Last Updated:
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30 Day Readmissions
05/01/2025
admission,subsequent,readmission,criteria,related,hospital,related
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Advance Care Planning
09/01/2024
Planning,advanced,directive,will,99497,99498,proxy,attorney,
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Advanced Practice Provider Billing
01/01/2025
Advanced,Nurse,Midwives,asistants,anesthesia,CRNA,APRN,PA
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Allergy Testing and Immunotherapy
09/01/2024
allergy,allergic,reaction,immunotherapy,95004,95012,95017,95018,95024,95027,95028,95044,95052,95056,95060,95065,95071,95076,95079
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Ambulatory Continuous Glucose Monitoring
12/01/2024
glucose,blood,sugar,CGM,95249,95250,95251,sensor,diabetes,99091,monitoring
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Anesthesia Processing
07/01/2024
anesthesia,epidural,sedation,PCA,01960,01961,01967,01969,01968,01996,31500,36563,36557,36558,36560,36561,36565,36566,36570,36571,36575,36576,36578,36581,36582,36583,36584,36585,36589,36590,62350,62351,62360,62361,62362,94002,94003,94004,ventilator,
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Bariatrics and B12 Injections
12/01/2024
Bariatrics, bariatric,B12,holotranscolbalamin,methylmalonic,screening,global,post-operative,90,vitamni,injectino,J3420,96372,43775,43770,43645,43644,43847,43842,43843,43845,43846
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Bilateral Procedures
06/01/2024
bilateral,indicator,modifier,descriptor,reimbursement,left,right,allowable,procedure
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Cardiac Rehabilitation
09/01/2024
rehabilitation, cardiac,assessment,93797,93798,G0422.G0423,exercise,modification,heart
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Chiropractic and Osteopathic Manipulative Services
12/01/2024
chiropractic,manipulation,manipulative,spinal,muskuloskeletal,extraspinal,therapeutic,98940,98941,98942,98943,98925,98926,98927,98928,98929,97110,97012
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Clinical Trials
07/15/2024
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Cloning of Documentation
03/01/2025
cloning,copy,paste,cut,template,default,cloned
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Codes Inclusive to Imaging Services
04/01/2025
contrast,radiopharmaceuticals,isotopes,inclusive,mri,pet,scan,ct,radiology,diagnostic,osmolar,supplies,imaging
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Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP) Devices
10/01/2024
CPAP,DME,equipment,sleep,apnea,hypercapnia,breathing,hypoventilation,obstructive,A4604,A7027,A7028,A7029,A7030,A7031,A7032,A7033,A7034,A7035,A7036,A7037,A7038,A7039,A7046,E0562,E0601,E1390,E0470,E0471,E0472,rented,pressure
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COVID 19 Billing and Coding
12/01/2024
COVID,19,Vaccine,Pfizer,Moderna,Jansen,booster,coronavirus,91300,91305,91307,91301,91306,91303,0001A,0051A,0071A,0011A,0031A,0002A,0052A,0072A,0012A,0003A,0053A,0013A,0004A,0054A,0064A,0034A,86328,86413,86769,87426,87635,U0001,U0002,U0003,U0004,U0005,guidelines,symptoms,suspected,exposure,testing,99072,S8031,99211,G2023,G2024,99000,99001,SARSCoV,CDC,AMA
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CPT Evaluation and Management Guidelines
01/01/2025
observation,deletion,revision,hospital,office,inpatient,G0378,G0379,88221,99222,99223,99231,99232,99233,99238,99239,99234,99235,99236,99242,99243,99244,99245,99251,99252,99253,99254,99255,99202,99203,99204,99205,99212,99213,99214,99215
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Critical Care Services
09/01/2024
critical,illness,injury,deterioration,time,life-threatening,organ-failure,99291,99292
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Cryosurgery for Benign Lesions
08/09/2024
cryosurgery,cryo,acne,warts,dermatofibroma,hemangioma,keloid,molluscum,contagiosum,myxoid,cyst,pyogenic,granuloma,sebborrheic,keratoses,skin,tags,actinic,lesion,benign
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Dental Services and Procedures
03/01/2025
dental,dentist,pedodontists,orthodontists,peridontists,endodontists,prosthodontists,ADA,CDT
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Durable Medical Equipment
11/01/2024
durable,equipment,DME,supplies,HCPCS,rental,
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Echocardiography
11/01/2024
Echo,sonogram,heart,doppler,ultrasound,transthoracic,-,transesophageal,transcatheter,93303,93304,93306,93307,93308,93312,93313,93314,93315,93316,93317,93318,93320,93321,93325,93350,93351,93352,93355,A9700,C1759,C8921,C9822,C8923,C8924,C8925,C8926,C8927,C8928,C8929,C8930
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Electroencephalogram (EEG) Video Monitoring
02/01/2025
electroencephalogram, eeg,diagnostic,epilepsy,seizures,data,monitoring,veeg,video,intractable,anticonvulsant
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Emergency Care
11/01/2024
emergency,ED,99281,99282,99283,99284,99285,G0380,G0381,G0382,G0383,G0384
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Esketamine (SPRAVATO)
08/01/2024
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Excision and Biopsy of Benign and Malignant Lesions
11/11/2024
lesions,benign,malignant,excision,skin,margins,11600,11601,11602,11603,11604,11606,11620,11621,11622,11623,11624,11626,11640,11641,11642,11644,11646,11400,11401,11402,11043,11404,11406,11420,11421,11422,11423,11424,11426,11440,11441,11442,11443,11444,11446,11450,11451,1462,11463,11470,11471
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Extracorporeal Membrane Oxygenation
03/01/2025
extracorporeal,oxygenation,membrane,ECMO,ECLS,33946,33947,33948,33949,33951,33952,33953,33954,33955,33956,33957,33958,33959,33962,33963,33964,33965,33966,33969,33984,33985,33986,33987,33988,33989
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Facility Observation G0379, G0379
07/01/2025
facility,supplies,equipment,materials,supplements,remedies
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Facility Routine Supplies and Services
09/01/2024
facility,supplies,equipment,materials,supplements,remedies
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Fracture Care
04/01/2025
fracture, dislocation, treatment, open, closed, cast, splint, reduction, strapping, supplies, global, restorative, repair
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Gastrointestinal Endoscopies and Related Services
08/09/2024
gastrointestinal,endoscopy,colonoscopy,screening,colorectal,polyp,preventive,biopsy,diagnostic,00812,00811,45378,45380,43232,43202,43216,43217,45385,polyp,flexible,tumor,mass,lesion
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General Coding and Billing
07/01/2024
coding,billing,CPT,HCPCS,ICD-10
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Global Surgical
07/01/2024
surgery,global,pre-operative,post-operative,-54,-55,-56,-57,99024,surgical
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Health Behavior Assessment and Intervention
03/01/2025
behavior,assessment,intervention,96156,96158,96159,96164,96165,96167,96168,96170,96171
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Hemodialysis Services
08/01/2024
hemodialysis,renal,end,stage,esrd,dialyzing,cycle,90935,90937,90951,90952,90953,90954,90955,90956,90957,90958,90959,90960,90961,90962,90967,90968,90969,90970,90999,professional,facility,urea,reduction,ratio,frequency,cg,kx,g1,g2.g3,g4,g5,g6,kx
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Hemodialysis, Home Hemodialysis, and Peritoneal Dialysis Services
07/01/2025
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Hypoglossal Nerve Stimulation
10/01/2024
hypoglossal,apnea,sleep,obstructive,0466T,64568,61886,61888,64569,64570,0467T,0468T,95970,95976,95977
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ICD-10 Manifestation and Sequela Diagnosis Codes
03/01/2025
manifestation,diagnosis,icd10,underlying,disease,primary,disease,principle
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IOP, PHP, and Inpatient Treatment Services for Substance Abuse and Psychiatric Care
01/01/2025
treatment,psychiatric,evauation,multidisciplinary,intensive,outpatient,h0015,s0201,h0035,h0018,h0010,90853,g0410,90791,90792,99484,therapy,group,inpatient,residential,psychiatrist,psycho,logist,facility,intervention
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Immunizations-Vaccines
10/01/2024
immunization,vaccine,component, antigen,conjugates,adjuvants,90460,90461,99071,90472,9473,90474,toxoid
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Implants - Inpatient Facility
09/01/2024
Implants, Inpatient, Facility, inserted, material, tissue, implantable, durable, medical, equipment
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Increased Procedural Service (Modifier 22)
02/01/2025
22, increased, service, greater, intensity, difficult, above, time. Effort
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JW and JZ Modifiers
09/01/2024
JZ,waste,drug, dose, SDV, biological, unused, discarded, administered, vial, smallest, FDA
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Knee Orthotics
10/01/2024
knee,orthotic,braces,injury,sprain,prefabricated,custom,osteoarthritis,L1834,L1840,L1844,L1846,L1860,L2320,L2330,L2755L2800,L2961,L1810,L1812,L1820,L1832,L1833,L1834,L1844,L1845,L1846,L1847,L1848,L1850,L1851,L1852,L1860,
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Laparoscopic Adjustable Gastric Banding (LAGB) Gastric Band Adjustment
04/01/2025
gastric,banding,restrictive,injection,saline,fill,adjustment,port,band,fluoroscopy,
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Lyric (formerly ClaimsXten) Editing
06/01/2024
lyric, reimbursement, claim, denial, accurate, edit,editing, adjudicate,software, guidelines, policies, rules, programs, CPT, HCPCS, procedure, validation, OCE, NCCI
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Maternity Services
07/01/2024
Maternity, Obstetrical, Antepartum, fetal, Delivery, Pregnancy, Gestation, Cesarean, Vaginal, Birth, VBAC, Postpartum, Newborn, Umbilical, 59400, 59409, 59410, 59412, 59414, 59425, 59426, 59530, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622, 59899, 99460, 99461, 99462, 99463, 99464, 99465, 99477, 99478, 99479, 99480
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Medically Unlikely Edits
07/01/2024
quantity, units, allowed,excess, MUE, NCCI, MAI, inappropriate, maximum,edits, unlikely
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Modifiers
08/25/2024
modifier, 22, 23, 24, 25, 26, 32, 33, 47, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 62, 63, 66, 76, 77, 78, 79, 80, 81, 82, 90, 91, 99 AA, AD, AS, AT, CC, CO, CQ, CT, E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F5, F6, F7,F8, F9,GN, GP, LT, RT, P1, P2, P3, P4, P5, P6, QK, QS, QX, QY, QZ, RR, SH, SJ, TA, T1, T2, T2, T3, T4, T5, T6, T7, T8, T9, TC
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Modifier AS Assistant Surgeon
02/01/2025
Modifiers
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Modifier SU
08/13/2024
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Modifiers 59, XE, XP, XS, & XU
59, XE,XP,XP,XS,XU,separate,distinct,unusual, NCCI,edit,conflict
06/01/2024
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MOHs Micrographic Surgery
10/01/2024
MOHS, Micrographic, Carcinoma, Dermatofibrosarcoma, Melanoma, malignant, Squamous, Cell, histiocytoma, microcystic, Sebaceous, 17311, 17312, 17313, 17314, 17315
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Multiple Surgery Reduction
03/01/2025
Multiple, Reduction, Bilateral
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National Correct Coding Initiative (NCCI)
02/15/2025
ncci,guidelines,edit,mue,addon,exclusive,extensive,standards,separate,rationale
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Negative Pressure Wound Therapy (NPWT)
08/09/2024
wound, negative,ulcer,delayed,npwt,diabetic,surgical,traumatic.pressure,therapy,E2402,A6550,A7000,A7001,K0743,K0744,K0745,K0746,97605,97606
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Newborn and Neonatal Critical and Intensive Care Services
11/01/2024
Newborn, Neonatal, NICU, Intensive, Care, Critical 99460, 99462, 99463, 99464, 99465, 99477, 99478, 99479, 99480, 99468, 99469, 31500, 36000, 36400, 36405, 36406, 36410, 36415, 36420, 36600, 36430, 36440, 36510, 36555, 36591, 36660, 43752, 43753, 51100, 51701, 51702, 71045, 71046, 62270, 92953, 93561, 93562, 94002, 94004, 94375, 94610, 94660, 94662, 94760, 94761, 94762, 94780, 949781
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Office Facility Fees
03/01/2025
Office, Facility, Fees, Place, Service, Clinic, Equipment, E/M
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Organ Acquisition Costs
01/01/2025
transplant,organ,acquisition,facility
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Pass Through Billing
03/01/2025
pass,billing
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Physician Fee Schedule Status Indicator Policy
07/01/2024
physician,fee,schedule,indicator,medicare,status,bundled,active,excluded,valid,invalid,measurement,noncovered,restricted,statutory,exclusion,cms
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Post FDA Approved Pharmaceutical products, Medical Therapies, and Devices
09/01/2024
new, FDA,pharmaceutical,therapies,devices,approved,exclusion
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Post Service Claim Review
12/01/2024
review,post-service,claim,reimbursed,fraud,waste,abuse,documentation
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Preventive Medicine Services
02/01/2025
preventive,medicine,evaluate,health,screening,99381,99382,99383,99384,99385,99386,99387,99391,99392,99393,99394,99395,99396,99397,99459
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Prolonged Service and Visit Complexity
03/01/2025
prolonged,99354,99355,99356,99357,99358,99359,99417
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Proton Beam Therapy
11/01/2024
proton, beam, therapy, particle, cancer, photon, gamma, rays, linear, accelerator, tumor, 77520, 77522, 77523, 77525
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Revenue Codes Requiring HCPCS Codes
02/01/2025
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Risk Adjustment and Acute Inpatient Diagnosis
01/02/2025
oig,risk,adjustment,acute,diagnosis,resolved,outpatient,history,inspector,general,conditions
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Robotic and Computer Assisted Surgery
03/01/2024
robot,robotic,surgery,s2900,surgical,procedure
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SBRT, SRS, FSRT
11/01/2024
SBRT,SRS,FSRT,radiotherapy,radiation,therapy,sterotactic,treatment,77470,77370,77300,77331,77293,77014,77301,77338,77371,77372,77373,77336,77401,OART,orthovoltage,evicore
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Serious Adverse Events, formerly Never Events
07/09/2024
serious, never,HAC,POA,adverse,infection,falls,wrong, PA, PB, PC
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Skilled Nursing Facility Gold Card
07/15/2024
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Status Indicator B Codes
12/01/2024
bundled,indicator,status,A4262,A4263,A4300,A4550,G0269,G0501,Q3031,R0076,0573T,0538T,0539T,15850,20930,20936,22841,34839,36000,36416,38204,90885,90887,90889,92352,92353,92354,92355,92358,92371,92531,92532,92533,92534,92605,92606,92618,92921,92925,92929,92934,92938,92944,93740,93770,94005,94150,96040,96902,97010,97602,98960,98961,98962,99000,99001,99002,99024,99050,99051,99053,99056,99058,99060,99070,99072,99071,99078,99080,99100,99116,99135,99140,99288,99339,99340,99366,99367,99368,99374,99377,99379,99380,99485,99486
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Telehealth
07/01/2024
telehealth,interactive,video,telecommunication
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Therapeutic, Prophylactic, and Diagnostic Injections and Infusions
10/01/2024
injection,infusions,prophylactic,therapeutic,diagnostic,86365,96366,96367,96368,96369,96370,96371,96372,96373,96374,96375,96376,96377,96379,A4211,G0260,G0429,D9610,D9612,
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Timed Therapeutic Procedures
10/01/2024
time,therapeutic,therapy,modalities,97032,97034,97035,97036,97039,97110,97112,97113,97116,97124,97139,97140,97150,97530,97532,97535,97537,97542,G0237,G0238,S5100,S5110,S5115,S5125,S5130,S5135,S8950,S9482
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Trigger Point Injections
10/01/2024
trigger,injection,corticosteroid,myofascial,20552,20553
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Tumor Treatment Field Therapy
10/01/2024
tumor,field,treatment,glioblastoma,temozolomide,77299,E0766,A4555,C71.0,C71.1,C71.2,C71.3,C71.4,C81.5,C71.6,C71.7,C71.8,C71.9,malignant,neoplasm
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Two-Midnight Benchmark
10/01/2024
midnight,inpatient,admission,hospital,MCG,physician,admitting,CMS,criteria,two
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Unlisted and Miscellaneous Codes
11/01/2024
unlisted
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Vasopneumatic Device
11/01/2024
Vasopneumatic, Device, Therapy, Lymphadema, 97016,97139,97140,97150,97530,97532,97535,97537,97542,G0237,G02389
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Lab Payment Policies
Last Updated:
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Allergen Testing
07/01/2025
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β-Hemolytic Streptococcus Testing
07/01/2025
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Biomarker Testing for Autoimmune Rheumatic Disease
07/01/2025
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Biochemical Markers of Alzheimer Disease and Dementia
07/01/2025
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Biomarkers for Myocardial Infarction and Chronic Heart Failure
07/01/2025
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Bone Turnover Markers Testing
07/01/2025
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Cardiovascular Disease Risk Assessment
07/01/2025
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Celiac Disease Testing
07/01/2025
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Cervical Cancer Screening
07/01/2025
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Colorectal Cancer Screening
07/01/2025
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Coronavirus Testing in the Outpatient Setting
07/01/2025
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Diabetes Mellitus Testing
07/01/2025
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Diagnosis of Idiopathic Environmental Intolerance
07/01/2025
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Diagnosis of Vaginitis
07/01/2025
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Diagnostic Testing of Common Sexually Transmitted Infections
07/01/2025
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Diagnostic Testing of Influenza
07/01/2025
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Diagnostic Testing of Iron Homeostasis and Metabolism
07/01/2025
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Epithelial Cell Cytology in Breast Cancer Risk Assessment
07/01/2025
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Evaluation of Dry Eyes
07/01/2025
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Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
07/01/2025
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Fecal Calprotectin Testing in Adults
07/01/2025
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Flow Cytomerty
07/01/2025
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Folate Testing
07/01/2025
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Gamma-Glutamyl Tranferase Testing In Adults
07/01/2025
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General Inflammation Testing
07/01/2025
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Helicobacter Pylori Testing
07/01/2025
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Hepatitis Testing
07/01/2025
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Human Immunodeficiency Virus (HIV)
07/01/2025
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Identification of Microorganisms using Nucleic Acid Probes
07/01/2025
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Immune Cell Function Assay
07/01/2025
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Immunohistochemistry
07/01/2025
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Immunopharmacologic Monitoring of Therapeutic Serum Antibodies
07/01/2025
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In Vitro Chemoresistance and Chemosensitivity Assays
07/01/2025
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Intracellular Micronutrient Analysis
07/01/2025
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Lyme Disease Testing
07/01/2025
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Metabolite Markers of Thiopurines Testing
07/01/2025
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Nerve Fiber Density Testing
07/01/2025
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Parathyroid Hormone, Phosphorus Calcium, and Magnesium Testing
07/01/2025
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Pathogen Panel Testing
07/01/2025
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Pediatric Preventive Screening
07/01/2025
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Prenatal Screening (Nongenetic)
07/01/2025
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Prescription Medication and Illicit Drug Testing
07/01/2025
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Prostate Biopsy Specimen Analysis
07/01/2025
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Prostate Specific Antigen (PSA) Testing
07/01/2025
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Salivary Hormone Testing
07/01/2025
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Serum Testing for Evidence of Mild Traumatic Brain Injury
07/01/2025
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Serum Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases
07/01/2025
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Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
07/01/2025
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Serum Tumor Markers for Malignancies
07/01/2025
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Testosterone
07/01/2025
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Testing for Autism Spectrum Disorder and Developmental Delay
07/01/2025
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Testing for Diagnosis of Active or Latent Tuberculosis
07/01/2025
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Testing for Vector-Borne Infections
07/01/2025
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Therapeutic Drug Monitoring for 5-Fluorouracil
07/01/2025
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Thyroid Disease Testing
07/01/2025
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Urinary Tumor Markers for Bladder Cancer
07/01/2025
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Urine Culture Testing for Bacteria
07/01/2025
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Vitamin B12 and Methylmalonic Acid Testing
07/01/2025
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Vitamin D Testing
07/01/2025
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