Billing, coding and denial recovery for pulmonary medicine groups, hospital-based pulmonary and critical care practices, interventional pulmonology programs and pulmonary rehab.
Pulmonology claims lose money on rules that repeat. A spirometry line billed inside the test that includes it, or ICU time counted to the wrong clock, is denied the same way every week. Missing or invalid prior authorization caused 17% of denials in our claim audit, which matters for any practice giving severe asthma biologics. Luxen fixes those patterns at the claim level, inside the EHR you already use.
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Pulmonology billing services manage coding, claims, denials and AR follow-up for pulmonary function tests, bronchoscopy and EBUS, critical care, pulmonary rehab and office visits. Luxen works inside your existing EHR for 3% to 6% of collections. Across 38 client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days.
Service lines include lung cancer screening and severe asthma biologics such as omalizumab (J2357), mepolizumab (J2182), benralizumab (J0517) and tezepelumab (J2356). Those need current authorizations and, on Medicare claims, the JZ or JW modifier. Our eligibility and prior authorization team tracks renewals before the next dose.
Most pulmonology leaks are rule errors that repeat on every claim of the same type. These are the patterns we check first, at 2026 national Medicare rates.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Spirometry billed with a bronchodilator study | 94010 + 94060 | 94060 already includes the spirometry, so the extra line is denied or recouped | $29.73 per 94010 line | 94010 was billed with 94060 on 6% of PFT claims |
| Diffusing capacity sent without its primary test | 94729 | Add-on code billed alone or with only an office visit | $63.46 global | Coding and modifier errors caused 21% of denials |
| Base bronchoscopy billed with lavage or biopsy | 31622 + 31624 or 31628 | Base code is not paid separately, and the denial is written off unchecked | $120.24 facility | 19% of denied claims were never reworked or appealed |
| ICU time counted to the wrong threshold | 99291 + 99292 | 99292 added before total time reaches 104 minutes | $100.20 facility | 99292 was billed under 104 total minutes on 9% of Medicare critical care claims |
| Pulmonary rehab past session 36 | 94625 or 94626 | KX modifier missing on sessions 37 to 72 | $87.18 to $109.22 per office session | The KX modifier was missing on 14% of Medicare pulmonary rehab sessions past 36 |
PFT codes are built to overlap. 2026 national Medicare amounts, non-APM conversion factor:
| Code | What it reports | Global | Interpretation (26) | Technical (TC) |
|---|---|---|---|---|
| 94010 | Spirometry, with or without maximal voluntary ventilation | $29.73 | $8.35 | $21.38 |
| 94060 | Spirometry as in 94010, pre- and post-bronchodilator | $43.42 | $10.35 | $33.07 |
| 94726 | Plethysmography for lung volumes | $63.80 | $12.02 | $51.77 |
| 94729 | Diffusing capacity, add-on | $63.46 | $9.35 | $54.11 |
| 94618 | Simple pulmonary stress test, such as a 6-minute walk | $37.07 | $22.71 | $14.36 |
In a hospital outpatient lab, the hospital is paid the technical component and the pulmonologist bills the interpretation with modifier 26. Medicare does not pay the practice the technical component for hospital patients (Claims Processing Manual Chapter 13, section 20.2.1).
94617 and 94619 test for exercise-induced bronchospasm with and without ECG, and 94621 is cardiopulmonary exercise testing. A 6-minute walk billed as 94621 instead of 94618 is an overpayment waiting to be found. Our certified medical coding team checks the order, the report and the code together before the claim goes out.
Place of service moves bronchoscopy payment more than any modifier, because in a hospital or ASC the facility is paid for the room and equipment.
| Code | Service | 2026 national, office | 2026 national, facility |
|---|---|---|---|
| 31622 | Diagnostic bronchoscopy (separate procedure) | $282.24 | $120.24 |
| 31624 | With bronchial alveolar lavage | $286.25 | $120.91 |
| 31628 | Transbronchial lung biopsy, single lobe | $408.49 | $158.65 |
| 31652 | EBUS sampling, 1 or 2 node stations or structures | $1,355.41 | $198.07 |
| 31653 | EBUS sampling, 3 or more node stations or structures | $1,399.16 | $219.11 |
| +31654 | Radial EBUS for peripheral lesion(s) | $131.27 | $59.79 |
| +31627 | Computer-assisted, image-guided navigation | $1,155.34 | $85.17 |
On the 2026 fee schedule, 31624, 31628 and other family members carry multiple procedure indicator 3 with 31622 as the base code. Special endoscopy pricing applies when two family members are billed together, and when a procedure is reported with its base code, Medicare does not pay the base code separately. 31652 and 31653 sit outside that family with indicator 2, so the standard multiple procedure reduction applies instead.
Medicare pays 99291 for 30 to 74 minutes and adds 99292 only when total time reaches 104 minutes, then for each further 30 minutes.
| Total critical care time | Medicare codes | 2026 national, facility |
|---|---|---|
| 30 to 103 minutes | 99291 | $199.07 |
| 104 to 133 minutes | 99291 + 99292 | $299.27 |
| 134 to 163 minutes | 99291 + 99292 x 2 | $399.47 |
G0424 was deleted after 2021. Medicare now pays 94625 without continuous oximetry or 94626 with it, per session. Under 42 CFR 410.47, patients qualify with moderate to very severe COPD (GOLD II to IV) or confirmed or suspected COVID-19 with respiratory symptoms lasting at least four weeks. A session needs at least 31 minutes, two sessions on one day need at least 91 minutes, and the benefit allows 36 sessions with an option for 36 more. Sessions 37 to 72 carry the KX modifier. NPs, PAs and clinical nurse specialists may supervise since January 1, 2024.
Pulmonology groups we support with Kentucky medical billing and West Virginia medical billing often treat miners in the federal Black Lung program. Those bills go through the Department of Labor OWCP Medical Bill Processing Portal, priced on a modified OWCP Medical Fee Schedule, not Medicare rates.
94760 and 94761 carry fee schedule status T, which means they are paid only when no other fee schedule service is billed on the same date by the same provider (payment policy indicators). Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting.
Home oxygen needs a qualifying result, such as arterial PO2 at or below 55 mm Hg or saturation at or below 88%, tested at the time of need (CMS oxygen compliance tips). The treating practitioner orders and evaluates that test, and suppliers may not perform it. Without it, the supplier's claim fails and the practice gets the records request. Eligibility and coverage errors caused 24% of denials.
A Medicare redetermination can be filed within 120 days of receiving the initial determination (CMS first-level appeals). Appeals filed by Luxen were overturned 68% of the time.
Physicians may bill retrospectively for 30 days before their enrollment effective date only when circumstances precluded enrolling in advance (42 CFR 424.521). Credentialing lapses delayed payment for 1 in 12 providers added in the prior year, which is why provider credentialing starts before the start date.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Office groups often run athenahealth, eClinicalWorks, NextGen Healthcare, AdvancedMD or Tebra, while hospital-based pulmonary and critical care groups document in Epic or Oracle Health. PFT labs use their own testing software, such as MGC Diagnostics, ndd Medical Technologies or COSMED systems, and bronchoscopy suites often document in Provation. Luxen works inside those systems after the BAA is signed. There is no data migration and no EHR switch. Our coders match each interpretation, procedure note and critical care time statement to its charge before the claim leaves.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Pulmonary function tests were being held because the order, completed test, and physician interpretation arrived at different times. Luxen created a completion queue, reducing billing lag from 12 days to three and releasing $35,400.
Practice Administrator, pulmonary medicine group
Hospital bronchoscopy procedures did not always appear on the office charge report. Luxen reconciled facility schedules against signed notes, captured 83 missed procedures, and recovered $62,100.
Billing Director, hospital-based pulmonology practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Under NCD 210.14, Medicare covers low-dose CT (71271) for patients aged 50 to 77 with at least 20 pack-years who smoke or quit within the last 15 years, after a counseling and shared decision-making visit (G0296). Neither line carries coinsurance or a deductible, so a statement for an eligible screening is a billing error. The USPSTF grades screening for adults 50 to 80 as B, and most commercial plans must cover grade B services without cost sharing. Our patient billing team checks eligibility before any statement.
In our billing reviews, 27% of total AR sat past 90 days in the average practice reviewed. Practices that reviewed AR ageing monthly carried 12 fewer days in AR, and every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year. Split AR by service line so ICU and hospital balances are not hidden, then send the oldest money to denial and AR recovery first.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Take a pulmonary and critical care group collecting $1.8M a year, or $150,000 a month. At Luxen's 3% to 6% of collections, billing costs $4,500 to $9,000 a month. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data, which is $11,850 a month or $142,200 a year for this group.
| Service line (illustrative split) | Monthly collections | In-house at 7.9% | Luxen at 3% | Luxen at 6% |
|---|---|---|---|---|
| Office visits and PFT lab | $82,500 | $6,517.50 | $2,475 | $4,950 |
| Bronchoscopy, EBUS and critical care | $52,500 | $4,147.50 | $1,575 | $3,150 |
| Pulmonary rehab and other services | $15,000 | $1,185 | $450 | $900 |
| Total | $150,000 | $11,850 | $4,500 | $9,000 |
The rate depends on volume, hospital and ICU share, and aged AR at the start. In-house also carries staffing risk: open biller roles took a median 67 days to fill. See what full-service medical billing covers.
In the Luxen Practice Manager Survey 2026, 44% could not name the fee basis in their current billing contract, and 52% of practices that switched billing vendors cited missing denial reporting as the main reason. Get both in writing, then compare medical billing companies on the same questions.
| Partner type | Pulmonology coding depth | Hospital and ICU charge capture | Works in your EHR | Terms |
|---|---|---|---|---|
| In-house team | One or two billers | Needs hospital system access | Yes | Salary, benefits and turnover |
| Generalist billing company | Built around office visits | Depends on hospital access | Usually | Varies |
| Specialty billing company | PFT and procedure focus | Varies | Varies | Varies |
| EHR vendor RCM | Tied to the vendor's workflow | Limited outside that system | That EHR only | Bundled with the software contract |
| Luxen | Certified coders on PFT, bronchoscopy and critical care rules | Hospital encounters matched to charges | Yes, no migration | 3% to 6% of collections, month to month, 30 days notice, no setup or exit fee |
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
94010 is spirometry, and 94060 is spirometry before and after a bronchodilator. Because 94060 already includes the spirometry, the two are not billed together for the same test. The 2026 national Medicare global payment is $29.73 for 94010 and $43.42 for 94060.
Luxen charges 3% to 6% of collections, so a group collecting $150,000 a month pays $4,500 to $9,000. For comparison, fully loaded in-house billing cost 7.9% of collections for practices under $2M in our billing reviews. The rate depends on volume, hospital and ICU work, and aged AR.
We sign a BAA before touching data, then work the oldest money first. Median time from signed BAA to first claims worked was 9 business days, and first recovered payments usually arrive in about 3 weeks. The contract is month to month with 30 days notice and no setup or exit fee.
No. We work inside Epic, Oracle Health, athenahealth, eClinicalWorks, NextGen Healthcare and other systems. PFT interpretations and bronchoscopy notes are matched to charges where they are stored, before a claim is sent.
Not on a Medicare claim. CMS pays 99291 for 30 to 74 minutes and allows 99292 only when total critical care time reaches 104 minutes, then for each further 30 minutes. Other payers may set different time rules.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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