Pulmonary medicine billing is uniquely difficult because pulmonary function testing involves multiple components: spirometry, lung volume measurement, diffusion capacity, and bronchodilator response. Each has its own CPT code and documentation requirement, and bundling errors across these tests are common. Add biologic billing for severe asthma and COPD (Fasenra, Tezspire, Nucala), sleep study interpretation billing, and prior authorization burdens for advanced pulmonary procedures, and most pulmonary practices leave real revenue on the table from systematic coding gaps.
Pulmonary medicine billing demands real proficiency in the individual PFT components: spirometry (94010), plethysmography (94726), diffusion capacity (94729), and bronchodilator response (94060), plus nebulizer treatment (94640), bronchoscopy (31622–31646), sleep study billing (95782–95811), and biologic prior authorization and J-code billing for severe asthma and COPD. Bundling PFT components incorrectly, or missing a prior authorization, can cause systematic underbilling across an entire patient panel and can even prompt a coding audit. We bring years of hands-on pulmonary billing experience: coding education, timely billing updates, and a track record of recovering previously denied claims.
Billed Right has provided pulmonary medicine billing support since 2006, serving practices across the US from our base in Longwood, Florida.
Common Pain Areas
- Pulmonary function testing bundling errors can leave individually reimbursable components unbilled.
- Biologic prior authorization denials for severe asthma and COPD can stall treatment and delay reimbursement.
- Sleep study interpretation billing gaps can turn a correctly performed study into a denied claim.
- Bronchoscopy coding complexity can result in add-on procedures going unbilled alongside the base code.
- CPAP/BiPAP supply billing documentation requirements can turn a covered supply into a denied claim without compliance data on file.
Pulmonary Medicine Solutions
- Quick turnaround time in Denial management and follow up to appeal any denied pulmonary function test, biologic infusion, or sleep study claims. Once the alert is activated, we will follow up within 24-48 hours and appeal any denied claims within the same timeframe.
- Key Performance Indicators (KPI) to demonstrate if your practice is achieving key business objectives.
- We work with all major EMR (electronic medical records)
- Remote login for easy access.
- Quick and smooth transition.
- No negative impact on your daily operation.
- Bilingual representatives are available.
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Top Denial Reasons
PFT Components Incorrectly Bundled or Unbundled
Spirometry, lung volumes, and diffusion capacity each need their own code, and billing them as one bundled test instead of the components actually performed leaves revenue unbilled or triggers a denial.
Biologic Prior Authorization Missing or Expired
Fasenra, Nucala, and Tezspire require authorization renewed on a set schedule, and an expired authorization is an easy, avoidable denial.
Sleep Study Billed Without Physician Attestation
Sleep study interpretation requires a documented physician attestation, and billing without it on file is a routine, avoidable denial.
Bronchoscopy Add-On Codes Not Billed with Base Procedure
Add-on bronchoscopy codes billed without correctly referencing the base procedure leave reimbursable revenue on the table.
CPAP Compliance Documentation Insufficient
Ongoing CPAP and BiPAP supply reimbursement requires documented usage compliance, and thin documentation gets the claim denied.
Payer-Specific Considerations
Medicare covers pulmonary function testing but requires specific documentation of medical necessity and prohibits bundling certain PFT components that must be billed separately, so billing spirometry, lung volumes, and diffusion capacity as one combined service is a routine, avoidable denial. Medicare covers biologics for severe asthma under Part B when administered in office: benralizumab (Fasenra, J0517), mepolizumab (Nucala, J2182), and tezepelumab (Tezspire, J3297), but requires prior authorization and documented failure of inhaled corticosteroids. Commercial payers vary widely on sleep study coverage. Some require home sleep testing before approving in-lab polysomnography, so the same clinical picture can require a different testing pathway depending on the payer.
What to Expect
Billing Review
We audit recent pulmonary function test, biologic infusion, sleep study, and bronchoscopy claims and show you exactly where revenue is leaking.
Onboarding & EHR Setup
Payer setup and integration with your existing EHR/PM system, no rip-and-replace.
Credentialing Check
We verify provider enrollment status and handle re-credentialing if needed.
Claims Submission Begins
Correctly coded claims go out under full account management, same business day.
Denial Monitoring & Appeals
Denials are flagged and appealed within 24–48 hours of the alert.
Monthly Reporting
KPI dashboards show collections, A/R days, and denial trends every month.
Results Reflected in Our KPIs
Our medical billing solutions cover claim processing and follow-up on claim rejections from start to finish. We put our pulmonary medicine billing expertise to work reducing denials and strengthening your revenue cycle.
Frequently Asked Questions
Spirometry (94010), plethysmography for lung volumes (94726), diffusion capacity (94729), and bronchodilator response (94060) each have their own code and documentation requirement, and billing them as a single bundled test instead of the individual components performed is one of the most common ways pulmonary practices underbill.
Yes, nearly always. Fasenra, Nucala, and Tezspire all require documented failure of inhaled corticosteroids and prior authorization before the first dose, with most payers requiring periodic reauthorization. Missing or expired authorization is the leading cause of biologic denials in pulmonary practices.
Sleep study codes (95782-95811) require a documented physician attestation of the interpretation, separate from the technical component of the study. Billing the interpretation without that attestation on file is a routine, avoidable denial.
Bronchoscopy base codes and add-on codes (31622-31646) have to be billed together correctly relative to what was actually performed during the same procedure, and add-on codes billed without the correct base code get denied. The operative report has to clearly support each component billed.
Yes, under Part B when the biologic is administered in the office. Medicare covers benralizumab (Fasenra), mepolizumab (Nucala, J2182), and tezepelumab (Tezspire, J3297) using the appropriate J-code, but still requires prior authorization and documented failure of inhaled corticosteroids before covering the drug.
Payers require documented compliance data, typically a minimum number of hours of nightly use over a defined tracking period, before they'll continue reimbursing CPAP or BiPAP supplies. Missing or incomplete compliance documentation is one of the fastest ways a covered supply becomes a denied claim.
More on pulmonary medicine billing.
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ReadReady to Strengthen Your Pulmonary Practice Revenue Cycle?
Schedule a conversation with our pulmonary billing team. We will review your current claims, identify where revenue is slipping, and show you exactly what we would do differently.