Left heart cath claims can generate more money than One week's worth of office visit billing, and payers carefully read each line on these claims. If you place even One wrong modifier or forget to include an authorization on your left heart cath claim, it will be turned into a two-month appeal. This guide compares the top cardiology billing firm in the USA based on those items that move cardiology practices' cash.
We rank 10 firms with side by side table comparisons of real cost, common denial codes and questions to ask before signing.
Quick Answer: Which Cardiology Billing Company Is Best?
Human Medical Billing is generally the best option for an Independent Cardiology Practice or Single-Specialty Group. They allow you to run all of your Cath, EP, Echo, Nuclear, and Device Claims (as well as other) through cardiology-specific coding checks in your existing EHR. They will also provide each practice with its own Account Manager. And they can offer month-to-month billing contracts. If you are a larger group or would like to start using new billing software there are many other great options available.
Best cardiology billing companies by type of practice:
- Best Overall – Human Medical Billing, the best cardiology billing company in the United States (USA).
- Large cardiology groups: Athenahealth, which was chosen by a national cardiology management group for its affiliated practices.
- Billing and software contracted together: CareCloud, which sells its own cardiology electronic health record (EHR) alongside billing services.
- Cath lab owners and multi-specialty groups: Coronis Health.
- Hospital affiliates: R1 RCM, a company offering billing service to both hospital-owned physician groups and independently owned physician groups.
- Small Practices: Tebra - designed for small, independent offices.
How did we Rank these Cardiology Billing Services?
Each of our firms was ranked in four categories; Cardiology billing Coding levels, Prior authorization and denials, contract options with flexible terms and ease of contact for an actual service representative. Every fact about a competitor comes from that company's own public pages or press releases.
No one has been rated on marketing claims; if we were unable to find documentation for a particular company then it will be listed as "Ask" in the chart below to help guide your questions during the sales call.
Top 10 Cardiology Billing Companies in the USA
1. Human Medical Billing
Best for: Independent Cardiology Practices and Single or Multi-Specialty Groups That Would Like to Continue Using Their Current Electronic Health Record (EHR).
Human Medical Billing has been providing medical billing and accounts receivable services for independent physicians and physician-owned groups since 2001. From its headquarters in Ventura, California, our staff will process your claims within the EHR and Practice Management System (PMS) you currently utilize. Your front office does not have to learn how to use new software or how to complete the steps in a different order.
Our pricing is based on a percentage of what you collect. Therefore, we earn our fee only when you collect and our incentive is directly tied to your incentives for processing claims. Due to this reason, we price after we've seen your specific payer mix and the type and quantity of procedures performed by your office, not before.
Claims submitted for Cardiology Services receive Cardiology Rules. When coding claims, we split Professional and Technical Components using modifiers 26 and TC. We also verify that all necessary NCCI pairs were checked prior to submitting Cath or PCI Claims. Additionally, we identify each diagnostic test for the local coverage determination (LCD) governing it. To avoid gaps between vendors, the same team processes Echo, Nuclear, Electrophysiology and Device Work.
Prior Authorization sits at the beginning of the billing cycle, not the end. Staff review patient benefits, request prior authorization for Scheduled CATHS, Nuclear Studies and Device Implants before the date of service. Once approved, the staff attaches the approval number to the claim.
Our Denial Management Services Team will also handle an Appeal of a Denied Claim from Payer if denied after processing through our services. We track each reason for denial so that it does not continue to be denied. If a Payer continues to deny a specific Nuclear Study Code, we correct the Front End Step in the process that was causing this denial.
What you get day to day:
- Dedicated Account Manager Who Knows Your Payers, Physicians and Specific Coding Requirements
- Month-to-Month Terms (No Long-Term Lock-Ins)
- Reports Monthly On Clean Claims Rate, Denials Rate, A/R Days & Net Collection Rate
- Certified Coders With Cath Lab, EP Lab, Echo, Nuclear & Device Experience
- A+ Rating From BBB (Better Business Bureau).
Considerations: Human Medical Billing is a services company, not a software company. The certified medical billers work for you.
Verdict: This service is best suited for Independent Cardiologists, Group Practices that wish to have Specialty Coding performed but do not wish to enter into a lengthy Contract or have any Lock-In Period.
See Human Medical Billing’s cardiology billing services
2. CareCloud
Best for: Practices that want all three (EHR, Practice Management & Billing) from the same company.
Strengths: CareCloud's Cardiology Page includes Cardiology specific CPT, ICD-10, Modifiers, Payer Specific Prior Authorization Support and Denial Mgmt. Also, they sell a Cardiology EHR which will allow Clinical Notes to be attached to Claims in the Same System.
Considerations: Although CareCloud states that their Cardiology Billing is compatible with others' Systems; Their Cardiology Page does not show Pricing.
Verdict: Good option if you are going to change your EHR regardless.
3. Athenahealth
Best for: Cardiology practice groups with large numbers of providers who are looking to utilize one electronic health record (EHR) platform.
Strengths: The EHR, Revenue Cycle Management and Patient Engagement can be combined into one system via the use of athenaOne. In June 2024, Cardiovascular Associates of America, a management services organization that provides support for cardiology practices, announced that they will be utilizing the athenahealth platform for their affiliated physician practices.
Considerations: Since athenahealth's revenue cycle operations utilize the same athenaOne EHR platform as their clinical and administrative functions, you would have to utilize athenaOne. athenahealth pricing is based upon quoted figures.
Verdict: athenahealth could be an excellent choice for those cardiology practice groups that wish to utilize one vendor for both their clinical and billing needs.
athenahealth revenue cycle page
4. AdvancedMD
Best for: Practices that want to run their own billing now and keep a managed option open in the future.
Strengths: AdvancedMD's strengths are that it sell cardiology billing and coding software as well as provide a fully managed revenue cycle service by its own billers. AdvancedMD's website states that its managed service is from 4-8 % of collections.
Considerations: AdvancedMD's managed service is that it must be used on AdvancedMD's platform. AdvancedMD's cardiology page discusses mostly features of the software with very little information about outsource cardiac coding.
Verdict: AdvancedMD is a Good option for teams that want control over their own billing today but also want the ability to use a managed path for future billing needs.
5. Tebra
Best for: Small independent practices.
Strengths: Tebra formed in 2021 when Kareo merged with PatientPop. Tebra offers to independent offices electronic health record (EHR), billing and patient engagement services. Kareo has long offered a managed billing service.
Considerations: If your group is larger than one site or will be growing into multiple sites, they can quickly outgrow this product. Verify that their managed billing service includes cardiac and electrophysiology claims prior to signing up.
Verdict: This would be an excellent choice for a smaller independent office that wishes to have patient marketing tools as well.
6. Medical Billers and Coders
Best for: Practices that are looking for coders familiar with each states' payers.
Strengths: Medical Billers and Coders has developed state-specific cardiology billing resources by coding page. They say their medical coders have experience with all areas of cardiology including; Interventional, Cath Lab, Electrophysiology (EP), Cardiac CT Coding.
Considerations: They describe themselves as a "consortium" of billers/coders therefore you need to get specific information about which individuals are going to be working on your practice's account. Pricing for cardiology is also not listed.
Verdict: Make an inquiry and discuss further if you're seeking coder knowledge at the state level.
Medical Billers and Coders cardiology page
7. R1 RCM
Best for: Physician Groups with large or affiliated with hospitals.
Strengths: R1 identifies cardiology as one of many (more than 70) specialty areas that they support for physicians; R1 supports both independent and hospital-based physician groups; R1 has reported an average clean claim rate of 97.5 percent when working in physician revenue cycles.
Considerations: R1 was established from working with hospitals/health systems; therefore, the needs of a 3 cardiologist office may be too small to match their normal clientele; pricing is determined by a sales process.
Verdict: Built for enterprise scale.
8. Coronis Health
Best for: Multi-specialty group and private practice with a cath lab.
Strengths: Coronis is a cardiology billing company that has also released guidance on billing mistakes when you are an owner of the cath lab. They have expanded by buying other billing companies such as PractiSource.
Considerations: Companies acquired can be operated separately by regional teams; thus, it is essential to know which team, and what systems they are using to process claims. Pricing isn’t public.
Verdict: Coronis can be a good choice for those who have a cath lab and/or work in a mixed-specialty group.
Coronis Health cardiology page
9. BellMedEx
Best for: Groups that need an external coding team and an ehr system at no cost.
Strengths: BellMedEx is able to offer support to every type of provider (from small to large) and states on their website that they are able to offer cardiology specific coders which are certified by AAPC. They also state they have a free EHR available through their company.
Considerations: Although BellMedex states they support all types of providers (smaller to larger), there was no information regarding contract terms and/or exit clauses, therefore, you should ensure these items are included in your written contract.
Verdict: When price becomes the determining factor, this is worth adding to your shortlist.
10. MedCare MSO
Best for: Cardiology offices wanting both employees to bill and specific cardiology billing software.
Strengths: The cardiology services provided by Medcare include; eligibility verification, prior authorizations, CPT and ICD-10 coding, charge entry and denial management for all cardiology related billing claims. Its software page cites more than 300 cardiology coding rules for cath, EP, device, stress and echo claims.
Considerations: The Company’s website shows potential revenue increases. Ask for the base case from which the stated revenue increase is calculated before relying on this information.
Verdict: A good match for cardiology offices wishing to combine a package of people with a package of software.
The Best Cardiology Billing Companies Compared
Here's how the 10 firms line up on the questions cardiology practices ask first. The "ask" refers to those who do not have this information posted on their website.
| Company | Contract | Pricing model | Prior auth support | Cath/EP depth | Works in your EHR | Best for |
|---|---|---|---|---|---|---|
| Human Medical Billing | Month-to-month | % of collections | Yes | Cath, EP, echo, nuclear, device | Yes | Independent or group practices |
| CareCloud | Ask | Ask | Yes | Cardiology CPT and modifier coding listed | Yes, per CareCloud | EHR switchers |
| athenahealth | Ask | Quote | Yes | Platform rules | No, runs on athenaOne | Large groups |
| AdvancedMD | Ask | 4 to 8% of collections | Software workflow | Software focus | No, runs on AdvancedMD | In-house teams |
| Tebra | Ask | Ask | Ask | Ask | No, runs on Tebra | Small practices |
| Medical Billers and Coders | Ask | Ask | Ask | Cath, EP, cardiac CT listed | Ask | State payer know-how |
| R1 RCM | Ask | Quote | Ask | Ask | Yes | Enterprise groups |
| Coronis Health | Ask | Quote | Ask | Cath lab guidance | Ask | Multi-specialty |
| BellMedEx | Ask | Ask | Yes | Ask | Yes, or free EHR | Price-focused buyers |
| MedCare MSO | Ask | Ask | Yes | Cath, EP, device, echo rules | Yes | Software plus staff |
What makes Cardiology billing different than other specialties?
Billing for cardiology services is much different from other specialty billing. This is due to fact that in many instances a single encounter may be comprised of both a procedure(s), an imaging component as well as a device service; each has their own unique code, modifier and rules of reimbursement. Payers are very aggressive when auditing claims submitted by cardiologists based upon the high dollar amounts associated with each claim. A small coding error can be costly.
Additionally, office-based lab (OBL) billing adds additional complexity. When practices bill under the global service they are responsible for both the professional and technical components on all claims.
The following codes create the most problems:
- 93458 - Left Heart Cath with Coronary Angiogram & Left Ventriculography. The biller will need to split these into Add-ons and Same Session Services.
- 92928 - PCI Stent Placement in a Single Major Coronary Artery/Branch; each additional vessel requires different coding.
- 93653 - Ablative Therapy for Supra-Ventricular Tachycardia during Electrophysiology Study; payers verify whether there is a "bundled" package of Mapping and/or Stimulation Codes.
- 93306 - Complete Transthoracic Echo with Spectral and Color Doppler Imaging
- 78452 - Myocardial Perfusion SPECT with multiple studies (often combined with a separate stress test code)
- Device Checks: 93288 In-Person Pacemaker Checks interrogation codes have frequency limits that trip up schedulers
Modifiers are really what make these services happen. The Professional Read Modifier (26) will bill the physician; Technical Component (TC) will bill the equipment and personnel involved; and Global Billing is billed for none. If you have two different services performed on a patient in the same session, Modifier 59 or the more specific XS can be used to separate those two services. And if you are billing for multiple services in the same session, Modifier 51 flags that you are doing this.
And don't forget about your Global Periods. Most CPT Codes assigned by CMS have a Global Indicator (000), (010), (090) or (XXX). Most Catheterization, Percutaneous Coronary Intervention (PCI), Ablation Procedures are coded with a 0 Day Global period. If the Physician Implants a Pacemaker using Code 33208, he/she has a 90 Day Global Period. Therefore, the Follow-up Visit would likely be non-reimbursable during the 90 Day Post-Procedure time frame, according to AAPC.
The Medical Necessity for these Services also plays an important role. Each Service has an LCD from your MAC and/or a National Coverage Determination (NCD) (such as NCD 20.8.3 Permanent Pacemakers) defining which Diagnoses Support Which Services.
Medicare and Payer Changes Affecting Cardiology Billing
Three Federal Changes from 2024 through 2026 will affect cardiac billing: A cut to procedure values; a faster deadline for prior authorization for many insurance plans; and decreased payment for services in a hospital setting. As each change occurs, it will change how a billing department operates.
1. -2.5% cut to work RVU’s (2026)
The CMS Physician Fee Schedule Final Rule of 2026 has reduced work RVU's and intra-service time by 2.5%, for almost all non-time based CPT codes, with CMS planning to make this same reduction every three years, according to the American College of Cardiology (ACC, 2025). Although the ACC lobbied against the reduction, it went into effect on January 1, 2026. The ACC reports, as a result of Medicare reductions, cardiac services lost $700 million in revenue over five years (ACC, February 2026).
2. Conversion Factor (2026)
The conversion factor for the year 2026 was increased by the Centers for Medicare & Medicaid Services (CMS) to $33.5675 for eligible Alternative Payment Model (APM) Participants (ACC, 2025). However, according to the American College of Cardiology (ACC), with an RVU reduction, it is estimated that most of this increase in value will be lost as a result of reduced payment for services related to procedures and diagnostics.
3. Deadline to request prior authorization (2026)
Medicare Advantage Plans, Medicaid and Children's Health Insurance Programs (CHIP) and all other payer entities that are subject to the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) will have 72 hours to process “Urgent” or expedited prior authorization requests and seven (7) calendar days for all other prior authorizations, beginning January 1st, 2026. Also, the payer must provide a clear reason as to why they denied the request. The APIs in the final rule are required of all affected entities on January 1, 2027.
4. Site of service rule 2026
CMS used a new method to calculate indirect practice expense under the Site of service rule; resulting in lower reimbursement rates for many physician services that are provided within hospital settings. The ACC did not support the new methodology.
5. What's next - proposed 2027 fee schedule
On September 10, 2026, the ACC submitted comments regarding CMS' proposed 2027 fee schedule and requested that CMS exempt those cpt codes which were previously reduced by CMS using the resurvey process.
Full Ranking Criteria
We have assigned weights to all the factors based on their influence on collection at cardiology practices.
| Criterion | Weight |
|---|---|
| Cardiology coding depth (cath, EP, echo, nuclear, device) | 25% |
| Prior auth and denial management | 20% |
| Contract flexibility and exit terms | 15% |
| Support access (named contact, response time) | 15% |
| Pricing transparency | 10% |
| EHR fit and reporting | 10% |
| Compliance record | 5% |
The source for each number was either the publicly available cardiology page of the company, their price page and/or press release. In cases where we used a competitors’ denial rates and/accuracy ratings, those had to be published by that competitor.
How Much Do Cardiology Billing Services Cost?
Billing services for cardiology usually cost a percent of what they collect for your practice. A few will charge per claim and some charge a fixed month-to-month service fee. Ultimately, whether the "headline" rate is higher or lower does not matter as much as what it includes.
Here’s how the three models compare:
- Percentage of Collections: Collecting more increases the earnings of the firm. For example, AdvancedMD reports that its managed services model is based on collecting 4 – 8 percent of collections.
- Per Claim: Suitable for providers with low-volume claims. This method punishes Cardiologists due to the fact that they spend a great deal of time working on a single catheterization claim as opposed to multiple visits in their practice.
- Fixed Monthly Fee: Provides ease of forecasting costs, however, the amount earned by the firm does not increase if it works harder to resolve a denied claim versus simply dropping it.
Run the math on your own numbers. On $150,000 in monthly collections, a 5% rate costs $7,500 a month, while a 7% rate costs $10,500. That $3,000 gap only pays off if the higher-priced firm recovers more than $3,000 in denials and old A/R each month.
Ask every vendor what is included in their rate. Fees to ask about in writing:
- Setup or start-up fee
- Monthly minimums (if applicable)
- Cleanup of old account receivable from your previous vendor
- Patient statements and payment plans
- Credentialing for new physicians
- Exit fee and how fast do you get data back
Which Type of Cardiology Billing Company best Fits Your Practice?
The right choice will be dependent upon your size, location and volume of billed procedures. This is a good place to begin.
| Practice type | What matters most | Type of firm to look for |
|---|---|---|
| Solo or small practice | Low cost, a named contact, no software change | Services firm that works in your EHR |
| Mid-size group | Prior auth volume, coder depth, monthly reporting | Specialty-focused services firm |
| Hospital-employed | Professional fee billing, facility coordination | Enterprise revenue cycle firm |
| Office-based lab | Global and split billing, supply costs, LCD rules | Firm with cath lab and OBL experience |
| EP and device-heavy | Ablation bundling, device check frequency, 90-day global | Firm with EP and device coders |
| Multi-specialty | One process across specialties | Multi-specialty firm with a cardiology team |
Common Cardiology Claim Denials and How to Fix Them
Claim Adjustment Reason Codes that appear most frequently in remittance reports for cardiologists have a corresponding correction.
| Code | What it means | How to fix it |
|---|---|---|
| CO-4 | Modifier missing or doesn’t match the procedure | Check 26/TC splits and NCCI modifier needs before you submit |
| CO-16 | Claim lacks information the payer needs | Fill missing NPI, referring provider or authorization fields, then resubmit |
| CO-29 | Filing deadline passed | Track each payer’s filing limit and keep proof of timely submission |
| CO-50 | Payer says the service wasn’t medically necessary | Match the diagnosis to the LCD or NCD and appeal with notes |
| CO-97 | Service bundled into another paid service | Review NCCI pairs and use 59 or XS only when documentation supports it |
| CO-197 | Prior authorization missing | Get the authorization before the date of service and attach the number |
10 Questions to Ask Before You Sign
Ask every cardiology medical billing company the exact same ten questions and receive written responses. Reputable cardiology billing companies should be able to respond positively to all ten questions.
- How many cardiology practices are you currently billing for?
- Are your coders certified in cardiology coding, and who audits their work?
- How do you address Prior Auth requests for caths, Nuclear Studies and Device Implants?
- What percentage of your claims for cardiology services come back as clean claims versus denied claims and how do you arrive at these percentages?
- Will you work within our present Electronic Health Record (EHR) system or will we need to transition into a new EHR system?
- Who is my primary point of contact on a daily basis and what can I expect in terms of response time?
- What is included in your rates and what costs extra?
- How long is the length of the contract agreement and how much will it cost me to exit the contract agreement?
- What steps do you take to resolve the backlog of Accounts Receivable (A/R) that has been accumulated through my previous billing vendor?
- What reports can I expect to receive monthly?
Red flag examples to watch for:
- A rate is provided prior to viewing your payer mix
- Cardiology references cannot be called
- Multi-year contract with high exit fees
- Denial rates presented without explanation
- Answer unclear as to who will have possession of your patient data
How to Switch Cardiology Billing Companies without Cash-Flow Gaps
In order to minimize any cash flow gaps that may occur due to switching cardiology billing companies, a 90-day transition plan can be implemented to ensure claims continue to process, regardless if the practice chooses to hire another cardiology medical billing company or take the responsibility in house.
Days 1 – 30
Sign a new agreement with the new cardiology billing company and provide written notification to the previous provider. Obtain an A/R aging report and open denials along with payer enrolment information. Confirm which staff member(s) will handle processing of previously submitted claims post-cutover. Provide the new billing team with your most recent three months of remittance statements to help identify payer patterns immediately upon implementation.
Days 31 – 60
The new cardiology billing company establishes fee schedule, payer rule requirements and EHR access. The new team begins submitting new claims. The old vendor keeps working claims it already sent. Your medical credentialing services team should update any payer enrollment listing the previous billing company's address.
Days 61 – 90
Compare weekly collections to your baseline. Resolve outstanding A/R (close-out or transfer to a third-party medical accounts receivable services team). Verify the previous billing company has returned all of your patient data.
Why Human Oversight Wins
Software identifies a lost modifier. It does not contact a payor (for example) on Friday at 5pm asking about why an itemized catheter claim is in pending status. Also, software will not note that some physicians are consistently omitting stress test results when documenting their patients’ treatment plans.
Therefore, we assign trained personnel to review every cardiology client's accounts. The staff member assigned to each of our cardiology clients use automated systems to alert them to potential errors; however, a person (i.e. coder), reviews each high-dollar claim. Additionally, an Account Manager monitors the entire billing trend within the client's practice. We also provide Medical Coding Services as well as Healthcare Revenue Cycle Management Services which keeps the process "human" from time-of-charge until final payment.
Frequently Asked Questions
Human medical billing is first choice of this guide for cardiac coding, prior auth work flow and month to month terms that work with your current electronic health record (EHR) system. The best company will be based on your size and settings and whether you have any special requirements.
Most cardiology billing companies charge a percentage of collections. Advancedmd has listed 4-8% as the rate it charges for its managed service option. Other options include charging a flat monthly fee, per claim or variation thereof. Always find out what the rate includes as setup fees, minimums and old account receivable work can change the real cost.
The combination of procedure, imaging and device services in many encounters create complexity. To be correct each will need to have the proper CPT code(s), proper modifiers (e.g., professional vs. Technical) and an appropriate diagnosis to meet the payer's coverage criteria. The global period, NCCI bundling edits and prior authorization process add additional steps in which a claim may fail.
Some examples of commonly used CPT Codes for Cardiology are; 93458 Left Heart Catheterization w/ Angiography, 92928 Coronary Stenting, 93653 SVT Ablation, 93306 Complete Echo Study, 78452 Nuclear Spect Imaging. Also included would be the device interrogation codes (93288) and E/M Visit codes for Cardiology.
If you are paying more than what the vendor charges for denials, a/r delays, and coder changes then yes. An outside company will provide trained cardiology coding and prior authorizing personnel. Consider your current salaries (billing), software, and lost collections compared to your potential vendors total cost of service to determine whether this is something worthwhile.
Modifier 26 allows for payment for the professional component (physician interpretation) of a study. Modifier TC allows for payment of the technical component (equipment, staffing, supplies). When a cardiologist reads an echo or nuclear study at a hospital they use modifier 26 on their bill. The hospital uses modifier TC on its portion of the bill.
Prior authorization requirements may vary depending on payer type and plan type. Commercial and Medicare Advantage plans often require prior authorization for cardiac imaging (nuclear stress test, cardiac CT/MRI, etc.), elective catheterizations and device implants. Review your payers' prior authorization lists before booking appointments and initiate requests well ahead of time to ensure the requests are completed within the normal processing timeframe.
Lower is best for denials and Higher is Best for clean claims. Many billing companies target high 90's for clean claims.
Plan for a 90 day transition. Provide notification of your decision, request all accounts receivable (a/r) aging reports & open denial lists. Define which company will be responsible for working the older accounts. The new firm should establish its own payer rules and EHR access before you begin tracking the weekly collections from your previous baseline until the old a/r has closed.
Some will. Some won't. Service-based firms like Human Medical Billing operate within your current EHR. While platform vendors like athenahealth, advancedmd and tebra run billing through their own systems. Each vendor should be asked directly if they can operate within your current EHR system. Switching EHR's adds additional cost for training time and may cause short-term productivity decline.
Final Thoughts
The right cardiology billing company can identify a 26 from a TC; get an authorization before performing a cath lab procedure; tell you clearly how much your contract will cost you to walk away. Utilize the list of questions and denial table listed above to review each potential vendor on your list, including Human Medical Billing. Any good Cardiology billing companies should be able to answer all ten questions in writing with ease.
If you are interested in having another look at your current financials, we offer complimentary reviews of your cardiology claims, denials and accounts receivable (A/R) so that you can find out where the money is leaking before making any changes.
Get Your Free Cardiology Billing Audit from Human Medical Billing
Contact Human Medical Billing to schedule a compliance readiness review or learn more about our end-to-end billing and regulatory support services.
