Pulmonology

Pulmonology is one of the most active Medicare specialties in the United States, with 10K providers billing Medicare nationally. The average Pulmonology provider treats 175 Medicare beneficiaries and receives $95K in total annual Medicare payments, translating to $545 per patient — a figure that signals high-acuity care and complex case management.

Evaluation and Management coding patterns reveal how Pulmonology providers characterize visit complexity. The dominant code is 99214 at 65.2% of E&M visits, reflecting moderate-to-high complexity encounters that are typical when managing established patients with multiple chronic conditions. Meanwhile, 99213 accounts for 23.0% and high-complexity 99215 visits represent 11.8% of the mix.

Care management program adoption presents a significant revenue opportunity for Pulmonology practices. Chronic Care Management (1.4%), Remote Patient Monitoring (2.0%), Behavioral Health Integration (0.0%) remain substantially underutilized relative to the eligible patient population. Annual Wellness Visit adoption sits at just 1.3%, well below the 70% target — meaning a majority of eligible Medicare beneficiaries are not receiving this preventive service, and practices are missing a straightforward billing opportunity. Providers who implement these programs can unlock substantial per-patient monthly revenue while improving chronic disease outcomes — NPIxray can help identify exactly which patients qualify.