Will Medicare Create Separate Billing Codes for Urgent Care Visits?
What Are the Proposed Medicare Billing Codes for Urgent Care? As of August 2026, CMS has not yet proposed specific billing code numbers for urgent care visits, but the agency has spent three consecutive rulemaking cycles asking whether separate coding and payment is needed for evaluation and management services delivered at urgent care centers. In […]
99385 CPT Code in 2026: Age Limit, Reimbursement, and Billing Rules
What is the 99385 CPT code? The 99385 CPT code covers a comprehensive preventive medicine visit for a new patient aged 18 to 39. It applies only when the patient has not been seen by the practice or a same-specialty provider in the same group within the past three years. Traditional Medicare does not cover […]
CMS Proposes Restructuring G2211 for 2027: What Urgent Care Centers Need to Know
What Is Changing with G2211 in the 2027 Proposed Rule? As of July 14, 2026, the CMS 2027 Medicare Physician Fee Schedule proposed rule (CMS-1848-P) proposes converting HCPCS code G2211, the office/outpatient E/M visit complexity add-on, from a flat-payment add-on code into a modifier that adds approximately 16 percent to the underlying E/M service. G2211 […]
CPT Code 99214 in Urgent Care: When to Bill It, How to Document It, and Why It Gets Denied
What Is CPT Code 99214? CPT 99214 is an evaluation and management code for an established patient office or outpatient visit requiring moderate medical decision-making. In urgent care, it is the most commonly billed E/M level for patients presenting with conditions that require clinical judgment beyond a straightforward problem but do not reach the complexity […]
99201 CPT Code: Why It Was Deleted and What Urgent Care Should Bill Instead
What is CPT code 99201 and how is it billed now? CPT code 99201 is a deleted evaluation and management code. It was removed from the CPT code set effective January 1, 2021, as part of the office and outpatient E/M overhaul, and it cannot be billed for any date of service on or after […]
New No Surprises Act IDR Rules Are Now in Effect: What Urgent Care Centers Need to Know
What Changed in the No Surprises Act IDR Rules on August 3, 2026? As of August 3, 2026, the updated Federal Independent Dispute Resolution (IDR) Operations final rule requires health plans and providers to use standardized Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) in all IDR-related communications, defines bundled payment arrangements […]
What Is CPT Code 99213? A 2026 Guide to the Established Patient Visit
What is CPT code 99213 and how is it billed? CPT code 99213 is an office or outpatient E/M visit for an established patient at a low level of complexity, supported by either low-complexity medical decision making or 20 to 29 minutes of total time spent on the encounter date. An established patient is one […]
CPT Code 99051: After-Hours Billing for Urgent Care (2026 Guide)
QUICK ANSWER CPT code 99051 is an add-on code that reports services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to a basic service. It exists to recognize the cost of staying open outside traditional business hours. It cannot be billed alone, Medicare treats it as bundled, and […]
Modifier 25 Payment Cut in 2027: What Urgent Care Clinics Need to Know
How Does the 2027 Modifier 25 Change Affect Urgent Care Billing? As of July 2026, the CY 2027 Medicare Physician Fee Schedule proposed rule (CMS-1848-P) proposes reducing payment to 50% for any separately identifiable E/M visit billed on the same day as a procedure with a 0-, 10-, or 90-day global period. Urgent care clinics […]
HCPCS Code A0427: ALS1 Emergency Ambulance Transport (2026 Guide)
Understand CPT Code A0427 for emergency transport services with advanced life support (ALS). Learn its use in urgent care for immediate medical attention.
