Endocrinology medical billing: the prior-authorization grind that eats your revenue
Most of what an independent endocrinology practice loses runs through prior authorization. GLP-1s, CGMs, insulin pumps, growth hormone, testosterone: almost all of it now needs an authorization before it pays. On GLP-1s alone, that went from about 5% of Medicare Part D patients before 2024 to close to 100% by 2025. Miss one required element and it denies.
The denials are winnable, which is what makes the loss so avoidable. More than 80% of appealed Medicare Advantage prior-authorization denials get overturned, but only about 12% are ever appealed. For a practice with no biller, the rest is abandoned revenue, plus the visit and the patient behind it.
A lot of it turns on what the claim has to prove. A GLP-1 is covered for type 2 diabetes and denied for obesity, so the claim and the notes have to carry the covered indication, or the drug and the visit both fall through. CGMs have their own catch: Medicare wants an in-person or telehealth visit within six months before you order, and every six months after, or coverage lapses.
Altair is the done-for-you billing service, run by AI, backed by our expert in-house billers. We run the prior authorizations and appeals on every drug and device, work the denials, and scrub every claim before it goes out, so you never touch a portal, fax, or peer-to-peer again.
Talk to us, and we will show you the prior-authorization revenue you are losing.
Common questions
Why do so many of our GLP-1 and diabetes device claims get denied?
Because almost all of them now go through prior authorization, and each one has a required element that auto-denies when it is missing: step-therapy proof, a second lab, the covered indication. A GLP-1 is covered for type 2 diabetes and denied for obesity. Most of these are winnable on appeal, but only if someone works them.
What is the fastest way to recover this revenue?
Work the prior authorizations and appeals every time. More than 80% of appealed Medicare Advantage prior-authorization denials get overturned, yet only about 12% are ever appealed, so most of that money is left on the table.
We have no biller on staff. Can you run all of this for us?
Yes. Altair is the done-for-you billing service, run by AI, backed by our expert in-house billers. We run the entire prior-authorization and appeals workload on your diabetes drugs and devices, work the denials, and scrub every claim, so you never touch a portal, fax, or peer-to-peer again.
Sources: Klebanoff et al., JAMA, and Penn LDI on Medicare Part D GLP-1 coverage (2025); KFF, Medicare Advantage prior authorization determinations, 2024 (2025); AAFP FPM, Medicare CGM coverage (2024); CMS Glucose Monitors LCD L33822; FDA GLP-1 prescribing information.