Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...
Gastroenterology Billing & RCM Services
Screening versus diagnostic colonoscopy, polyp removal techniques and ASC billing all affect what GI practices get paid. Specialist billers get it right on every scope.
- Screening-to-diagnostic colonoscopy conversions billed correctly
- Biopsy, snare and ablation techniques coded per lesion
- Professional, ASC and anesthesia claims coordinated
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Why GI billing needs specialists
Gastroenterology billing revolves around endoscopy. A colonoscopy can start as a preventive screening and become diagnostic or therapeutic when a polyp is removed, which changes the codes, modifiers and patient cost-sharing. Medicare and commercial payers handle this differently, so the claim must follow each payer’s rules.
Polyp removal technique matters: cold biopsy forceps, snare and ablation are coded separately, and multiple techniques on different lesions need the right modifiers. Upper endoscopy, ERCP, capsule endoscopy and motility studies add more code families, plus pathology and anesthesia claims that must line up with the procedure.
Many GI groups own or partner with ambulatory surgery centers, creating separate facility and professional claims. A gastroenterology billing partner coordinates these claims, verifies screening benefits in advance and works denials related to frequency limits and diagnosis sequencing.
Common gastroenterology billing challenges
Screening vs. diagnostic rules
Converting a screening colonoscopy requires modifiers like PT (Medicare) or 33 (commercial) and correct diagnosis order.
Technique-based polyp coding
Biopsy, snare and ablation codes must match the technique documented for each lesion.
Frequency limitations
Screening intervals vary by risk level; claims outside allowed intervals are denied.
ASC and professional claims
Facility and professional claims must match procedures and modifiers to avoid denials.
Anesthesia for endoscopy
Monitored anesthesia care for screening has its own coverage and modifier rules.
Prior authorization for advanced procedures
ERCP, EUS and capsule studies often need authorization and strong documentation.
What a gastroenterology billing partner should handle
- Screening benefit verification and patient estimates
- Endoscopy coding from procedure and pathology reports
- PT and 33 modifier management for preventive services
- ASC facility and professional claim coordination
- Prior authorization for ERCP, EUS and capsule studies
- Infusion billing for IBD biologics
- Pathology charge reconciliation
- Denial management and appeals
- Patient statements for converted screenings
- KPI reporting by provider and procedure
Key codes in gastroenterology billing
| Code(s) | What it covers |
|---|---|
| 45378 | Diagnostic colonoscopy. |
| 45380 | Colonoscopy with biopsy, single or multiple. |
| 45385 | Colonoscopy with removal of lesion(s) by snare technique. |
| G0105 / G0121 | Medicare screening colonoscopy for high-risk / average-risk patients. |
| 43239 | Upper GI endoscopy (EGD) with biopsy. |
| 43260–43265 | Endoscopic retrograde cholangiopancreatography (ERCP) procedures. |
| 91110 | Gastrointestinal tract imaging, intraluminal (capsule endoscopy). |
Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.
Protect patients from surprise bills
When a screening becomes therapeutic, patient cost-sharing can change. Clear pre-procedure explanations, correct modifiers and accurate diagnosis sequencing reduce complaints and payer disputes.
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Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.
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Top-rated medical billing companies
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Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...
How much does gastroenterology billing cost?
Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.
Most common. You pay only on money collected.
Predictable for high-volume, low-complexity claims.
Dedicated billers working inside your systems.
Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.
Gastroenterology billing FAQs
It is billed with the therapeutic code (for example 45385) plus modifier PT for Medicare or 33 for many commercial payers, with the screening diagnosis listed first.
45380 is used when lesions are removed or sampled with biopsy forceps; 45385 is used when a lesion is removed with a snare.
Yes. GI billers handle ASC facility claims alongside professional claims and keep them consistent.
Common causes include frequency limits, missing modifiers, incorrect diagnosis order and lack of high-risk documentation.
Yes, including drug codes, NDCs, infusion administration codes and prior authorizations for biologics.
Typically 4% to 7% of collections, depending on volume and whether ASC billing is included.
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