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Rheumatology billing services · Biologics · Infusions
PhysiAssist runs rheumatology billing and revenue cycle management for practices with in-office infusion suites. We get biologics authorized before the chair is booked, bill every infusion and injection by the unit with the right waste line, help patients on self-injectables start on time, and keep office visits, labs and DEXA paid.
Biologic infusion units
Try itDose
400 mgBilled units
J1745 × 405 mg/kg from 100 mg vials: 4 vials, nothing discarded, so the drug line carries JZ.
Label dosing; your physician's order always rules
The basics
Rheumatology billing services manage the revenue cycle of a rheumatology practice: benefits checks and prior authorization for biologics, coding of visits, infusions, joint injections and DEXA, drug units and waste modifiers, specialty pharmacy coordination for self-injectables, claim submission, payment posting, denials, AR follow-up and patient billing. In rheumatology most revenue and most denials sit in the biologics.
Infliximab and biosimilars, rituximab, tocilizumab, abatacept: units, waste lines, administration codes and site-of-care rules.
20610 and 20611 with the image on file, steroids and viscosupplements billed by the unit.
E/M levels, in-house labs and DEXA (77080) with the diagnosis and frequency rules each payer uses.
Benefits investigation, prior authorization, specialty pharmacy hand-off, copay cards and foundations.
What we check
| Codes | What they cover | What we check |
|---|---|---|
| J1745 · Q5103 · Q5104 · Q5121 | Infliximab and its biosimilars, per 10 mg | Which product the payer prefers, units from the weight-based dose, and the JW or JZ line |
| J9312 · Q5115 · Q5119 · Q5123 | Rituximab and its biosimilars, per 10 mg | Authorization for the course, the biosimilar on the payer's list, and the diagnosis link |
| J0129 · J3262 | Abatacept per 10 mg, tocilizumab per 1 mg | Weight-band or mg/kg dose, vial combination and discarded units |
| 96365–96368 · 96413 | Infusion administration | Start and stop times, and the administration codes each payer accepts for the drug |
| 20610 · 20611 | Large joint injection, without and with ultrasound guidance | A recorded ultrasound image for 20611, and the side and joint documented |
| J3301 · J7321 · J7324 · J7325 | Triamcinolone per 10 mg, hyaluronan viscosupplements | Units, knee-only coverage rules and repeat-course intervals |
| 77080 | DEXA bone density scan | Covered diagnosis and the payer's frequency limit |
Free infusion and biologic audit
Send us a recent month of infusion and injection claims. A certified coder checks every drug line and authorization and sends a written report you keep, whether or not you work with us.
Drug lines reviewed
286With an issue
23Dollar impact
$14,350What the report covers
Where we work
We run billing today for a rheumatology practice in Connecticut, infusion suite included. Our team works inside your system, so your nurses and physicians keep their workflow.
The systems we work in every day
We log in to your system; nothing about it changes for your team.
Claims, rejections and remittances worked through your clearinghouse.
Submissions, status checks and renewals in each payer's own portal.
Pricing
One rate of 2.8% to 5% of net collections, quoted in writing before you sign. Where you land depends on monthly collections, specialty mix, the scope of services, and your AR backlog and payer mix.
The rate covers medical coding, claim submission, payment posting, denials and AR follow-up. Front desk services, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
Estimate your rate →Benefits checks and prior authorization for biologics, coding of visits, infusions, joint injections and DEXA, drug units and waste modifiers, specialty pharmacy coordination for self-injectables, claim submission, payment posting, denials, AR follow-up and patient billing.
The drug is billed by its HCPCS unit (for example infliximab J1745 per 10 mg, abatacept J0129 per 10 mg, tocilizumab J3262 per 1 mg) plus the infusion administration codes. Discarded drug from single-dose vials goes on its own line with JW, or JZ when nothing was discarded.
Most denials come from authorizations: step therapy not documented, the payer preferring a biosimilar, an expired approval, or site-of-care rules that push infusions out of the hospital. Unit errors and missing JW or JZ lines are next.
Yes. Large joint injections are billed with 20610 without ultrasound or 20611 with ultrasound guidance and a recorded image, plus the drug: corticosteroids such as triamcinolone (J3301) or viscosupplements such as J7321, J7324 and J7325.
Yes. For self-injected drugs we run the benefits investigation and prior authorization, coordinate with the specialty pharmacy, and apply for copay cards or foundation help, so patients start and stay on therapy.
PhysiAssist charges 2.8% to 5% of net collections, quoted in writing before you sign. Collections volume, services, scope, AR backlog and payer mix decide where you land.
We review recent infusion and injection claims and send a written report: unit and waste errors by drug, authorization and step-therapy gaps, biosimilar preferences by payer, denials by root cause and the dollar impact of each.
A free infusion and biologic audit by a certified coder, with a written report you keep.