Pulmonology Billing Services in Texas with TMHP Compliance
Texas runs one of the strictest Medicaid timely filing windows in the country, and its billing rules are unforgiving of small errors. Here’s how we handle it for your pulmonary practice:
- Filing every claim inside TMHP’s 95-day deadline, since Texas Medicaid allows no exceptions and no appeal past it
- Managing prior auth across Texas’s five Medicaid MCOs, like Superior HealthPlan
- Catching the 94010-vs-94060 mix-up and bundling edits on 31622 that cost bronchoscopy reimbursement
- Fixing unspecified COPD coding, denied or downcoded twice as often as a specific code like J44.0
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Where Do Texas Pulmonology Practices Lose the Most Revenue?
Five Medicaid plans, a strict filing deadline, and a large military population make billing in Texas harder than in most states. The revenue leaks below are where it actually adds up:
TRICARE Claims Mismatch
Texas has one of the largest military populations in the country, and TRICARE uses a claims format most billing teams never learn. A claim built like a commercial one gets bounced before it's even reviewed.
Sleep Study Prior Auth Confusion
Superior HealthPlan dropped prior auth for certain sleep study codes in April 2025, but not all of them. Practices that don't track which codes changed either seek auth they don't need or skip auth they do.
STAR+PLUS Transition Fallout
Texas ended its Dual Demonstration Program in December 2025, moving patients in Dallas, Harris, Bexar, and other counties to new STAR+PLUS plans. Practices that weren't ready saw claims rejected from day one.
95800 vs 95811 Substitution
Billing an unattended home study (95800) when the patient actually needed a full attended titration (95811) gets denied by any payer that requires attended CPAP titration. The two aren't interchangeable.
Which Texas Pulmonology Practices Trust Our Billing Services?
Texas pulmonology practices rely on us to handle complex respiratory claims, reduce avoidable denials, and keep their reimbursements moving. From pulmonary function testing to chronic respiratory care, these practices trust our pulmonology billing services:
Which Pulmonology Billing Services Does Transcure Provide in Texas?
Texas gives providers one shot to file a claim, since TMHP’s 95-day window applies to everyone. Our pulmonology billing services clear that deadline and cover the full revenue cycle below.
MCO and TRICARE Verification
We confirm the correct payer, a Texas Medicaid MCO, TRICARE, or commercial plan, before every pulmonary visit, so claims are routed right the first time.
STAR+PLUS Transition Monitoring
Transcure proactively tracks plan code changes as Texas Medicaid shifts patients between MCOs. This protects you the next time Texas restructures a plan.
Sleep and Respiratory Prior Auth
PRIA tracks which Texas Medicaid codes still need authorization after the 2025 policy changes, so your team never seeks approval it no longer requires.
Pulmonary CPT and ICD-10 Coding
Our coders carefully distinguish 94010 from 94060 and 95800 from 95811 before submission, catching the substitution errors behind sleep and PFT denials.
Vendor Drug Formulary Tracking
We closely monitor updates to Texas Medicaid’s Vendor Drug Program so a nebulizer or biologic prescription billed under last quarter’s rules isn’t denied.
95-Day Compliant Submission
Every bronchoscopy or PFT claim is filed well inside TMHP’s strict 95-day window, since Texas Medicaid allows no exceptions once that deadline has passed.
Which Cities are Served by Transcure Medical Billing Services in Texas?
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Austin, Texas
Fort Worth, Texas
Abbott, Texas
Corpus Christi, Texas
El Paso, Texas
Plano, Texas
Irving, Texas
How Does Transcure Fix the Documentation Gaps Behind Most Pulmonology Denials?
Roughly 1.3 million Texans live with COPD, generating a heavy, steady load of sleep studies, home oxygen orders, and biologics prescriptions. Payers scrutinize these services hardest for documentation and medical necessity. A denial here means the patient has no other pulmonologist nearby, turning a documentation gap into a delay.
Transcure closes that documentation gap before the claim goes out. Our AI agent PRIA checks the clinical note against each payer’s medical necessity rules for sleep studies, CPAP, and biologics such as Xolair and Nucala. It flags any claim where the record doesn’t yet support what’s being billed. This lets you get paid for claims that should have been approved in the first place.
Which Texas Counties Does Transcure Cover for Pulmonology Billing Services?
Andrews County, Texas
Aransas County, Texas
Bexar County, Texas
Tarrant County, Texas
Collin County, Texas
Travis County, Texas
Pulmonology Billing Services Across States in the US
As a leading medical billing company, Transcure supports practices across Texas and beyond. State healthcare rules never stay the same, but our pulmonology billing services do, spread across states nationwide.
What Pulmonary Procedures Does Transcure's Texas Billing Team Handle?
Texas pulmonology practices handle the same mix of procedures as anywhere else, but TMHP and the state’s five MCOs each score these claims differently. Here’s how our Texas billing team handles the ones that matter most.
Bronchoscopy Billing
Texas hospital systems often pair bronchoscopy with a same-day biopsy, and one missing modifier denies half the claim. Our coders apply the correct modifier and sequence both procedures so the payer accepts them together.
Polysomnography (Sleep Study) Billing
Superior HealthPlan removed prior auth on some sleep study codes in 2025, but only for patients 17 and under. We check the patient's age and plan before every submission, so your team never wastes time on an authorization.
Critical Care Billing
A same-day PFT eats into documented critical care time if no one separates the two codes. We isolate the PFT minutes first, then bill the remaining critical care time separately, so the code holds up under any payer review.
Spirometry and PFT Billing
Texas payers downcode PFT claims with a thin interpretation note, even when the CPT code is correct. We build the interpretation to match the billed complexity before submission, so the note supports the level you're claiming.
EBUS Billing
Some Texas MCOs cap payment per lymph node station, and overbilling stations triggers a denial or an audit flag. Our team cross-checks the operative note against the billed stations before every single claim submission.
Bronchial Thermoplasty Billing
Texas Medicaid authorizes LDCT screening for only 90 days, and a missing smoking-history code denies the claim outright. We file the authorization before the scan, so the window never closes before the patient is seen.
Why Should Pulmonology Practices in Texas Choose Transcure?
Pulmonary practices across Texas trust Transcure’s expertise in pulmonology billing services. Here are some reasons why you should choose us as well:
Pulmonology-Trained Coders
Our coders specialize in pulmonology, so they know the specialty’s coding rules cold. They catch EBUS station limits, PFT interpretation gaps, and bundling errors a generalist team would never think to check.
Flat 5% Fee Structure
A Texas medical biller costs roughly $39,756 per year before benefits and training. Our flat 5% fee replaces that cost with a full team of certified billers and coders, for less than the cost of one salary.
Authorization Deadline Tracking
We track every time-sensitive approval, including the 90-day LDCT window, from the moment it’s filed until it expires. A scheduled scan or procedure is never blocked by an authorization that quietly lapsed.
Dedicated Texas Account Manager
Every practice gets one billing lead who knows your account, your payer mix, and your claim history inside out. When a TX MCO issue comes up, you’re talking to someone who already understands your practice.
Is Your Billing Ready for Texas's Next Medicaid MCO Transition?
Most practices in TX were not ready for the last Medicaid transition, and the next one is already on the calendar. The Dual Demonstration Program ended December 31, 2025, and patients from various counties woke up on a new STAR+PLUS MCO plan overnight. Practices that missed the switch billed under deactivated codes and spent weeks reworking auths that should have carried over automatically.
With Transcure, you don’t have to worry about any of this. We monitor HHSC and MCO bulletins before any plan code goes live, so your practice never bills under a code that’s already been retired. Our team updates auths ahead of the deadline and confirms each patient’s new MCO assignment before their next visit.
Which Pulmonology EHR Systems Does Transcure Support in Texas?
Transcure bills directly inside the EHR your Texas practice already runs, so your clinical team never has to learn a new system.
What Do Pulmonology Practices in Texas Say About Transcure?
Hear from Texas pulmonology practices that cut denial rates and sped up collections after partnering with Transcure.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions (FAQs)
Get answers to the most common questions Texas pulmonology practices ask about our billing services, compliance, and state-specific regulations.
How does Transcure handle denial management for pulmonology practices in Texas?
Transcure works denied claims through correction, resubmission, and payer follow-up while tracking recurring denial patterns. Across its billing operations, Transcure maintains a 99% first-pass clean claims rate, reducing avoidable rework before claims ever reach TMHP.
Does Transcure support solo and small pulmonology practices in Texas?
Yes, Transcure works with practices of any size, from a single pulmonologist to a multi-provider group. Billing support scales with your patient volume, so you’re never paying for more infrastructure than you need.
What does Transcure charge for pulmonology billing in Texas?
Transcure charges a flat 5% of monthly collections for full-cycle billing, with no setup fees. The fee is tied directly to what we collect for your practice, so our incentive is always aligned with getting your claims paid.
Can Transcure increase my pulmonary practice's revenue?
Yes, Transcure’s billing support captures revenue your practice already earns but doesn’t fully collect. Practices typically see up to a 20% increase in overall revenue through cleaner claims and active denial resolution.