Practice Mate is a Texas-based medical billing company serving endocrinology practices across all 50 states. We handle the codes that general billers miss: DSMT, CGM, RPM, biologic J-codes, DEXA, so your practice collects every dollar Medicare and commercial payers owe you.
First-Pass Clean Claim Rate
Years Specialty Billing
Denial Response Time
States Served
Endocrinology is not E/M-driven outpatient care. Most revenue lives in the codes general billers don't know exist: DSMT, RPM, MNT, J-code waste, and DME billing for CGMs and insulin pumps.
Endocrinology billing crosses professional fee, DME (CGMs and insulin pumps under PDAC), and pharmacy (biologic J-codes). Most teams work one lane. Errors at the seams cost the most.
Medicare's CGM coverage rules — insulin therapy criteria, device frequency limits, supply HCPCS codes — are revised regularly. A general team doesn't track them. We do.
Not provider credentialing. Most practices don't bill DSMT because their billing team has never set up a program-level NPI. It's a process, not a code.
CCM, TCM, RPM, and DSMT all require time-stamped documentation. General billers code by encounter. Endocrinology bills by the minute.
These are not billing errors. They’re silent underpayments that your current team has no way of catching.
| Challenge | Revenue Impact | Practice Mate's Solution |
|---|---|---|
|
CGM denials (no documented medical necessity) |
100% write-off per device |
Pre-submission NCD 40.1 checklist |
|
Insulin pump unbundling (supplies billed separately) |
Audit risk + recoupments |
NCCI edit validation before submission |
|
Missed J-code waste (single-use vial unused drug) |
15–30% drug cost loss |
JW/JZ modifier audits |
|
Incorrect infusion vs. injection coding |
Underpayment by 40%+ |
Time-based MDM review |
|
Missing CCM/TCM documentation |
100% denial of chronic care codes |
Structured documentation templates |
|
DSMT not billed (no accreditation OR no G0108/G0109 capture) |
$5K–$15K per patient lifetime benefit lost |
Program enrollment + time-tracking |
|
RPM under-captured for CGM patients |
$300–$500/month per eligible patient lost |
Patient panel audit + monthly billing |
From device claims to chronic care management, we bill every code your endocrinology practice generates — including the ones general billers miss entirely.
The fastest-growing source of endocrinology coding errors involves Continuous Glucose Monitors and insulin pumps. We handle device codes (95249, 95250, 95251 for CGMs; A9274, A9276, A9278 for pumps), DME enrollment, benefit verification, and prior authorization. Every CGM claim is verified against Medicare’s NCD 40.1 and commercial payer LCD policies before submission.
When your CGM patient transmits glucose data that you review and act on, that’s billable under Remote Patient Monitoring — separate from the CGM device codes themselves.
| Code | Service | Unit |
|---|---|---|
|
99453 |
RPM device setup & patient education |
Once per episode |
|
99454 |
Device supply with daily recordings (≥16 days) |
Per 30 days |
|
99457 |
First 20 min clinical staff time + interactive communication |
Monthly |
|
99458 |
Each additional 20 min
|
Same month |
Payer requirements we verify on every RPM claim:
We audit your CGM patient panel for RPM eligibility, set up time-tracking, and bill 99457/99458 monthly alongside CGM device codes, recurring revenue that most practices leave on the table.
Endocrinology practices administer biologic infusions for postmenopausal osteoporosis (Prolia, Evenity), acromegaly (Somatuline Depot), and hypogonadism. We handle accurate J-code selection (including J3490 and J3590 for unclassified drugs), waste documentation with JW (discarded amount) and JZ (no waste) modifiers, and correct billing for infusion administration (96365–96379) versus injection (96372). Every dollar captured for both drug cost and administration time.
Differentiated thyroid cancer management often involves nuclear medicine procedures requiring distinct coding from standard E/M services. We code thyroid uptake and scan (78070), I-131 therapy (79005), fine needle aspiration with imaging guidance (10005–10012), and thyroid ultrasound (76536). Documentation review includes tracer dose, uptake percentages, and ultrasound correlation.
For postmenopausal osteoporosis management, we bill DEXA scans, anti-resorptive infusions, and follow-up evaluations as a coordinated claim chain.
| Code | Service |
|---|---|
|
77080 |
DEXA — axial skeleton (hip, spine) |
|
77081 |
DEXA — appendicular skeleton |
|
77085 |
DEXA + vertebral fracture assessment |
We check Medicare’s 24-month frequency limits, apply technical/professional split (TC/26) when equipment ownership requires it, and verify M80–M81 ICD-10 diagnosis linkage before submission.
For practices with a Registered Dietitian on staff or under contract, MNT is a separately billable service from DSMT and Medicare covers it for diabetes and chronic kidney disease.
| Code | Service |
|---|---|
|
97802 |
MNT initial assessment, individual |
|
97803 |
MNT follow-up, individual, per 15 min |
|
97804
|
MNT group, per 30 minutes |
|
G0270 |
MNT reassessment (diet/medical change) |
|
G0271 |
MNT reassessment, group |
Every CGM claim is checked against four coverage criteria before it leaves our system:
These are not billing errors. They’re silent underpayments that your current team has no way of catching.
| Modifier | Application in Endocrinology |
|---|---|
|
JW |
Drug amount discarded (not administered to patient)
|
|
JZ |
No drug amount discarded (single-dose vial fully administered)
|
|
KX |
Medical necessity requirements have been met (used with CGM claims) |
|
GA |
Advance Beneficiary Notice (ABN) signed for non-covered service |
|
GY |
Service excluded from Medicare coverage by statute |
|
TC / 26 |
Technical / Professional component split (DEXA, nuclear medicine) |
One billing standard. CGM, DSMT, biologic capture without an in-house RCM team.
Standardized coding across providers. One reporting dashboard. One denial workflow.
CGM, insulin pump, RPM, DSMT, and MNT billing are fully integrated.
Epic integration, split/shared visit logic, facility versus professional component handling.
Specialty-specific coding for growth disorders, hypogonadism, and infertility hormone therapy.
Codes 78070, 79005, FNA with imaging guidance, ultrasound correlation, tracer documentation.
Confirm CGM coverage, insulin pump tier status, and drug benefits before every encounter.
Submit clinical documentation to meet payer-specific NCDs and LCDs. Track approval, effective dates, and expiration windows.
Assign CPT, ICD-10, and HCPCS codes with modifiers (JW, JZ, KX, GA, GY) after full chart review.
NCCI edit validation, frequency limit checks, and modifier sequencing — caught before submission, not after denial.
Match ERA and EOB payments to fee schedules. Underpayments are flagged and appealed.
No software switch. No data exports. No manual entry layer between your EMR and our billing operations. Encrypted, HIPAA-compliant connection. Charges flow in. Payments post back. Your team keeps the workflow they already know.
Program accreditation guidance, referral tracking, G0108/G0109 capture, and follow-up benefit monitoring are built into our endocrinology workflow.
99453, 99454, 99457, and 99458 alongside CGM device codes — recurring monthly revenue most practices have never captured.
Diagnosis (E11.65), insulin therapy documentation, and six-month follow-up — every CGM claim verified before submission.
AAPC-certified coders. HIPAA-compliant infrastructure. Real performance reporting.
Solo Endocrinology Practice "We had 18 months of CGM patients we never billed RPM for. Practice Mate audited our panel, identified 60+ eligible patients, set up time-tracking, and started billing 99457/99458 in month two. The recurring revenue alone covered our billing fee."
Diabetes-Focused Practice "Our DSMT program had accreditation, but we'd never billed a single G0108. Practice Mate walked us through enrollment under the program NPI and started capturing $53 per 30-minute session. Six months in: $90K+ in DSMT we'd left behind."
Multi-Physician Endocrinology Group "The biologic billing complexity was killing us — J-code waste, JZ versus JW, infusion versus injection. The first billing cycle with Practice Mate caught the gaps. Prolia and Evenity claims now go out clean the first time."
Practice Mate Medical Billing Services is headquartered in Texas and serves endocrinology practices, diabetes centers, thyroid clinics, and hormone therapy specialists across all 50 states. Every new client starts with a free Endocrinology Revenue Audit — no cost, no obligation.
30-minute call to map your patient panel, payer mix, and current billing setup.
Secure review of recent claims, denied claims, and unbilled DSMT/RPM opportunities.
Written report identifying revenue leaks with a specific dollar-recovery estimate.
Transition plan and fee proposal — your call on whether to proceed.
FaqsThree to four weeks for most endocrinology practices. We run parallel processing so claims never stop going out. Practices with DSMT program accreditation work or large open AR balances may take five to six weeks.
No. Guaranteed in writing. If your clean claim rate drops below your previous rate in the first 60 days, we work three months at no charge until we close the gap.
We don't issue accreditation — that comes from ADA or ADCES. We do walk you through the application, documentation, program NPI setup, and the billing structure once you're accredited. If you already have accreditation but aren't billing G0108/G0109, we can start within two weeks.
Yes. We audit your CGM patient panel for RPM eligibility, document the 16-day data threshold, set up time-tracking for 99457/99458, and bill monthly. Most practices haven't billed RPM at all — we typically recover six months of eligible RPM revenue in the first 90 days.
Yes. We bill under your NPI and Tax ID. No re-credentialing. No re-enrollment. If you have open credentialing in progress, we manage it as part of onboarding at no additional charge.
Yes. We execute a Business Associate Agreement (BAA) before accessing any patient record. Encrypted transmission. Access-controlled environments. HIPAA-auditable pipeline.
Percentage based on collections. We are paid when you are paid. No flat monthly fees. No per-claim fees that reward volume over accuracy. Written fee proposal before any agreement is signed.
