Infectious Disease Billing Services
Infectious disease billing spans three code worlds at once: evaluation and management for consults and follow-up, microbiology for cultures and susceptibility testing, and molecular diagnostics for panels and probes. Each world has its own unit rules and its own bundling traps, and a practice that codes only the visit while ignoring the lab side, or that bills a panel by the test instead of by the target count, leaves revenue behind or invites denials.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for infectious disease practices, built around the specialty’s actual code families and payer requirements.
Infectious Disease billing challenges
Consult coding is the first trap. Medicare does not pay consultation codes, so inpatient and office infectious disease consults for Medicare patients are billed with hospital or office evaluation and management codes, with the level supported by medical decision making or time. Some commercial payers still accept consultation codes, so the same consult may be coded differently depending on the payer, and the practice must know which rule applies before the claim goes out.
Microbiology coding follows the bench workflow: culture, then identification, then susceptibility, and each step can carry its own code. Culture codes in the 87040 through 87158 range must be coded to the highest level of specificity for the source and the organism type, and a screening culture and a culture for definitive identification are not reported together on the same specimen on the same day. Susceptibility testing is reported per organism tested, so unit counts depend on how many isolates were actually worked up, not on how many tests were ordered.
Molecular testing has its own structure. Nucleic acid probe testing is reported with codes in the 87471 through 87801 range, and multiplex panels are coded by target count: 87631 for 3 to 5 targets, 87632 for 6 to 11 targets, and 87633 for 12 to 25 targets for respiratory virus panels. Medicare policy generally prohibits separate payment for testing a single organism from one anatomic site by more than one methodology, with limited exceptions, so ordering both an immunoassay and a molecular test for the same organism at the same site will usually pay only once. Payers also increasingly limit large syndromic panels to specific patient groups, so medical necessity documentation must support the panel size ordered. Outpatient parenteral antimicrobial therapy adds coordination work across infusion, lab monitoring, and follow-up visits, and the billing must keep the drug, the administration, and the visit components correctly separated.
What MedPlus RCM handles for Infectious Disease practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve infectious disease practices nationwide, including hospital consult services, outpatient clinics, and practices offering outpatient parenteral antimicrobial therapy.
Results Infectious Disease practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
How are infectious disease consults billed to Medicare?
Medicare does not pay consultation codes, so consults are billed with hospital or office evaluation and management codes. Some commercial payers still accept consultation codes, so the coding rule depends on the payer.
How are cultures coded?
Culture codes are selected by source and organism type to the highest specificity, and a screening culture and a definitive identification culture are not reported together for the same specimen on the same day.
Why did our molecular panel claim deny?
Common causes include billing a panel size that exceeds the payer’s medical necessity policy for the patient group, and billing the same organism at the same site by two methodologies, which Medicare generally pays only once.
How is susceptibility testing billed?
Susceptibility testing is reported per organism tested, so units must match the number of isolates actually worked up rather than the number of tests ordered.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your infectious disease practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
