CPT Code 99282: Emergency Department Visit Level 2 Billing Guide for 2026
What Is CPT Code 99282? CPT code 99282 is the evaluation and management code for a level 2 emergency department visit. It covers encounters where a physician or qualified healthcare professional performs a medically appropriate history and examination with straightforward medical decision making, typically for conditions of low to moderate severity that do not pose […]
Q4 2026 NCCI Edit Update: What Urgent Care Billing Teams Must Change Before October 1
What Are the Q4 2026 NCCI Edit Changes for Urgent Care? As of September 2026, CMS posted the Q4 2026 National Correct Coding Initiative update, including revised Procedure-to-Procedure edit files and Medically Unlikely Edit tables effective October 1, 2026. These edits control which CPT code combinations Medicare will pay on the same claim and how […]
CPT 87804: Rapid Influenza Test Billing Guide (2026)
What Is CPT Code 87804? CPT code 87804 reports a rapid influenza antigen test performed by immunoassay with direct visual observation, typically from a nasal or throat swab. It is a CLIA-waived point-of-care test that requires modifier QW on the claim, and it may be reported up to twice per encounter when the test differentiates […]
Medicaid Work Requirements Start in 2027: What Urgent Care Billing Teams Should Do Now
How Do Medicaid Work Requirements Affect Urgent Care Billing? As of September 2026, Medicaid work requirements are a federal mandate requiring most adults aged 19 to 64 in expansion states to document at least 80 hours per month of work, education, or community service to maintain coverage. Enforcement begins January 1, 2027, in most states. […]
J02.9 Acute Pharyngitis, Unspecified: The 2027 ICD-10 Coding and Billing Guide for Urgent Care
What Is ICD-10 Code J02.9? J02.9 is the ICD-10-CM diagnosis code for acute pharyngitis, unspecified, the standard code for a sore throat when no specific cause is documented. It is a billable, HIPAA-valid code for FY2027, effective October 1, 2026, through September 30, 2027. Urgent care centers report it as the primary diagnosis for a […]
FY 2027 ICD-10-CM Updates: What Urgent Care Practices Need to Change Before October 1
What Are the FY 2027 ICD-10-CM Code Updates? As of October 2026, the FY 2027 ICD-10-CM code set adds 238 new diagnosis codes, deletes 21, and revises 4 across 33 clinical categories, according to the CMS FY 2027 ICD-10-CM code files. These changes take effect for all patient encounters on or after October 1, 2026, […]
J06.9 Acute Upper Respiratory Infection, Unspecified: The 2026 ICD-10 Coding and Billing Guide for Urgent Care
What Is ICD-10 Code J06.9? J06.9 is the ICD-10-CM diagnosis code for an acute upper respiratory infection, unspecified. It is the catch-all URI code used when the infection is viral, spans multiple sites, or is not localized to a single structure. J06.9 is billable and HIPAA valid for FY2026 and carries into FY2027 unchanged when […]
2027 Medicare Conversion Factor Cut: What Urgent Care Practices Need to Know
What Is the 2027 Medicare Conversion Factor Cut? As of August 2026, the CMS CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P) includes a conversion factor reduction that would lower Medicare payments for nearly every service urgent care centers bill. The proposed non-APM conversion factor is $32.84, a 1.68% decrease from the 2026 rate of […]
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 […]
