Infectious Disease Billing Services
Infectious disease physicians work mostly as consultants. Much of the revenue comes from inpatient and hospital consults, followed by office visits and long-term antibiotic management. That makes the work spread across settings, with different documentation and payer rules in each one.
Many practices also manage outpatient antibiotic therapy, where drugs and infusions are given at home or in a clinic. Cultures, drug levels, and follow-up labs add more claims. Westmont Revenue Partners connects infectious disease practices with vetted billing experts who understand infectious disease billing, including consult rules and infusion-related claims.
Who this is for
- Infectious disease physicians in private practice
- Hospital-based infectious disease groups
- Practices that run outpatient antibiotic therapy programs
- Clinics with in-office infusion capacity
- Antimicrobial stewardship consultants
- Travel and HIV care clinics
What gets billed
- Inpatient consultations and follow-up visits
- Office visits for new and established patients
- Outpatient antibiotic therapy management
- In-office therapeutic infusions
- Antibiotic drug supply, where billed by the practice
- Venous access device care
- Culture and sensitivity testing, where done in-office
- Care coordination for complex infections
- Counseling on prevention and treatment
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99214 | CPT | Established patient office visit at a moderate level |
| 99215 | CPT | Established patient office visit at a high level |
| 96365 | CPT | Therapeutic infusion, first hour |
| 96366 | CPT | Therapeutic infusion, each additional hour |
| 96523 | CPT | Flushing a venous access device in the office |
| 87040 | CPT | Blood culture for bacteria |
| 87086 | CPT | Urine culture with colony count |
| J0878 | HCPCS | Daptomycin injection, billed per 1 mg |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in infectious disease
Consult versus other visit codes. Some payers no longer pay consultation codes, and each has its own preference. A biller keeps a payer-by-payer list and applies the right visit category for each.
Splitting care across settings. A patient may be seen in the hospital, then in the office, then by infusion. Dates and place of service need to line up. A biller tracks each stage so claims do not overlap.
Outpatient antibiotic therapy. Home and clinic infusion billing involves drug, supplies, nursing, and sometimes a per-diem. Payers differ widely. A biller confirms who bills which piece before therapy starts.
Drug units and codes. Antibiotic codes are tied to specific products and units. A biller checks the order against the claim so units are correct.
Long-term therapy monitoring. Patients on long courses need regular labs and visits. Payers may question frequency. A biller ties each visit to the monitoring reason in the note.
Diagnosis detail. Infection claims often need the organism, site, and severity. A biller works with the provider so notes support the diagnosis chosen.
Prior authorization. Many high-cost drugs need approval. A biller tracks authorization dates and covered quantities so treatment is not interrupted.
How Westmont can help
- Matching you with vetted billing experts experienced in infectious disease
- End-to-end revenue cycle support across hospital, office, and infusion settings
- Denial management for consult, drug, and infusion claims
- Credentialing support for new physicians and hospital-based groups
- Reporting by setting, payer, and service
Frequently asked questions
Do payers still pay for consultation codes?
Policies vary. Some payers accept consultation codes, while Medicare generally does not, and other payers have their own rules. Using the wrong category can cause denials. A biller maintains a payer-by-payer reference so each visit is billed in the way that payer expects. Always check current payer updates.
How is outpatient antibiotic therapy billed?
It depends on where care happens and who supplies the drug and nursing. Clinic infusions use infusion codes and drug codes. Home therapy may involve a pharmacy or home infusion provider billing separately. Payers differ, so confirm who bills what before therapy begins. A billing expert can map the roles clearly.
Can I bill for culture tests in my office?
Only if your practice is set up to perform the tests and meets the lab certification requirements. Otherwise, an outside lab bills for them. Payers may also limit tests to certain diagnoses. A biller confirms your lab setup and payer policy first.
Why do infectious disease claims get denied?
Common reasons include the wrong visit category, missing authorization, incorrect drug units, and unclear diagnoses. Overlapping dates across hospital and office care can also trigger denials. A biller checks these before submission and works denials promptly.
Is outsourcing infectious disease billing worth it?
Many practices consider it because care crosses settings and drug claims are detailed. Westmont does not submit claims itself. We connect you with vetted billing experts, and you decide whether a match fits your practice.
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