Rheumatology billing
Protect high-dollar biologic claims and secure complex autoimmune reimbursements.
Rheumatology is one of the highest-risk billing environments in medicine — driven by expensive buy-and-bill biologics, multi-hour infusion coding and high-complexity leveling. We ensure your drug units are perfectly calculated, medical necessity rules are satisfied, and high-dollar claims are paid without delay.
Services we provide for rheumatology practices
Specialty-trained coders and billers who know your workflows, payers and compliance requirements inside out.
- High-complexity rheumatology consultation billing
- Biologic infusion & IV therapy claims management
- Joint aspiration & injection billing
- Musculoskeletal ultrasound & DEXA scan billing
- Specialty pharmacy & buy-and-bill tracking
- Biologic prior authorization & step-therapy management
- Drug wastage (JW & JZ) compliance auditing
- Co-pay assistance & foundation fund tracking
Codes we manage every day
A representative sample of the CPT, ICD-10 and modifier expertise our team applies to rheumatology claims.
Common CPT codes
- 96413, 96415Chemotherapy IV infusion (initial/add'l)
- 96365, 96366Therapeutic IV infusion
- 96372Subcutaneous / IM injection
- 20610, 20611Major joint aspiration/injection
- 77080DEXA bone density study
- J1745Injection, infliximab (Remicade)
- J9312Injection, rituximab (Rituxan)
Common diagnosis codes
- M05.79 / M06.9Rheumatoid arthritis
- M32.9Systemic lupus erythematosus
- M45.9Ankylosing spondylitis
- M10.9Gout, unspecified
- M81.0Postmenopausal osteoporosis
Modifiers we manage
- JW / JZDrug wasted / zero waste (single-dose vials)
- 25Separate E/M on injection day
- 50Bilateral joint injection
- 26 / TCProfessional / technical for DEXA
Common billing challenges we solve
- High-dollar buy-and-bill denials from unit mismatches
- JW/JZ modifier omissions triggering compliance audits
- Infusion vs. hydration bundling downcoding
- Step-therapy 'fail first' tracking for biologic approvals
- DEXA frequency-limit denials (24-month rule)
Payers we work with
- Medicare & Medicare Advantage (Part B vs. Part D)
- Medicaid & Managed Medicaid
- Commercial carriers (BCBS, UHC, Aetna, Cigna, Humana)
- Manufacturer co-pay cards & assistance programs
- HSA / FSA
Why rheumatology practices choose Core MBS
Biologic and specialty-medication experts
Flawless drug-unit calculations avoid whole-claim rejections
Proactive payer-policy monitoring on preferred biologics
Buy-and-bill inventory margin audits
Let's get your revenue cycle healthy.
Send us a note for a free, no-obligation billing review — we'll show you exactly where revenue is leaking and how we'd fix it.
- Corembs5@gmail.com
- corembs.com
- 30 N Gould St, Ste N, Sheridan, WY 82801