Understanding Rheumatology Data on Sunlight Ledger

What Rheumatologists Do

Rheumatologists diagnose and treat autoimmune and inflammatory conditions that affect the joints, muscles, and connective tissues. Common conditions include rheumatoid arthritis, lupus, ankylosing spondylitis, psoriatic arthritis, gout, Sjogren's syndrome, vasculitis, and inflammatory myopathy. Rheumatology is a primarily cognitive specialty — diagnosis often requires integrating clinical findings, laboratory results, and imaging — but rheumatologists also perform joint and soft tissue injections.

Common Procedures in Medicare Data

  • Office visits — Evaluation and management codes constitute the majority of rheumatology billing
  • Joint injections — Corticosteroid or hyaluronic acid injections into affected joints
  • Soft tissue injections — Tendon sheath and bursa injections
  • Infusion therapy — Administration of biologic medications (e.g., rituximab, abatacept) in the office or infusion center
  • Laboratory ordering — ANA, rheumatoid factor, complement levels, and other specialized tests
  • Bone density testing — Ordered for patients on long-term corticosteroids

What Normal Volume Looks Like

Rheumatology practices focused on autoimmune disease management will bill primarily for office visits and potentially for in-office biologic infusions. A rheumatologist administering infusion biologics will show higher total Medicare payment amounts because the drug acquisition cost is included in those figures — similar to oncology. High payment totals do not necessarily indicate high fees; they often reflect the cost of the drugs being administered.

Pharma Payments in Rheumatology

Rheumatology has among the highest average pharmaceutical payment levels of any specialty. Biologic drugs for rheumatoid arthritis and other autoimmune conditions — TNF inhibitors, IL-6 inhibitors, JAK inhibitors, and other targeted therapies — are among the most expensive medications in existence, with annual costs often exceeding $25,000 per patient. Companies marketing these drugs invest substantially in rheumatologist consulting, speaker bureaus, and continuing medical education. A rheumatologist with significant payments from multiple biologic manufacturers is not unusual, but the specific relationships are worth understanding in context of their prescribing patterns.

Questions to Ask Your Rheumatologist

  • Do you have financial relationships with the companies that make the biologic medications you are recommending?
  • Is the biologic you are prescribing the lowest-cost option with equivalent evidence for my condition, including biosimilars?
  • How do you measure treatment response, and what is the plan if I do not respond within a defined timeframe?
Data Disclaimer — Data sourced from the Centers for Medicare & Medicaid Services (CMS): National Plan and Provider Enumeration System (NPPES), Open Payments program, Medicare Provider Utilization and Payment Data, and Provider Enrollment & Certification data (PECOS). Published under the Freedom of Information Act (FOIA). This website is not affiliated with, endorsed by, or authorized by CMS, HHS, or the U.S. Government. Data may contain errors as reported to CMS by providers and reporting entities. Industry payment disclosure alone establishes neither wrongdoing nor legality. Medicare data reflects only patients aged 65+ or those with qualifying disabilities. For corrections, contact CMS directly. This information does not constitute medical advice and should not be used as the sole basis for choosing a healthcare provider. Procedure descriptions use plain language and do not reference CPT® codes, which are copyrighted by the American Medical Association. Full methodology → · Report a data error → · Privacy policy →