How are insulin pump medical necessity criteria verified?

Our clearance engine cross-references the patient's A1C history, C-peptide levels, and hypoglycemic episode documentation against active Local Coverage Determinations before submitting authorization requests.

Can we track patient A1C compliance for MIPS reporting?

Absolutely. We map A1C result dates and values directly from EHR templates to MIPS quality measure fields, automatically submitting performance data to CMS registries.

How does the system handle thyroid nodule biopsy and ablation billing?

We support ultrasound-guided thyroid FNA biopsy billing (CPT 10005, 10006) and radiofrequency ablation of thyroid nodules (CPT 0600T, 0601T), automatically pairing imaging guidance codes, verifying cytopathology add-on codes, and confirming that documentation supports the medical necessity criteria required by payers for ablative procedures.

What HCPCS codes are used for CGM sensors, receivers, and transmitters?

Current CGM billing uses HCPCS codes including A9276 (sensor), A9277 (transmitter), and A9278 (receiver) for non-therapeutic CGM, and K0553/K0554 for therapeutic CGM systems meeting the Medicare CGM coverage criteria. Our system maintains payer-specific quantity limits, prior authorization requirements, and documentation standards for each CGM component code.

How does the platform support billing for diabetes education programs (DSMES)?

We support Diabetes Self-Management Education and Support (DSMES) billing under CPT codes 98960–98962 and G0108–G0109, tracking the initial 10-hour program and follow-up hours, verifying that programs meet Medicare certification requirements, and confirming referring physician order documentation for covered diabetes education claims.

Does the system track bone density (DEXA) scan frequency limits for osteoporosis?

Yes. Medicare covers DEXA scans every 24 months for qualified patients. Our scheduling engine calculates each patient's next eligible scan date from prior claim history, prevents premature orders that will be denied, and confirms that the ordering provider documentation supports the appropriate osteoporosis monitoring or fracture risk assessment indication.

How are adrenal insufficiency testing and growth hormone stimulation tests billed?

We support complex endocrine function testing including cosyntropin stimulation (J0834), insulin tolerance testing, and growth hormone stimulation protocols, correctly sequencing the drug administration code, nursing time, and clinical interpretation E/M while verifying prior authorization for the injectables and documenting the medical necessity criteria required by payers.

Endocrinology PM & RCM Software

Endocrinology Practice Management and RCM Billing, Built to Perform

Automate continuous glucose monitor supply billing, insulin pump authorizations, and thyroid diagnostic coding. See why endocrinology practices choose Unlimited Systems for practice management and RCM software.

Why Endocrinology billing is different

Endocrinology practices manage a complex mix of chronic disease monitoring, high-cost supply billing, and pharmaceutical interventions for diabetes, thyroid disorders, osteoporosis, and metabolic conditions. Generic RCM systems cannot handle the intricate documentation requirements these conditions demand.

Continuous glucose monitors (CGMs) and insulin pumps require precise HCPCS coding, quantity limits, and documentation of medical necessity. Missing a single clinical indicator in the patient chart can trigger the full rejection of a high-cost supply order worth thousands of dollars.

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★★★★★4.8/5

★★★★★5/5

6,500+ specialty providersSOC 2 certified

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Endocrinology workspace preview coming soon

HOME SPECIALTIESEndocrinology Practice RCM

Trusted Payer & EHR Integration Partners

6,500+

providers nationwide

$70B+

in claims processed annually

4.8/5

average client rating

Designed Around How Your Endocrinology Practice ACTUALLY Works

Our connected workflows are built to make you and your work easier to do and increase your revenue.

Visit-ready

Keep authorization and coverage aligned before the appointment is booked.

Claim-ready

Validate endocrinology codes, modifiers, and documentation before submission.

Practice-ready

Give teams one view of denials, margin, and A/R priorities.

Specialty RCM intelligence

Endocrinology Revenue Cycle Challenges

GLP-1s, biologics, and hormone therapies create emerging buy-and-bill complexity.

13%

Est. denial rate

7/10

Prior-auth burden

Where revenue is at risk

GLP-1 PA Explosion

Ozempic, Wegovy, and Mounjaro coverage varies widely; obesity versus diabetes indication determines channel and coverage.

How the platform addresses this

Native prior authorization integration eliminates manual PA queues.
Coverage criteria and documentation requirements are prompted at order entry.
Renewals and denials are tracked through to resolution.

See it on your own claims

Buy-and-bill drug reference5 agents · codes, channel, prior-auth, and billing notes

Drug	Code	Route	Channel	Cost	PA	Billing notes
Prolia (denosumab)	J0897	SQ	Part B	$4K/yr	Yes	Every 6 months; refrigerated; cold chain critical.
Evenity (romosozumab)	J3111	SQ	Part B	$22K/yr	Yes	12-month limit; PA renewal at month 6.
Reclast (zoledronic acid)	J3489	IV	Part B	$1K/yr	Sometimes	Annual infusion; PA often required.
Somatuline (lanreotide)	J1930	SQ	Part B	$60K/yr	Yes	Acromegaly/carcinoid; deep SQ depot injection.
Signifor (pasireotide)	J2502	IM	Part B	$80K/yr	Yes	Cushing's disease; narrow formulary coverage.

Cabinet integration: Endocrinology practices administering Prolia and Evenity in-office have moderate cabinet integration need. Cold chain documentation for denosumab is critical, and EHR-linked dispensing ties temperature compliance records to the claim.

Real Endocrinology Practices, Real Results

See how endocrinology groups across the country use Unlimited Systems to lift collections, cut denials, and reclaim staff time.

Featured Practice

Endocrinology Partners of the Midwest

Columbus, OH14-provider group practice

“Unlimited Systems gave our endocrinology billing team the specialty-specific automation we could never get from a generic platform. First-pass claim acceptance climbed fast.”

- Director of Revenue Cycle

23%

Fewer denials

11 days

Faster A/R

Calculate Your RCM Revenue Leakage

Drag the sliders to estimate how much unrealized cash remains locked in your current specialty billing cycles before optimization.

Model your current claim volume

Adjust both inputs to match your practice.

Monthly specialty claims1,500

200 claims15,000 claims

Average claim value$250

$80 value$3,500 value

Estimated annual revenue recovered

$315,000

Calculated using a 7.0% reduction in write-offs from rejection recovery, pre-authorization verification, and drug-waste capture.

Monthly invoiced volume: $375,000
Standard industry loss: $31,875

Unlimited Systems Guarantee: Fully integrated bi-directional EHR triggers maintain first-pass bill submission scores above 98.6% across regional payer rules on day one.

Review my results

See your recovery estimate

Enter your work email to unlock your estimated annual recovery.

See Your Results Immediately5/55/54.8/5

One platform for every endocrinology workflow

Eight connected capabilities, grouped around the way your practice works.

Front office

Keep registration and appointment calendars in sync.

Patient intake Scheduling

Before the visit

Verify coverage and catch charge risk early.

Financial clearance Charge validation

Revenue cycle

Post payments, route denials, and prioritize A/R.

Payment and denials A/R management

Practice intelligence

See margin, performance, and value-based results.

Analytics Value-based care

The Endocrinology suite

Every part of the endocrinology revenue cycle, in one system

Each module is configured for the codes, modifiers, and payer rules endocrinology teams work with, not adapted from generic billing software.

Endocrinology Patient Intake SoftwareCapture diabetes device eligibility and verify CGM coverage limits prior to dispensing.Endocrinology Scheduling SoftwareBalance frequent A1C follow-ups, quarterly device checks, and thyroid panels in one grid.Endocrinology Financial Clearance SoftwareValidate insulin pump and CGM formulary requirements against active payer coverage criteria.Endocrinology Charge Validation SoftwareEnforce HCPCS device quantity limits and ICD-10 medical necessity matches before submission.Endocrinology Payment Posting SoftwarePost and reconcile durable medical equipment and pharmaceutical remittances automatically.Endocrinology AR Management SoftwareAuto-assemble medical necessity letters and A1C documentation for CGM and pump appeals.Endocrinology Analytics SoftwareTrack collections by diagnosis class, device type, and pharmaceutical category.Endocrinology Value-Based Care SoftwareSubmit MIPS quality measures on A1C control, eye exams, and nephropathy screening.

The cost of generic billing

You went into endocrinology to treat patients, not to chase claims

These are the places endocrinology practices most often lose revenue when their billing platform wasn’t built for the work. Unlimited Systems closes each one with rules configured for your specialty.

Review your workflow

Common endocrinology revenue leaks

Frequent denials on CGM device supplies due to missing formulary eligibility documentation.
Complex insulin pump prior authorization renewals with strict medical necessity standards.
Missed thyroid and bone density diagnostic scan billing on same-day evaluation days.
High administrative lag tracking patient self-monitoring logs and A1C compliance reports.

Challenges we solve for endocrinology

The work that generic platforms leave to your staff is the work endocrinology margin actually turns on.

CGM Supply Eligibility

Automated eligibility checks validate CGM dispensing frequency rules before each order.

Insulin Pump Prior Auth

Centralized authorization dashboard monitors renewal windows 60 days in advance.

Same-Day Diagnostic Billing

Charge scrubber identifies and appends diagnostic codes with proper -25 modifiers.

Legacy software vs. Unlimited Systems

See why endocrinology practices move off general-purpose billing platforms.

CRITERIA

LEGACY SYSTEM COMPROMISE

UNLIMITED SYSTEMS VALUE

CGM Supply Eligibility

✕Claims rejected because frequency limits and prior CGM use documentation are not verified.

✓Automated eligibility checks validate CGM dispensing frequency rules before each order.

Insulin Pump Prior Auth

✕Staff manually tracks complex pump authorization renewals across multiple payer portals.

✓Centralized authorization dashboard monitors renewal windows 60 days in advance.

Same-Day Diagnostic Billing

✕Bone density and thyroid scan fees are missed on days with office evaluation claims.

✓Charge scrubber identifies and appends diagnostic codes with proper -25 modifiers.

Still evaluating

Not Ready to Switch Yet? That's Exactly When to Start the Conversation.

You don't have to be actively replacing your current system to have a useful conversation with Unlimited Systems. Many endocrinology practices talk with us months before a contract renewal or system evaluation to understand where GLP-1 prior authorization, Prolia/Evenity documentation, CGM and DME billing, and hormone therapy rules may already be showing up.

Get a Demo Benchmark Your Current Workflow

A conversation can help identify where GLP-1 PA growth, Prolia and Evenity bone-density documentation, CGM/DME channel splits, and hormone therapy medical-necessity rules may be reducing clean-claim performance.

Less billing work between the visit and payment

Specialty rules and connected data keep your team focused on the exceptions that need judgment.

Verify before the visit

Coverage and authorization stay tied to the order.

Validate specialty charges

Code, unit, and modifier checks happen before filing.

Work the right accounts

Denials and A/R are ranked by value and filing risk.

Care team in scrubs walking through a clinic corridor

35%less manual workflow time

One platform

The rest of the platform your endocrinology practice runs on

The same connected system handles the operational work that sits either side of billing.

Patient Intake

Digital intake, eligibility, and demographic capture before the visit.

Explore Patient Intake

Patient Scheduling

Smart calendars and resource scheduling across providers and locations.

Explore Patient Scheduling

Financial Clearance

Automated eligibility checks and prior authorization management.

Explore Financial Clearance

Charge Validation

Pre-claim scrubbing for coding, modifiers, and compliance accuracy.

Explore Charge Validation

Built for endocrinology

Follow one endocrinology patient from intake to payment

Eight stages, one record. Nothing is rekeyed between systems, so a detail captured at the front desk is still there when the claim goes out, and when the remittance comes back.

Walk the workflow with us

Frequently asked questions

Yes. We maintain distinct HCPCS billing pathways for the CGM receiver, transmitter, and disposable sensor supplies, each with correct quantity limits and frequency rules per payer.

New to revenue cycle terminology? Browse our healthcare RCM & billing glossary.

We Love Hearing From Our Users

Practices like yours, on what changed after moving to Unlimited Financials.

EXPLORE PRODUCTS GET A DEMO

★★★★★4.8/5

★★★★★5/5

“

I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.

Sam Wheeler

CFO, SCOA

“

The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.

Ernelita Dacumos

Billing Manager, SHOM

“

Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.

Melissa Shook

Medical Biller, SHOM

“

I would recommend Unlimited Financials to other specialty practices.

Michelle Leandri

CEO, NEPA

“

We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.

Gina

Administrator, FOUR

“

We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.

Renee Bernacchi

Accounts Receivable Coordinator, COAS

“