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Billing Guides

Medical billing guides for practices and billing teams

Practical, specialty-specific billing guides for medical billing companies, physician practices, and behavioral health organizations. Each guide covers CPT code families, documentation, telehealth rules, prior authorization, and common denials.

These guides are for general operational reference only and are not legal or coding advice. Always verify each payer's policy, your provider contracts, and the current AMA CPT manual before submitting claims.

Sleep Medicine

Sleep Medicine Billing Guide

Sleep medicine billing across E/M visits, home sleep apnea testing (95800, 95801, 95806, G0398-G0400), attended polysomnography (95807-95811, 95782/95783), split-night studies, MSLT and MWT, professional and technical components, prior authorization, Medicare PAP coverage and the day 31 to day 91 compliance window, oral appliance coordination, telehealth, denial prevention, and AR.

Read the sleep medicine billing guide
Wound Care

Wound Care Billing Guide

Wound care billing across diagnosis specificity, debridement by tissue depth and area (97597/97598, 97602, 11042-11047), E/M and modifier 25, NPWT, compression and casting, cellular and tissue-based products, the 2026 Medicare skin substitute payment change, hyperbaric oxygen therapy, NCCI edits, denial prevention, and AR.

Read the wound care billing guide
Home Health

Home Health Billing Guide

Medicare home health billing under PDGM: eligibility and homebound status, the 60-day certification and 30-day payment periods, Notice of Admission timing and TOB 032A, OASIS, PDGM clinical groups, HIPPS and revenue code 0023, LUPA management, partial period payments, claim types, denial prevention, AR follow-up, and 2026 updates.

Read the home health billing guide
Behavioral Health

Behavioral Health Integration Billing Guide

General BHI and Psychiatric CoCM billing across 99484, 99492-99494, G2214, and G0323: initiating visits, documented consent, the behavioral health care plan, registry and measurement-based care, monthly time capture, same-month overlap controls, the 2026 APCM add-ons and RHC/FQHC transition, and denial prevention.

Read the BHI billing guide
Physical Therapy

Physical Therapy Billing Guide

Outpatient PT billing across evaluation codes 97161-97164, timed treatment codes and the Medicare 8-minute rule, GP/KX/CQ and modifier 59, plan-of-care certification, diagnosis and medical necessity, NCCI edits, denial prevention, payment posting, and billing KPIs.

Read the physical therapy billing guide
Neurology

Neurology Billing Guide

Neurology billing across E/M and G2211, EEG (routine, long-term, technical/professional components), EMG and nerve conduction studies, botulinum toxin and drug units, infusions, lumbar puncture, neuropsychological testing, prior authorization, modifiers, and denial prevention.

Read the neurology billing guide
Primary Care

Remote Patient Monitoring Billing Guide

RPM CPT codes 99453, 99454, 99457, 99458, and the 2026 additions 99445 and 99470: medical necessity, consent, device and data transmission requirements, time tracking, example scenarios, and the billing mistakes that cause denials.

Read the RPM billing guide
Behavioral Health

Spravato Billing Guide

Esketamine (Spravato) billing for psychiatry and behavioral health: J0013, G2082/G2083, units and NDC reporting, REMS and 2-hour monitoring documentation, prior authorization, buy-and-bill vs. specialty pharmacy scenarios, and denial prevention.

Read the Spravato billing guide
Behavioral Health

ABA Billing Guide

Applied Behavior Analysis CPT codes, prior authorization, unit calculation, session documentation, modifiers, place of service, same-day services, clean claim checks, and denial prevention for ABA and autism service providers.

Read the ABA billing guide
Behavioral Health

Psychiatry Billing Guide

Psychiatric diagnostic evaluations, E/M and medication management, psychotherapy add-on codes, telepsychiatry, Spravato/esketamine, TMS, collaborative care, documentation, and denial prevention for psychiatry practices.

Read the psychiatry billing guide
Behavioral Health

Psychology Billing Guide

Psychotherapy CPT codes, psychological and neuropsychological testing, telehealth modifiers, documentation checklists, prior authorization, and common denials for psychology and behavioral health practices.

Read the psychology billing guide
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