's state with HCPCS codes and modifiers such as NU (new), RR (rental) and KX (coverage criteria met). Many items need a standard written order and face-to-face documentation, and capped rental items transfer to the patient after 13 months of rental.
Home Health billing
Medicare pays home health agencies in 30-day periods under PDGM, using OASIS data and diagnosis coding to set payment. A Notice of Admission must be filed within 5 days of the start of care. Physicians bill certification with G0180, recertification with G0179 and care plan oversight with G0181.
Hospice billing
Hospice is paid per day at four levels of care billed with revenue codes 0651, 0652, 0655 and 0656. The Notice of Election must be filed within 5 calendar days of election, and a face-to-face encounter is required before the third benefit period. Attending physicians not employed by the hospice bill Part B with modifier GV, and care unrelated to the terminal condition uses modifier GW.
Telehealth billing
Place of service 10 is used when the patient is at home and POS 02 for other locations, with modifier 95 for video or 93 for audio-only as the payer requires. Medicare telehealth flexibilities have been extended several times, and commercial plan rules vary by state parity laws. We check current payer rules before billing.
Behavioral Health / ABA Therapy billing
ABA is billed with 97151 for assessment, 97153 for treatment by a technician, 97155 for protocol modification by the BCBA and 97156 for family guidance, each in 15-minute units. Nearly every payer requires prior authorization with set unit limits per week. Technician and supervisor credentials must match what the payer requires.
Substance Use Treatment billing
Medicare opioid treatment programs bill weekly bundles such as G2067 for methadone, and office-based treatment uses G2086 to G2088 for monthly care management and counseling. Medicaid and commercial plans often use HCPCS H-codes like H0001 for assessment and H0015 for intensive outpatient. Screening and brief intervention is billed with 99408 or 99409, or G0396 and G0397 for Medicare.
Speech Therapy billing
Speech therapy treatment (92507) is billed per session, and evaluations include 92521 to 92524 and 92610 for swallowing. Medicare requires modifier GN, and speech therapy counts toward the same KX threshold as physical therapy, $2,480 combined for 2026. A certified plan of care is required.
Audiology billing
Common tests include comprehensive audiometry (92557), tympanometry (92567) and tympanometry with reflex testing (92550). Medicare lets audiologists see patients without an order for certain non-acute hearing assessments once every 12 months with modifier AB. Hearing aids are not covered by Original Medicare, though many Medicare Advantage plans offer some coverage.
Chronic Care Management programs billing
CCM is billed with 99490 for the first 20 minutes of clinical staff time per month, 99439 for each additional 20 minutes, 99491 for 30 minutes of provider time and 99487 for complex CCM. Patients need two or more chronic conditions and documented consent. Remote patient monitoring (99453, 99454, 99457, 99458) and Medicare's Advanced Primary Care Management codes (G0556 to G0558) are related programs with their own rules.
Infusion Centers billing
Infusion billing follows a hierarchy: chemotherapy first, then therapeutic infusions (96365), then hydration (96360), with only one initial service per encounter. Sequential and concurrent infusions use 96367 and 96368. Drug units, JZ and JW modifiers and site-of-care rules from payers all affect payment.
Bariatrics billing
Sleeve gastrectomy (43775) and laparoscopic gastric bypass (43644) carry 90-day globals. Medicare covers bariatric surgery for patients with a BMI of 35 or more with at least one related comorbidity and prior unsuccessful medical treatment, and commercial plans often add supervised weight loss requirements. Intensive behavioral therapy for obesity is billed with G0447 for Medicare.
Hematology billing
Bone marrow biopsy (38221) and combined biopsy and aspiration (38222) are common office procedures. IV iron is billed with the drug code, such as J1439 for ferric carboxymaltose or J1756 for iron sucrose, plus an infusion or push code. Therapeutic phlebotomy is billed with 99195.
Sports Medicine billing
Ultrasound-guided joint injections are billed with 20611, and 76942 is not reported separately with it. Splints, braces and DME supplied in the office need HCPCS L-codes and payer-specific documentation. Platelet-rich plasma injection is reported with Category III code 0232T and is not covered by most payers.
Occupational Medicine billing
Work injuries are billed to the workers' compensation carrier under state fee schedules and forms, with claim numbers and employer details on each claim. Pre-employment physicals, DOT exams and drug screens are usually billed to the employer. Work-related disability exams use 99455 and 99456.
Frequently asked questions
Do you bill for specialties that are not listed on your site?
Yes. We bill for 28+ specialties, and if yours is not listed, we review your codes and payer mix during a free practice audit before we take on any claims.
Do you work in our current EHR?
Yes. We work inside your existing system, including Epic, eClinicalWorks, NextGen, athenahealth, Kareo/Tebra, AdvancedMD and 50+ others.
How is pricing set for specialty billing?
Pricing is a flat $500 a month under $15,000 in insurance collections, a flat $1,000 a month from $15,000 through $30,000, and 3.5% of insurance collections above $30,000, with no long-term contracts. Provider credentialing is included free with every billing plan.
Specialties with their own page
Do not see your specialty?
Ask us. If we bill for it, we will tell you how. If we do not, we will tell you that too.