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Neurology Billing Services
Component Splits, Infusion Drug Units, and Auth Denials Drain Neurology Revenue
What Neurology Billing Requires
Neurology billing requires splitting each test into its professional and technical parts, counting nerve studies and drug units exactly, and getting prior authorization for infusions, imaging and sleep studies before the patient arrives. E/M level selection matters too: in Medicare's audit data, coding errors account for more than half of neurology's improper payments. Qualigenix handles each step with neurology-trained coders. Call 786-259-0231 for a free billing audit.
01
EEG, EMG & NCS Coding
NCS codes 95907–95913 are billed by the number of studies, not the number of nerves tested in the room. When EMG is done the same day as NCS, the needle EMG goes on add-on codes 95885–95887 instead of the standalone 95860–95864. Both rules get missed.
02
Infusion & Sleep Study Auths
Ocrelizumab, natalizumab, IVIG and CGRP infusions need prior authorization, and so do most in-lab sleep studies. Some payers require a home sleep test first.
03
Professional vs. Technical Splits
A practice that owns the EEG equipment bills globally. A neurologist reading a hospital study bills the professional component with modifier 26. Mixing the two leads to duplicate-payment denials or lost technical revenue.
04
Telehealth Neurology Visits
Follow-ups for epilepsy, MS and migraine often happen by video. Medicare telehealth rules have changed several times since 2020, and commercial plans each set their own modifier and place-of-service rules.
05
Specialty Drug Benefit Checks
The same drug can fall under the medical benefit with one plan and the pharmacy benefit with another. If nobody checks, the practice buys and infuses a drug the payer expected a specialty pharmacy to supply.
06
Necessity for Repeat Testing
Repeat EMG, NCS or long-term EEG needs a documented change in symptoms or a clear clinical question. MAC local coverage policies limit how often these studies are paid.
07
Infusion & Testing Denials
Drug unit mismatches, missing JW or JZ modifiers, and diagnosis codes that don't match the coverage policy are the most frequent neurology denials we see.
08
LCD & CCM Compliance
Chronic care management for Parkinson's, MS or dementia patients requires documented patient consent and tracked monthly time. MAC coverage policies set the diagnosis lists for nerve conduction studies.
The Qualigenix Fix for Each Neurology Gap
Qualigenix pairs your practice with coders trained on neurodiagnostic and infusion billing, and each gap has a fixed control.
Neurodiagnostic Charge Capture
We count studies from the report, apply EMG add-on rules, and check every test against the order.
Infusion & Study Authorizations
We track approval dates, dose and unit limits, and reauthorization windows for every infusion patient.
26/TC Modifier Control
We map each test to where it was performed and who owns the equipment, then bill global, 26 or TC to match.
Telehealth Claim Support
We check the current Medicare and payer telehealth rules for each date of service and apply the right modifier and place of service.
Drug Coverage Verification
Before the first dose, we confirm whether the drug is covered under the medical or pharmacy benefit and what the patient will owe.
Test Indication Review
We compare the diagnosis on each study to the payer's coverage policy and query the provider when the note falls short.
Denial Recovery & Appeals
Neurology denials are worked with the test report and authorization attached. Qualigenix overturns 79% of denials across its client base.
LCD & Consent Tracking
We keep CCM consent and monthly time logs ready for audit, and update edits when a MAC policy changes.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Coding for Every Neurology Service Line
Qualigenix codes the services neurology practices actually bill, from routine visits to long-term monitoring.
EEG & Long-Term Monitoring (95812–95822, 95700–95726)
Routine EEG by recording length and state, plus long-term and video EEG setup, recording and interpretation.
COMPLIANCE
How We Keep Neurology Billing Compliant
Qualigenix keeps neurology billing compliant by counting every nerve study, drug unit and minute from the signed report, following MAC coverage policies for EMG and nerve conduction testing, and reporting JW or JZ on every single-dose drug. Underbilling a long-term EEG or an infusion loses real money. Overbilling study counts or visit levels invites audits and repayment. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
0%
Audit Pass Rate
<0%
Variance Threshold
Why Qualigenix
0%
IMPROPER PAYMENT RATE
0%
FROM DOC GAPS
0%
FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Qualigenix quotes each neurology practice after reviewing claim volume, testing mix and infusion volume. Most practices start with a free billing audit that shows where revenue is lost.
Yes. When needle EMG is performed with nerve conduction studies, we bill the NCS by number of studies (95907–95913) and the EMG with add-on codes 95885–95887.
For drugs from single-dose vials, we report discarded units with JW, or append JZ when nothing was discarded. Medicare requires one or the other on these Part B drug claims.
Yes. We work aged claims by dollar value and filing deadline. Across our clients, Qualigenix has cut days in A/R from 54 to 36.
We submit the authorization with the diagnosis, prior treatment history and dosing plan, then track the approval's dates and unit limits. Reauthorization starts before the current approval runs out.
Yes. Qualigenix checks the Medicare and commercial telehealth rules in effect on each date of service and applies the modifier and place of service the payer requires.
Yes. Qualigenix works in 133 EMR/EHR platforms and bills from your existing system.
Qualigenix onboards new practices in 6 days on average.