Pulmonology Medical Billing Services

Get Pulmonology Claims Paid Without Chasing Every Detail

One set of rules for spirometry and sleep studies. A different set for bronchoscopy and critical care. A third for the office visits in between. Thrive bills all three correctly.

Complete RCM Services

Certified Billing & Coding Support

Credentialing & Enrollment

Most Billing Software Supported

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What Thrive Handles

What We Handle Behind Your Pulmonary Claims

Thrive manages the full billing cycle for pulmonology practices, from the first eligibility check to the last posted payment. That includes coding and submitting claims for office visits, pulmonary function tests, sleep studies, bronchoscopy, and hospital-based critical care, along with the prior authorization, denial management, and AR follow-up that keeps those claims from stalling.

Practices outsourcing pulmonology billing services to Thrive get a team that already knows why a spirometry claim gets folded into an office visit, and why a critical care claim gets rejected when ventilator management is billed on the same day. That is a different starting point than a generalist billing team applying primary care logic to a pulmonary chart.

HIPAA-Compliant Process

Certified Medical Coders

Nationwide Payer Coverage

✔ 95%+ of pulmonology claims paid on first submission through specialty-specific claim scrubbing

✔ Average AR held under 30 days across testing, procedural, and hospital claim types

✔ Claims submitted within 48 hours of finalized documentation

✔ Practices see an average 30% increase in collected revenue after transitioning to Thrive

The Framework

Three Billing Clocks, One Team Watching All of Them

Most billing companies treat pulmonology as a single workflow. It isn’t. An office visit for COPD management runs on E/M documentation rules. A sleep study runs on technical and professional component splits. A critical care admission runs on a literal clock, thirty to seventy-four minutes for the first unit, thirty-minute blocks after that. Thrive codes and bills each one on its own terms.

The Clinic Clock

Office-based chronic disease management. COPD, asthma, and interstitial lung disease follow-up visits, plus telehealth encounters billed under the Medicare flexibilities extended through December 31, 2027.

The Testing Clock

The diagnostic suite. Spirometry, lung volumes, diffusion capacity, sleep studies, and home oxygen therapy, where technical and professional components are billed separately by modifier.

The Procedure Clock

Procedural and hospital pulmonology. Bronchoscopy, critical care time, and ventilator management, where NCCI bundling edits and time documentation decide what actually gets paid.

Revenue Cycle Services

Pulmonology Revenue Cycle Services, Clock by Clock

Every task below is handled by coders who work inside that specific reimbursement model daily, not a single generalist covering all three.

Clinic Clock

Eligibility and benefits verification before every office visit
E/M coding for COPD, asthma, and interstitial lung disease management
Telehealth billing with correct place-of-service code and modifier for chronic follow-ups
Patient statements and collections for office-based balances

Testing Clock

Spirometry and bronchodilator responsiveness coding without bundling errors
Lung volume and diffusion capacity coding for restrictive disease workups
Sleep study coding with correct technical and professional component splits
Prior authorization tracking for polysomnography, home sleep testing, and CPAP
Home oxygen and respiratory DME billing under current documentation rules

Procedure Clock

Bronchoscopy coding across diagnostic, biopsy, lavage, and navigation-guided procedures
Critical care time documentation and coding
Ventilator management coding, kept separate from critical care time
Credentialing and payer enrollment for pulmonology providers

Coding Reference

Pulmonology CPT and HCPCS Code Reference

Our pulmonology billing and coding services are built around the code families where reimbursement is actually won or lost. This is not a full fee schedule. It is the coding logic behind spirometry, sleep studies, bronchoscopy, critical care, and home oxygen.

Spirometry

Baseline breathing capacity testing and bronchodilator responsiveness testing, the two most frequently billed pulmonary function codes

Bronchial Challenge

Methacholine or mannitol challenge testing to evaluate airway hyper-responsiveness

Lung Volumes & DLCO

Body plethysmography, gas dilution lung volume studies, and diffusion capacity testing for restrictive disease workups

Sleep & Home Testing

Unattended home sleep apnea testing through full attended in-lab polysomnography, with or without CPAP titration

Bronchoscopy

Diagnostic bronchoscopy through biopsy, lavage, navigation, and endobronchial ultrasound procedures

Critical Care Time

Time-based evaluation and management for critically ill pulmonary patients

Ventilator Management

Daily management of invasive mechanical ventilation in the hospital, nursing facility, or home setting

Home Oxygen & DME

Oxygen concentrators, portable systems, and related respiratory durable medical equipment

What's the difference between the technical and professional component in pulmonology testing?

The technical component, billed with modifier TC, covers the equipment, technologist time, and facility overhead for a study like a sleep test or a PFT. The professional component, billed with modifier 26, covers the physician's interpretation of the results. If the practice owns the equipment and the same physician interprets the study, it is billed globally with no modifier at all.

Denial Patterns

Where Pulmonology Claims Actually Get Denied

These are the denial patterns Thrive sees repeat across pulmonology practices, not a generic list of billing mistakes.

Spirometry Bundled Into the Same-Day Office Visit

Payers fold spirometry into the E/M charge for that day unless modifier 25 is appended and the documentation shows the test was a separately identifiable service.

Baseline and Bronchodilator Spirometry Billed as Two Codes

Billing basic spirometry alongside bronchodilator responsiveness testing for the same session is a near-automatic bundling denial, since the bronchodilator code already includes the baseline study.

Diagnostic Bronchoscopy Denied as Not Separately Payable

The base diagnostic bronchoscopy code is designated a separate procedure and is absorbed into biopsy, lavage, or navigation codes performed in the same session.

Sleep Study Modifier Mismatches

When the facility and the interpreting physician bill separately, a missing or duplicated TC or 26 modifier produces duplicate-service denials on both claims.

Critical Care Time Overlapping Ventilator Management

Ventilator management is bundled into critical care time when billed by the same provider on the same day. Billing both is a frequent audit and recoupment trigger.

Home Oxygen Claims Missing Qualifying Test Results

Initial oxygen certification still requires qualifying blood gas or oximetry results on file, and eight oxygen-related HCPCS codes were added to CMS’s face-to-face documentation list in the January 2026 update.

Missing Prior Authorization for Sleep Testing

Commercial payers increasingly require authorization before polysomnography or home sleep testing. A missing auth number on the claim is recoverable. No authorization at all is not.

Telehealth Follow-Ups Billed With the Wrong Place of Service

COPD and asthma telehealth follow-ups billed with the wrong place-of-service code or the wrong audio versus audio-video modifier get paid at the wrong rate or rejected outright.

Our Process

How Thrive Clears These Denials Before They Start

The same five steps run for every claim, whichever clock it belongs to.

Eligibility, Benefits & Prior Authorization

Coverage is confirmed and authorization is secured for PFTs, sleep studies, and DME before the patient is even seen.

Specialty-Trained Coding & Claim Scrubbing

Coders trained specifically in pulmonary CPT logic apply the correct spirometry, bronchoscopy, and sleep study code combinations, catching bundling conflicts before submission.

Clean Claim Submission

Claims go out within 48 hours of finalized documentation, with technical, professional, and distinct-service modifiers applied correctly the first time.

Denial Root-Cause Analysis & Appeal

Every denial is traced to its source, whether that's a bundling edit, a missing authorization, or a documentation gap, and appealed with the specific evidence that reverses it.

AR Follow-Up & Reporting

Aged claims are worked on a defined schedule, payments are posted and reconciled, and the practice gets monthly reporting on exactly where revenue stands.

AR Follow-Up and Reporting

Aging claims are worked on a set schedule, with reporting that shows exactly what is outstanding, by procedure type and by payer.

Why Thrive

Why Pulmonology Practices Choose Thrive

Not every billing partner spends real time learning pulmonary coding logic. Here’s what separates Thrive from other pulmonology billing providers.

Coders Who Know Pulmonary Codes, Not Just E/M

Trained specifically in PFT, sleep, bronchoscopy, and critical care coding, not generalist billers applying primary care logic to a pulmonary chart.

HIPAA-Compliant Across Every Claim Type

Office visits, diagnostic testing, and hospital-based claims all move through the same compliance-checked process.

Nationwide Payer Experience

Credentialing and claims experience across Medicare, Medicare Advantage, and commercial payers in all 50 states, not one regional network.

Transparent, Practice-Level Reporting

Monthly reporting shows claim status, denial trends, and AR aging without the practice having to ask.

Audit-Ready Documentation Standards

Coding and claim files are kept to a standard that holds up if a payer or CMS contractor requests records.

Get Started

Talk to a Pulmonology Billing Specialist

Thrive is a pulmonology billing services company built around three reimbursement clocks instead of one generic billing workflow. Start with a free 15-minute practice revenue review. No commitment, just a clear look at where claims are stalling.

Book Your Free Revenue Analysis

Schedule a 15-minute meeting to review where anesthesia claims, denials, payments, and AR follow-up are slowing collections.

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Common Questions

Pulmonology Billing FAQs

How much does pulmonology billing cost?

Fees are typically a percentage of collections and depend on claim volume and how much of your work is office visits versus testing and procedures. Practices with heavier bronchoscopy and critical care volume are priced differently than clinic-only practices. You'll get an exact number after a free revenue review, not a generic rate card.

How long does onboarding take?

Most pulmonology practices are fully transitioned within two to four weeks. That includes payer enrollment checks, a review of open AR, and a short period where Thrive works alongside your current process before taking it over completely.

Can you take over our existing AR and open claims?

Yes. Thrive reviews your current aging report, prioritizes claims closest to timely filing deadlines, and works both the backlog and new claims at the same time so nothing gets dropped during the switch.

Do you bill technical and professional components separately for sleep studies and PFTs?

Yes, when that split applies. If your practice owns the equipment and the same physician interprets the results, the study is billed globally. If a hospital or outside facility performs the technical portion, Thrive applies modifier 26 for your physician's interpretation.

How do you handle denials and appeals?

Every denial is traced to a root cause, a bundling edit, a missing authorization, or a documentation gap, before an appeal is filed. That targeted approach recovers more revenue than a generic resubmission and reduces repeat denials on the same code pairs.

How do you keep our data protected?

All claims processing follows HIPAA-compliant handling standards, from eligibility checks through payment posting. Access to patient information is limited to the team members working your account.

How do we track our numbers?

You receive monthly reporting covering claim status, denial trends by code, and AR aging by clock, clinic, testing, and procedural, so you can see exactly where revenue stands without requesting a special report.

Do you work with pulmonology practices in every state?

Yes. Thrive provides pulmonary medical billing services nationwide, with credentialing and claims experience across Medicare, Medicare Advantage, and commercial payers in all 50 states, not a single regional payer network.

Ready When You Are

Stop Losing Revenue to Wrong-Payer Claims

Get a free, no-obligation review to identify where your pulmonology billing is losing revenue through denied claims, underpayments, or incorrect payer submissions.

We don’t just process claims - we recover lost revenue and prevent it from happening again.

About Us

At Thrive Medical Billing, we specialize in providing precise, efficient, and personalized medical billing services. As a trusted medical billing company, we are committed to helping your practice succeed by handling all your billing needs, allowing you to focus on what matters most—providing exceptional care to your patients. Partner with us to elevate your practice and experience growth—because when your practice thrives, so do we.