Rheumatology
Revenue analysis for Rheumatology practices. Complex medication management, care coordination billing, and E&M coding benchmarks.
$98K
Avg Missed/Year
6K
US Providers
420
Avg Patients
3.0
Avg Chronic Dx
Specialty Overview
Rheumatology practices manage complex autoimmune conditions requiring intensive medication management (biologics, DMARDs) and multi-specialist coordination. This complexity naturally supports high-level E&M coding and strong CCM eligibility, yet many rheumatologists undercode and haven't adopted care management programs.
Key Insight: Biologic medication management automatically meets the 'high risk' MDM element for 99215 — yet many rheumatologists code these visits as 99214, leaving $84+ per visit on the table.
E&M Coding Distribution
National benchmark for Rheumatology E&M code distribution. Compare your practice against these targets to identify coding optimization opportunities.
99213
25%
$92/visit
99214
50%
$130/visit
99215
25%
$176/visit
Revenue Gap Breakdown
E&M Coding Gap
Biologic medication management meets high-risk MDM criteria. Benchmark: 25% 99213 / 50% 99214 / 25% 99215.
CCM (99490)
12% adoption. RA patients with comorbid conditions are ideal CCM candidates — medication monitoring alone requires significant coordination.
RPM (99453-99458)
Disease activity monitoring and medication adherence tracking. 6% adoption.
BHI (99484)
Chronic pain and autoimmune conditions are strongly associated with depression (22% prevalence).
AWV (G0438/G0439)
16% AWV completion. Rheumatology patients benefit from comprehensive preventive screening.
Care Management Adoption Rates
CCM
12%
Target: 15%
RPM
6%
Target: 10%
BHI
4%
Target: 10%
AWV
16%
Target: 70%
Common Chronic Conditions
Recommended Billing Guides
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