Comprehensive Guide to CPT Coding for U.S. Medical Specialties

1. Allergy and Immunology

Allergy and immunology specialists diagnose and treat allergic diseases, asthma and immunologic disorders. Routine services include allergy testing, immunotherapy and complex consultations.

Common CPT codes

• 99202–99215 – New and established patient E/M visits. Use the time or decision‑making criteria for level selection.
• Case example: A patient receives new and established patient E/M visits. Use the time or decision‑making criteria for level selection. This service is billed using CPT code 99202–99215.
• 95004 – Percutaneous allergy testing (scratch or puncture tests). Bill per prick. Modifier −59 may be necessary if performed with other skin tests.
• Case example: A patient receives percutaneous allergy testing (scratch or puncture tests). Bill per prick. Modifier −59 may be necessary if performed with other skin tests. This service is billed using CPT code 95004.
• 95024 – Intradermal testing. Requires separate billing per test; may use modifier −59.
• Case example: A patient receives intradermal testing. Requires separate billing per test; may use modifier −59. This service is billed using CPT code 95024.
• 95115 – Professional services for allergen immunotherapy; single injection. Bill with 95165 when the antigen is also prepared.
• Case example: A patient receives professional services for allergen immunotherapy; single injection. Bill with 95165 when the antigen is also prepared. This service is billed using CPT code 95115.
• 95117 – Immunotherapy; multiple injections. Use only once per date of service.
• Case example: A patient receives immunotherapy; multiple injections. Use only once per date of service. This service is billed using CPT code 95117.
• 95165 – Preparation of antigens, single or multiple antigens in a multidose vial. A maximum of ten doses per vial is allowed.
• Case example: A patient receives preparation of antigens, single or multiple antigens in a multidose vial. A maximum of ten doses per vial is allowed. This service is billed using CPT code 95165.
• 95144 – Single dose vials prepared by the physician. CMS guidelines require payment at the 95165 rate when 95115/95117 and 95144 are billed together.
• Case example: A patient receives single dose vials prepared by the physician. CMS guidelines require payment at the 95165 rate when 95115/95117 and 95144 are billed together. This service is billed using CPT code 95144.

Modifiers and tips

• Use −25 when a separately identifiable E/M service is provided in addition to testing or injections on the same day.
• −59 distinguishes percutaneous testing (95004) from intradermal testing (95024) when performed at different sites or times.

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2. Anesthesiology

Anesthesiologists provide perioperative anesthesia care, pain management and critical care. CPT codes for anesthesia are based on surgical procedure, with additional units for time and modifying circumstances.

Common CPT codes

• 00100–01999 – Anesthesia for surgical procedures. Each code corresponds to a specific body region or type of surgery (e.g., 00840 for anesthesia for gastric procedures).
• Case example: A patient receives anesthesia for surgical procedures. Each code corresponds to a specific body region or type of surgery (e.g., 00840 for anesthesia for gastric procedures). This service is billed using CPT code 00100–01999.
• 01996 – Daily management of epidural or subarachnoid continuous drug administration. Bill for each day of post‑operative pain management.
• Case example: A patient receives daily management of epidural or subarachnoid continuous drug administration. Bill for each day of post‑operative pain management. This service is billed using CPT code 01996.
• 99100/99116/99135/99140 – Qualifying circumstances for anesthesia (e.g., extreme age, hypothermia). Report these add‑on codes when appropriate.
• Case example: A patient receives qualifying circumstances for anesthesia (e.g., extreme age, hypothermia). Report these add‑on codes when appropriate. This service is billed using CPT code 99100/99116/99135/99140.
• 01960 – Anesthesia for caesarean delivery; used by anesthesiologists when providing anesthesia for c‑sections.
• Case example: A patient receives anesthesia for caesarean delivery; used by anesthesiologists when providing anesthesia for c‑sections. This service is billed using CPT code 01960.

Modifiers and tips

• Physical status modifiers (P1–P6) indicate patient condition; add to anesthesia code to adjust unit value.
• −23 identifies unusual anesthesia (when a procedure typically performed without anesthesia requires it).
• −53 indicates discontinued procedure due to patient safety.
• Time units – Document start and end times accurately because anesthesia reimbursement is calculated using base units plus time units.

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3. Bariatric Surgery

Bariatric surgery encompasses procedures to treat morbid obesity and metabolic diseases. Surgeons must document pre‑operative evaluation, surgical technique and post‑operative care.

Common CPT codes

• 43770 – Laparoscopic gastric sleeve resection (sleeve gastrectomy). Most common bariatric procedure.
• Case example: A patient receives laparoscopic gastric sleeve resection (sleeve gastrectomy). Most common bariatric procedure. This service is billed using CPT code 43770.
• 43644 – Laparoscopic Roux‑en‑Y gastric bypass (RYGB). Used for combined restrictive and malabsorptive surgery.
• Case example: A patient receives laparoscopic Roux‑en‑Y gastric bypass (RYGB). Used for combined restrictive and malabsorptive surgery. This service is billed using CPT code 43644.
• 43845 – Open gastric bypass (Roux‑en‑Y). Rare since laparoscopic techniques predominate.
• Case example: A patient receives open gastric bypass (Roux‑en‑Y). Rare since laparoscopic techniques predominate. This service is billed using CPT code 43845.
• 43775 – Laparoscopic gastric restrictive procedure with partial gastrectomy (vertical sleeve gastrectomy).
• Case example: A patient receives laparoscopic gastric restrictive procedure with partial gastrectomy (vertical sleeve gastrectomy). This service is billed using CPT code 43775.
• 43786 – Laparoscopic revision of gastric restrictive procedure. Bill when converting one bariatric surgery to another.
• Case example: A patient receives laparoscopic revision of gastric restrictive procedure. Bill when converting one bariatric surgery to another. This service is billed using CPT code 43786.
• 49585 – Repair of ventral hernia; may be performed concurrently if discovered intraoperatively.
• Case example: A patient receives repair of ventral hernia; may be performed concurrently if discovered intraoperatively. This service is billed using CPT code 49585.

Modifiers and tips

• −51 multiple procedure modifier applies when performing hernia repair with bariatric surgery.
• Use −22 for increased procedural services (e.g., extensive adhesiolysis beyond typical work).
• Document BMI, co‑morbidities and medically supervised weight‑loss attempts to justify bariatric procedures.

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4. Cardiology

Cardiology covers the diagnosis and treatment of heart and vascular conditions. Codes range from non‑invasive testing to catheter‑based interventions.

Common CPT codes

• 93000 – Routine electrocardiogram (ECG) with interpretation and report; includes tracing and interpretation.
• Case example: A patient receives routine electrocardiogram (ECG) with interpretation and report; includes tracing and interpretation. This service is billed using CPT code 93000.
• 93005/93010 – ECG without interpretation (93005) or interpretation and report only (93010). Use these when technical and professional components are performed separately.
• Case example: A patient receives eCG without interpretation (93005) or interpretation and report only (93010). Use these when technical and professional components are performed separately. This service is billed using CPT code 93005/93010.
• 93015 – Cardiovascular stress test (maximal or submaximal exercise or pharmacologic). Code includes physician supervision, test tracing and interpretation.
• Case example: A patient receives cardiovascular stress test (maximal or submaximal exercise or pharmacologic). Code includes physician supervision, test tracing and interpretation. This service is billed using CPT code 93015.
• 93458 – Left heart catheterization with coronary angiography; includes cardiac catheterization and imaging of major coronary arteries.
• Case example: A patient receives left heart catheterization with coronary angiography; includes cardiac catheterization and imaging of major coronary arteries. This service is billed using CPT code 93458.
• 92920 – Percutaneous transluminal coronary angioplasty (PTCA). Use additional codes (92928) when a stent is placed.
• Case example: A patient receives percutaneous transluminal coronary angioplasty (PTCA). Use additional codes (92928) when a stent is placed. This service is billed using CPT code 92920.
• 93287 – Remote monitoring of implantable loop recorder; includes review and report.
• Case example: A patient receives remote monitoring of implantable loop recorder; includes review and report. This service is billed using CPT code 93287.
• 93295/93296 – Interrogation and programming of implantable cardioverter defibrillator (ICD) systems; used for follow‑up visits.
• Case example: A patient receives interrogation and programming of implantable cardioverter defibrillator (ICD) systems; used for follow‑up visits. This service is billed using CPT code 93295/93296.
• 93306 – Echocardiography, transthoracic, real‑time with Doppler and spectral analysis; complete. Use −26/−TC modifiers to bill professional and technical components separately.
• Case example: A patient receives echocardiography, transthoracic, real‑time with Doppler and spectral analysis; complete. Use −26/−TC modifiers to bill professional and technical components separately. This service is billed using CPT code 93306.

Modifiers and tips

• −26 for professional component and −TC for technical component when billing imaging (e.g., echocardiography).
• −59 may be needed when billing multiple catheterization services performed through separate access sites.
• Document medical necessity for diagnostic tests (e.g., chest pain, syncope) to support reimbursement.

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5. Dermatology

Dermatologists diagnose and treat skin conditions. Dermatology billing involves E/M visits, biopsies, excisions and destruction of lesions.

Common CPT codes

• 99202–99215 – E/M visits for new and established patients. Level depends on complexity and time.
• Case example: A patient receives e/M visits for new and established patients. Level depends on complexity and time. This service is billed using CPT code 99202–99215.
• 17000 – Destruction of benign or premalignant lesion (e.g., actinic keratosis) by cryotherapy or other techniques. Bill each additional lesion with 17003 and 17004 when 15 or more lesions are treated.
• Case example: A patient receives destruction of benign or premalignant lesion (e.g., actinic keratosis) by cryotherapy or other techniques. Bill each additional lesion with 17003 and 17004 when 15 or more lesions are treated. This service is billed using CPT code 17000.
• 11102 – Tangential (shave) biopsy of skin lesion; add 11103 for each additional lesion.
• Case example: A patient receives tangential (shave) biopsy of skin lesion; add 11103 for each additional lesion. This service is billed using CPT code 11102.
• 11104/11105 – Punch biopsy of skin; initial and each additional lesion.
• Case example: A patient receives punch biopsy of skin; initial and each additional lesion. This service is billed using CPT code 11104/11105.
• 11200/11201 – Removal of skin tags, up to 15 lesions (11200) or each additional 10 lesions (11201).
• Case example: A patient receives removal of skin tags, up to 15 lesions (11200) or each additional 10 lesions (11201). This service is billed using CPT code 11200/11201.
• 11400–11446 – Excision of benign lesions including margins; choose code based on location and lesion diameter.
• Case example: A patient receives excision of benign lesions including margins; choose code based on location and lesion diameter. This service is billed using CPT code 11400–11446.
• 11600–11646 – Excision of malignant lesions; code selection depends on lesion size and anatomic site.
• Case example: A patient receives excision of malignant lesions; code selection depends on lesion size and anatomic site. This service is billed using CPT code 11600–11646.
• 12031–12057 – Layered closure (intermediate repair) of wounds; use when deeper subcutaneous tissues are closed.
• Case example: A patient receives layered closure (intermediate repair) of wounds; use when deeper subcutaneous tissues are closed. This service is billed using CPT code 12031–12057.
• 17110/17111 – Destruction of benign lesions other than skin tags or premalignant lesions; 17110 covers up to 14 lesions, 17111 covers 15 or more.
• Case example: A patient receives destruction of benign lesions other than skin tags or premalignant lesions; 17110 covers up to 14 lesions, 17111 covers 15 or more. This service is billed using CPT code 17110/17111.
• 17311/17313 – Mohs micrographic surgery; used for treatment of skin cancers requiring intraoperative histologic examination.
• Case example: A patient receives mohs micrographic surgery; used for treatment of skin cancers requiring intraoperative histologic examination. This service is billed using CPT code 17311/17313.

Modifiers and tips

• −59 identifies distinct procedures (e.g., separate lesions or locations).
• −25 for E/M visit on the same day as minor surgery (e.g., biopsy or lesion destruction).
• −51 for multiple procedures when performing several excisions or destructions in one session.
• Document lesion size and location carefully; incomplete documentation may lead to downcoding.

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6. Emergency Medicine

Emergency medicine physicians evaluate and treat acute illnesses and injuries. E/M codes for emergency department (ED) visits depend on the level of service rather than patient status.

Common CPT codes

• 99281–99285 – Emergency department visits for evaluation and management. Levels are based on complexity of history, examination and medical decision‑making rather than time. 99281 covers minor problems; 99285 covers high‑severity cases requiring urgent intervention.
• Case example: A patient receives emergency department visits for evaluation and management. Levels are based on complexity of history, examination and medical decision‑making rather than time. 99281 covers minor problems; 99285 covers high‑severity cases requiring urgent intervention. This service is billed using CPT code 99281–99285.
• 99291/99292 – Critical care services. 99291 covers the first 30–74 minutes of critical care; 99292 is used for each additional 30 minutes.
• Case example: A patient receives critical care services. 99291 covers the first 30–74 minutes of critical care; 99292 is used for each additional 30 minutes. This service is billed using CPT code 99291/99292.
• 99288 – Physician direction of prehospital ambulance services. Bill when providing medical direction to emergency medical technicians via radio or telephone.
• Case example: A patient receives physician direction of prehospital ambulance services. Bill when providing medical direction to emergency medical technicians via radio or telephone. This service is billed using CPT code 99288.
• 92950 – Cardiopulmonary resuscitation (CPR), manual, in addition to other services.
• Case example: A patient receives cardiopulmonary resuscitation (CPR), manual, in addition to other services. This service is billed using CPT code 92950.
• 93042 – Rhythm ECG interpretation only; includes report.
• Case example: A patient receives rhythm ECG interpretation only; includes report. This service is billed using CPT code 93042.
• 36000 – Insertion of non‑tunneled central venous catheter (CVC); e.g., for fluid resuscitation or vasopressors.
• Case example: A patient receives insertion of non‑tunneled central venous catheter (CVC); e.g., for fluid resuscitation or vasopressors. This service is billed using CPT code 36000.
• 31500 – Endotracheal intubation; includes placement and initial ventilation.
• Case example: A patient receives endotracheal intubation; includes placement and initial ventilation. This service is billed using CPT code 31500.

Modifiers and tips

• −25 when performing minor procedures (e.g., laceration repair) in addition to an ED visit.
• −59 may apply if performing separate procedures (e.g., abscess drainage and foreign body removal) on different sites.
• Document time spent providing critical care to justify using 99291/99292.

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7. Endocrinology

Endocrinologists manage endocrine disorders such as diabetes, thyroid disease and hormonal imbalances.

Common CPT codes

• 99202–99215 – Office E/M visits.
• Case example: A patient receives office E/M visits. This service is billed using CPT code 99202–99215.
• 82947 – Glucose; quantitative measurement (glucometer). Often part of metabolic panel.
• Case example: A patient receives glucose; quantitative measurement (glucometer). Often part of metabolic panel. This service is billed using CPT code 82947.
• 83036 – Glycated hemoglobin (HbA1c) test. Used to monitor diabetes control.
• Case example: A patient receives glycated hemoglobin (HbA1c) test. Used to monitor diabetes control. This service is billed using CPT code 83036.
• 84439 – Thyroid‑stimulating hormone (TSH) assay. May pair with 84436 (free thyroxine).
• Case example: A patient receives thyroid‑stimulating hormone (TSH) assay. May pair with 84436 (free thyroxine). This service is billed using CPT code 84439.
• 95250 – Ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid; includes patient training and sensor placement (72 hours). Bill once per session.
• Case example: A patient receives ambulatory continuous glucose monitoring (CGM) of interstitial tissue fluid; includes patient training and sensor placement (72 hours). Bill once per session. This service is billed using CPT code 95250.
• 95251 – CGM analysis; scanning and interpretation of data. Bill once per device reading.
• Case example: A patient receives cGM analysis; scanning and interpretation of data. Bill once per device reading. This service is billed using CPT code 95251.
• 91132/91133 – Gastric emptying breath test; used for diabetic gastroparesis evaluation.
• Case example: A patient receives gastric emptying breath test; used for diabetic gastroparesis evaluation. This service is billed using CPT code 91132/91133.

Modifiers and tips

• Use −25 with E/M services if performing separate procedures such as ultrasound‑guided thyroid biopsy.
• Document laboratory results and medical necessity for endocrine testing to avoid denials.

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8. Family Medicine / Primary Care

Family physicians provide comprehensive, continuous care for patients of all ages. Primary care coding includes preventive services, chronic disease management, minor procedures and vaccinations.

Common CPT codes

• 99213 & 99214 – Routine office visits for established patients; 99213 covers low to moderate complexity, while 99214 requires moderate complexity and more time.
• Case example: A patient receives routine office visits for established patients; 99213 covers low to moderate complexity, while 99214 requires moderate complexity and more time. This service is billed using CPT code 99213 & 99214.
• 99202–99205 – New patient visits; choose based on complexity and time.
• Case example: A patient receives new patient visits; choose based on complexity and time. This service is billed using CPT code 99202–99205.
• 99381–99397 – Preventive visits (well‑child, adolescent and adult physicals). These codes cover routine check‑ups and counseling.
• Case example: A patient receives preventive visits (well‑child, adolescent and adult physicals). These codes cover routine check‑ups and counseling. This service is billed using CPT code 99381–99397.
• 97110 – Therapeutic exercises; often used in primary care for musculoskeletal rehabilitation.
• Case example: A patient receives therapeutic exercises; often used in primary care for musculoskeletal rehabilitation. This service is billed using CPT code 97110.
• 85025 – Complete blood count (CBC).
• Case example: A patient receives complete blood count (CBC). This service is billed using CPT code 85025.
• 80053 – Comprehensive metabolic panel (CMP).
• Case example: A patient receives comprehensive metabolic panel (CMP). This service is billed using CPT code 80053.
• 36415 – Routine venipuncture for blood tests.
• Case example: A patient receives routine venipuncture for blood tests. This service is billed using CPT code 36415.
• 80048 – Basic metabolic panel (BMP).
• Case example: A patient receives basic metabolic panel (BMP). This service is billed using CPT code 80048.
• 80061 – Lipid panel; measures cholesterol and triglycerides.
• Case example: A patient receives lipid panel; measures cholesterol and triglycerides. This service is billed using CPT code 80061.
• 90662, 90688 – Influenza vaccines; can vary by age and formulation.
• Case example: A patient receives influenza vaccines; can vary by age and formulation. This service is billed using CPT code 90662, 90688.
• 90471/90472 – Immunization administration (per injection); report each vaccine separately.
• Case example: A patient receives immunization administration (per injection); report each vaccine separately. This service is billed using CPT code 90471/90472.

Modifiers and tips

• Apply −25 when performing a minor procedure (e.g., joint injection) on the same day as an E/M visit.
• Preventive services are separate from problem‑oriented visits; bill both if documentation supports two services.
• Use vaccine product codes (e.g., 91318–91322 for COVID‑19 vaccines) together with administration codes.

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9. Gastroenterology

Gastroenterologists diagnose and treat diseases of the digestive tract. Coding covers endoscopic procedures, imaging and motility studies.

Common CPT codes

• 45378 – Colonoscopy, diagnostic, with or without specimen collection. Bill 45380 when biopsies are taken and 45385 when polyps are removed by snare technique.
• Case example: A patient receives colonoscopy, diagnostic, with or without specimen collection. Bill 45380 when biopsies are taken and 45385 when polyps are removed by snare technique. This service is billed using CPT code 45378.
• 43239 – Esophagogastroduodenoscopy (EGD) with biopsy. Use 43235 for diagnostic EGD without biopsy.
• Case example: A patient receives esophagogastroduodenoscopy (EGD) with biopsy. Use 43235 for diagnostic EGD without biopsy. This service is billed using CPT code 43239.
• 91110 – Wireless capsule endoscopy of the small intestine; includes interpretation and report.
• Case example: A patient receives wireless capsule endoscopy of the small intestine; includes interpretation and report. This service is billed using CPT code 91110.
• 91035 – Esophageal motility study (high‑resolution manometry). Requires specialized equipment.
• Case example: A patient receives esophageal motility study (high‑resolution manometry). Requires specialized equipment. This service is billed using CPT code 91035.
• 91010/91013 – Esophageal pH monitoring; catheter‑based or impedance monitoring.
• Case example: A patient receives esophageal pH monitoring; catheter‑based or impedance monitoring. This service is billed using CPT code 91010/91013.
• 96372 – Therapeutic, prophylactic or diagnostic injection (subcutaneous or intramuscular). Used for medication administration (e.g., vitamin B12 injections).
• Case example: A patient receives therapeutic, prophylactic or diagnostic injection (subcutaneous or intramuscular). Used for medication administration (e.g., vitamin B12 injections). This service is billed using CPT code 96372.

Modifiers and tips

• −33 for preventive colonoscopy; indicates the service is preventive and patient cost‑sharing is waived.
• −59 when performing multiple endoscopic procedures on the same day (e.g., EGD and colonoscopy) through different access points.
• Document bowel prep, sedation and findings to support appropriate code selection.

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10. General Surgery

General surgeons perform a broad array of procedures, from hernia repairs to abdominal surgeries.

Common CPT codes

• 49505 – Repair of inguinal hernia (age 5 years or older); initial hernia. Use 49507 for recurrent hernia.
• Case example: A patient receives repair of inguinal hernia (age 5 years or older); initial hernia. Use 49507 for recurrent hernia. This service is billed using CPT code 49505.
• 47562 – Laparoscopic cholecystectomy (removal of gallbladder) with cholangiography. Code 47563 includes intraoperative cholangiography.
• Case example: A patient receives laparoscopic cholecystectomy (removal of gallbladder) with cholangiography. Code 47563 includes intraoperative cholangiography. This service is billed using CPT code 47562.
• 44970 – Laparoscopic appendectomy. Use 44950 for open appendectomy.
• Case example: A patient receives laparoscopic appendectomy. Use 44950 for open appendectomy. This service is billed using CPT code 44970.
• 44120 – Small bowel resection with anastomosis. Code selection depends on length of resection and presence of obstruction.
• Case example: A patient receives small bowel resection with anastomosis. Code selection depends on length of resection and presence of obstruction. This service is billed using CPT code 44120.
• 49082/49083 – Abdominal paracentesis without or with imaging guidance.
• Case example: A patient receives abdominal paracentesis without or with imaging guidance. This service is billed using CPT code 49082/49083.
• 36821 – Creation of arteriovenous fistula for dialysis; includes anastomosis of artery and vein.
• Case example: A patient receives creation of arteriovenous fistula for dialysis; includes anastomosis of artery and vein. This service is billed using CPT code 36821.

Modifiers and tips

• −50 for bilateral procedures (e.g., bilateral hernia repair).
• −51 for multiple procedures performed in one session (e.g., cholecystectomy and hernia repair).
• −58 for staged or related procedures performed during the postoperative period (e.g., second look laparotomy).
• Surgeons must document indications, findings, complications and postoperative plans to support the code level.

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11. Geriatrics

Geriatricians specialize in health care for older adults. Billing often focuses on cognitive assessments, chronic disease management and preventive care.

Common CPT codes

• 99324–99337 – Domiciliary, rest home or custodial care visits (new and established patient). Used when seeing patients in assisted living facilities.
• Case example: A patient receives domiciliary, rest home or custodial care visits (new and established patient). Used when seeing patients in assisted living facilities. This service is billed using CPT code 99324–99337.
• 99341–99350 – Home visits; bill according to time and complexity.
• Case example: A patient receives home visits; bill according to time and complexity. This service is billed using CPT code 99341–99350.
• 99202–99215 – Office E/M visits, including management of multiple chronic conditions.
• Case example: A patient receives office E/M visits, including management of multiple chronic conditions. This service is billed using CPT code 99202–99215.
• 99497 – Advance care planning; first 30 minutes face‑to‑face with patient and/or family discussing goals of care and directives. 99498 for each additional 30 minutes.
• Case example: A patient receives advance care planning; first 30 minutes face‑to‑face with patient and/or family discussing goals of care and directives. 99498 for each additional 30 minutes. This service is billed using CPT code 99497.
• 99483 – Cognitive assessment and care plan services (formerly 99483 replaced 99497 for cognitive test). Includes detailed history, standardized cognitive assessment and creation of care plan.
• Case example: A patient receives cognitive assessment and care plan services (formerly 99483 replaced 99497 for cognitive test). Includes detailed history, standardized cognitive assessment and creation of care plan. This service is billed using CPT code 99483.
• 99358/99359 – Prolonged services without direct patient contact (e.g., extensive chart review or family conferences). Bill in addition to E/M codes.
• Case example: A patient receives prolonged services without direct patient contact (e.g., extensive chart review or family conferences). Bill in addition to E/M codes. This service is billed using CPT code 99358/99359.

Modifiers and tips

• Use −25 when performing minor procedures (e.g., ear lavage) in addition to an E/M visit.
• Document time spent on advance care planning to support 99497/99498.

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12. Gynecology and Obstetrics (OB‑GYN)

OB‑GYN practices manage women’s reproductive health, pregnancy, childbirth and postpartum care.

Common CPT codes

• 99202–99215 – E/M visits for gynecologic and obstetric issues.
• Case example: A patient receives e/M visits for gynecologic and obstetric issues. This service is billed using CPT code 99202–99215.
• 58300 – Insertion of intrauterine device (IUD). Use 58301 for removal.
• Case example: A patient receives insertion of intrauterine device (IUD). Use 58301 for removal. This service is billed using CPT code 58300.
• 57170 – Diaphragm or cervical cap fitting with instructions.
• Case example: A patient receives diaphragm or cervical cap fitting with instructions. This service is billed using CPT code 57170.
• 58100 – Endometrial biopsy without cervical dilation; used for abnormal uterine bleeding evaluation.
• Case example: A patient receives endometrial biopsy without cervical dilation; used for abnormal uterine bleeding evaluation. This service is billed using CPT code 58100.
• 58660 – Laparoscopy, surgical; with fulguration or excision of endometriotic implants. 58661 for removal of adnexal structures.
• Case example: A patient receives laparoscopy, surgical; with fulguration or excision of endometriotic implants. 58661 for removal of adnexal structures. This service is billed using CPT code 58660.
• 59400 – Routine obstetric care including antepartum care, vaginal delivery and postpartum care. Use 59510 for routine cesarean delivery and postpartum care.
• Case example: A patient receives routine obstetric care including antepartum care, vaginal delivery and postpartum care. Use 59510 for routine cesarean delivery and postpartum care. This service is billed using CPT code 59400.
• 59610/59614 – Vaginal delivery after previous cesarean section (VBAC) with or without postpartum care.
• Case example: A patient receives vaginal delivery after previous cesarean section (VBAC) with or without postpartum care. This service is billed using CPT code 59610/59614.
• 76815 – Transabdominal limited obstetric ultrasound; first trimester to assess viability; 76816 for follow‑up.
• Case example: A patient receives transabdominal limited obstetric ultrasound; first trimester to assess viability; 76816 for follow‑up. This service is billed using CPT code 76815.

Modifiers and tips

• −25 with E/M visits when performing procedures like Pap smear (CPT Q0091 for Medicare) or colposcopy.
• Obstetric global codes (59400, 59510, 59610) cover antepartum, delivery and postpartum visits. Do not bill separate E/M visits unless unrelated issues are addressed.
• Use −51 for multiple laparoscopic procedures.

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13. Hematology

Hematologists diagnose and manage blood disorders such as anemia, clotting disorders and leukemia.

Common CPT codes

• 99202–99215 – E/M visits.
• Case example: A patient receives e/M visits. This service is billed using CPT code 99202–99215.
• 85025 – Complete blood count with automated differential white blood cell count.
• Case example: A patient receives complete blood count with automated differential white blood cell count. This service is billed using CPT code 85025.
• 85027 – Complete blood count without differential; used when manual differential (85007) is ordered separately.
• Case example: A patient receives complete blood count without differential; used when manual differential (85007) is ordered separately. This service is billed using CPT code 85027.
• 85610 – Prothrombin time; measures clotting tendency; used to monitor warfarin therapy.
• Case example: A patient receives prothrombin time; measures clotting tendency; used to monitor warfarin therapy. This service is billed using CPT code 85610.
• 85730 – Partial thromboplastin time; monitors heparin therapy and coagulation disorders.
• Case example: A patient receives partial thromboplastin time; monitors heparin therapy and coagulation disorders. This service is billed using CPT code 85730.
• 86141 – Beta‑2 glycoprotein antibodies; part of antiphospholipid antibody testing.
• Case example: A patient receives beta‑2 glycoprotein antibodies; part of antiphospholipid antibody testing. This service is billed using CPT code 86141.
• 87270 – Blood smear, thick or thin; evaluation for malaria or other parasites.
• Case example: A patient receives blood smear, thick or thin; evaluation for malaria or other parasites. This service is billed using CPT code 87270.
• 95251 – CGM analysis; relevant for hematologists managing diabetic patients with hematologic complications.
• Case example: A patient receives cGM analysis; relevant for hematologists managing diabetic patients with hematologic complications. This service is billed using CPT code 95251.

Modifiers and tips

• −91 indicates repeat laboratory test on the same day; use when repeating CBCs for transfusion decisions.
• Document indications for coagulation studies (e.g., suspected bleeding disorder) to support medical necessity.

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14. Hepatology

Hepatologists treat liver diseases, including hepatitis, cirrhosis and portal hypertension. Gastroenterologists often subspecialize in hepatology.

Common CPT codes

• 99205/99215 – High‑complexity E/M visits for evaluation of chronic liver disease.
• Case example: A patient receives high‑complexity E/M visits for evaluation of chronic liver disease. This service is billed using CPT code 99205/99215.
• 80076 – Hepatic function panel; includes bilirubin, transaminases and albumin.
• Case example: A patient receives hepatic function panel; includes bilirubin, transaminases and albumin. This service is billed using CPT code 80076.
• 36415 – Venipuncture for lab testing.
• Case example: A patient receives venipuncture for lab testing. This service is billed using CPT code 36415.
• 43235/43239 – Esophagogastroduodenoscopy to evaluate varices or portal hypertensive gastropathy.
• Case example: A patient receives esophagogastroduodenoscopy to evaluate varices or portal hypertensive gastropathy. This service is billed using CPT code 43235/43239.
• 93793 – Anticoagulant management for patients on warfarin due to portal vein thrombosis.
• Case example: A patient receives anticoagulant management for patients on warfarin due to portal vein thrombosis. This service is billed using CPT code 93793.
• 49406 – Exchange transfusion of whole blood; used in severe autoimmune hepatitis or fulminant hepatic failure.
• Case example: A patient receives exchange transfusion of whole blood; used in severe autoimmune hepatitis or fulminant hepatic failure. This service is billed using CPT code 49406.

Modifiers and tips

• −25 when performing paracentesis (49082/49083) during the same visit.
• Document MELD (Model for End‑stage Liver Disease) score and indications for transplant evaluations when billing high‑level E/M visits.

Learn more about Hepatology billing or credentialing services

15. Infectious Disease

Infectious disease (ID) physicians diagnose and treat bacterial, viral, fungal and parasitic infections. They also manage antibiotic stewardship and infection control.

Common CPT codes

• 99202–99215 – E/M visits for new or established patients with infectious diseases.
• Case example: A patient receives e/M visits for new or established patients with infectious diseases. This service is billed using CPT code 99202–99215.
• 87804 – Rapid influenza test (immunoassay); results in 15 minutes.
• Case example: A patient receives rapid influenza test (immunoassay); results in 15 minutes. This service is billed using CPT code 87804.
• 87811 – Rapid RSV test; used in pediatrics and immunocompromised adults.
• Case example: A patient receives rapid RSV test; used in pediatrics and immunocompromised adults. This service is billed using CPT code 87811.
• 87389 – HIV‑1 antigen/antibody combination test; identifies HIV infection.
• Case example: A patient receives hIV‑1 antigen/antibody combination test; identifies HIV infection. This service is billed using CPT code 87389.
• 87502/87503/87504 – Influenza A/B nucleic acid amplification test (NAAT).
• Case example: A patient receives influenza A/B nucleic acid amplification test (NAAT). This service is billed using CPT code 87502/87503/87504.
• 87635 – SARS‑CoV‑2 (COVID‑19) NAAT. Use as appropriate during outbreaks.
• Case example: A patient receives sARS‑CoV‑2 (COVID‑19) NAAT. Use as appropriate during outbreaks. This service is billed using CPT code 87635.
• 87491 – Chlamydia trachomatis NAAT. Combined with 87591 for gonorrhea testing.
• Case example: A patient receives chlamydia trachomatis NAAT. Combined with 87591 for gonorrhea testing. This service is billed using CPT code 87491.
• 87880 – Streptococcus group A antigen detection (rapid strep test).
• Case example: A patient receives streptococcus group A antigen detection (rapid strep test). This service is billed using CPT code 87880.
• 94640 – Pressurized inhalation treatment; used for nebulized medications in bronchitis or pneumonia.
• Case example: A patient receives pressurized inhalation treatment; used for nebulized medications in bronchitis or pneumonia. This service is billed using CPT code 94640.

Modifiers and tips

• −59 when billing multiple pathogen tests on the same specimen (e.g., 87491 and 87591).
• Document travel history, exposure and symptoms to justify ID consultations.

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16. Internal Medicine

Internists provide comprehensive care for adults, including prevention, diagnosis and treatment of acute and chronic conditions.

Common CPT codes

• 99202–99215 – Office visits; most commonly used codes in internal medicine.
• Case example: A patient receives office visits; most commonly used codes in internal medicine. This service is billed using CPT code 99202–99215.
• 99385–99387 – New patient preventive visits; age‑specific.
• Case example: A patient receives new patient preventive visits; age‑specific. This service is billed using CPT code 99385–99387.
• 99395–99397 – Established patient preventive visits.
• Case example: A patient receives established patient preventive visits. This service is billed using CPT code 99395–99397.
• 99490 – Chronic care management services; at least 20 minutes of clinical staff time per month directed by a physician for managing chronic conditions.
• Case example: A patient receives chronic care management services; at least 20 minutes of clinical staff time per month directed by a physician for managing chronic conditions. This service is billed using CPT code 99490.
• 99406/99407 – Smoking and tobacco use cessation counseling; intermediate (3–10 minutes) or intensive (>10 minutes).
• Case example: A patient receives smoking and tobacco use cessation counseling; intermediate (3–10 minutes) or intensive (>10 minutes). This service is billed using CPT code 99406/99407.
• 96160 – Administration of patient‑focused risk assessment instrument (e.g., depression screening). 96161 is used for caregiver‑focused risk assessment.
• Case example: A patient receives administration of patient‑focused risk assessment instrument (e.g., depression screening). 96161 is used for caregiver‑focused risk assessment. This service is billed using CPT code 96160.
• 96372 – Therapeutic injection; subcutaneous or intramuscular.
• Case example: A patient receives therapeutic injection; subcutaneous or intramuscular. This service is billed using CPT code 96372.

Modifiers and tips

• −25 when performing minor procedures (e.g., joint injection, cryotherapy) during the same visit.
• Use G2211 add‑on code for complex E/M visits requiring additional resources.
• Document chronic conditions (e.g., diabetes, hypertension, COPD) and time spent to justify higher E/M levels.

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17. Nephrology

Nephrologists manage kidney diseases, dialysis and electrolyte disorders.

Common CPT codes

• 99202–99215 – E/M visits, often for chronic kidney disease or hypertension management.
• Case example: A patient receives e/M visits, often for chronic kidney disease or hypertension management. This service is billed using CPT code 99202–99215.
• 90935 – Hemodialysis procedure with physician evaluation; single evaluation. Use 90937 for evaluation requiring repeated physician involvement.
• Case example: A patient receives hemodialysis procedure with physician evaluation; single evaluation. Use 90937 for evaluation requiring repeated physician involvement. This service is billed using CPT code 90935.
• 90945/90947 – Peritoneal dialysis (intermittent or continuous) physician services.
• Case example: A patient receives peritoneal dialysis (intermittent or continuous) physician services. This service is billed using CPT code 90945/90947.
• 90951–90970 – End‑stage renal disease (ESRD) services; monthly capitation payments based on age and number of visits.
• Case example: A patient receives end‑stage renal disease (ESRD) services; monthly capitation payments based on age and number of visits. This service is billed using CPT code 90951–90970.
• 36415 – Venipuncture; frequently used for lab tests such as creatinine, electrolytes and parathyroid hormone.
• Case example: A patient receives venipuncture; frequently used for lab tests such as creatinine, electrolytes and parathyroid hormone. This service is billed using CPT code 36415.
• 50300/50340 – Donor nephrectomy or kidney transplant; used by surgeons, but nephrologists may participate in evaluation.
• Case example: A patient receives donor nephrectomy or kidney transplant; used by surgeons, but nephrologists may participate in evaluation. This service is billed using CPT code 50300/50340.

Modifiers and tips

• Use −25 when performing ultrasound‑guided kidney biopsy (CPT 50542) during an E/M visit.
• ESRD codes (90951–90970) require documentation of monthly visits and face‑to‑face time with dialysis patients.

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18. Neurology

Neurologists diagnose and treat disorders of the brain, spinal cord and nerves. Coding encompasses E/M visits, diagnostic tests and procedures.

Common CPT codes

• 99202–99215 – E/M visits, including management of migraines, seizures, neuropathies and stroke.
• Case example: A patient receives e/M visits, including management of migraines, seizures, neuropathies and stroke. This service is billed using CPT code 99202–99215.
• 95816/95819 – Electroencephalogram (EEG) recordings (awake only or awake and drowsy). Use 95951 for continuous EEG monitoring (up to 24 hours).
• Case example: A patient receives electroencephalogram (EEG) recordings (awake only or awake and drowsy). Use 95951 for continuous EEG monitoring (up to 24 hours). This service is billed using CPT code 95816/95819.
• 95970–95972 – Intraoperative neurophysiology monitoring; necessary during neurosurgical procedures.
• Case example: A patient receives intraoperative neurophysiology monitoring; necessary during neurosurgical procedures. This service is billed using CPT code 95970–95972.
• 96105 – Assessment of aphasia with interpretation and report.
• Case example: A patient receives assessment of aphasia with interpretation and report. This service is billed using CPT code 96105.
• 96116 – Neurobehavioral status exam; includes cognitive evaluation.
• Case example: A patient receives neurobehavioral status exam; includes cognitive evaluation. This service is billed using CPT code 96116.
• 96125 – Standardized cognitive performance testing (e.g., Mini‑Mental State Exam) per hour.
• Case example: A patient receives standardized cognitive performance testing (e.g., Mini‑Mental State Exam) per hour. This service is billed using CPT code 96125.
• 64450 – Injection anesthetic agent into peripheral nerve or branch; used for occipital nerve blocks in headache management.
• Case example: A patient receives injection anesthetic agent into peripheral nerve or branch; used for occipital nerve blocks in headache management. This service is billed using CPT code 64450.

Modifiers and tips

• −26/−TC separate professional and technical components of EEGs and nerve conduction studies.
• −52 for reduced services when performing limited EEG.
• Document seizure description, EEG findings and neurologic examination to support code level.

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19. Neurosurgery

Neurosurgeons perform surgical procedures on the brain, spinal cord and peripheral nerves. Codes vary widely based on procedure complexity.

Common CPT codes

• 61510–61512 – Craniotomy for excision of brain tumor (supratentorial). Includes operating microscope (if used) and dural graft.
• Case example: A patient receives craniotomy for excision of brain tumor (supratentorial). Includes operating microscope (if used) and dural graft. This service is billed using CPT code 61510–61512.
• 61518 – Craniectomy with excision of infratentorial brain tumor.
• Case example: A patient receives craniectomy with excision of infratentorial brain tumor. This service is billed using CPT code 61518.
• 22551/22552 – Cervical spinal fusion via anterior approach with or without discectomy. Report instrumentation separately.
• Case example: A patient receives cervical spinal fusion via anterior approach with or without discectomy. Report instrumentation separately. This service is billed using CPT code 22551/22552.
• 63030 – Laminotomy with decompression of nerve root, lumbar; single interspace. For cervical or thoracic levels, use 63020/63035.
• Case example: A patient receives laminotomy with decompression of nerve root, lumbar; single interspace. For cervical or thoracic levels, use 63020/63035. This service is billed using CPT code 63030.
• 62270 – Spinal puncture, diagnostic; lumbar; includes obtaining CSF.
• Case example: A patient receives spinal puncture, diagnostic; lumbar; includes obtaining CSF. This service is billed using CPT code 62270.
• 64553 – Percutaneous implantation of neurostimulator electrode array; spinal cord or peripheral nerve.
• Case example: A patient receives percutaneous implantation of neurostimulator electrode array; spinal cord or peripheral nerve. This service is billed using CPT code 64553.

Modifiers and tips

• −50 for bilateral procedures (e.g., bilateral decompressive laminectomies).
• −62 for co‑surgeon when another surgeon shares responsibility.
• −80 for assistant surgeon.
• Neurosurgery codes often require documentation of imaging, operative report, instrumentation and levels operated.

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20. Oncology (Medical)

Medical oncologists treat cancer using chemotherapy, immunotherapy and targeted agents. Coding involves E/M visits, drug administration and care management.

Common CPT codes

• 99202–99215 – E/M visits for cancer consultations, treatment planning and follow‑up.
• Case example: A patient receives e/M visits for cancer consultations, treatment planning and follow‑up. This service is billed using CPT code 99202–99215.
• 96413 – Chemotherapy administration, intravenous infusion technique; up to one hour. 96415 for each additional hour.
• Case example: A patient receives chemotherapy administration, intravenous infusion technique; up to one hour. 96415 for each additional hour. This service is billed using CPT code 96413.
• 96409 – Chemotherapy administration, intravenous push technique; single drug.
• Case example: A patient receives chemotherapy administration, intravenous push technique; single drug. This service is billed using CPT code 96409.
• 96372 – Therapeutic injection of medication (e.g., subcutaneous injection of hormone therapy).
• Case example: A patient receives therapeutic injection of medication (e.g., subcutaneous injection of hormone therapy). This service is billed using CPT code 96372.
• 96401 – Subcutaneous or intramuscular chemotherapy; hormonal or antibiotic antineoplastic.
• Case example: A patient receives subcutaneous or intramuscular chemotherapy; hormonal or antibiotic antineoplastic. This service is billed using CPT code 96401.
• 96417 – Intravenous infusion of hydration, each additional hour beyond first.
• Case example: A patient receives intravenous infusion of hydration, each additional hour beyond first. This service is billed using CPT code 96417.
• 77427 – Radiation treatment management; used once per week during radiation therapy.
• Case example: A patient receives radiation treatment management; used once per week during radiation therapy. This service is billed using CPT code 77427.
• 77300/77301/77332 – Radiation therapy planning and dosimetry; includes treatment devices and calculation of therapy.
• Case example: A patient receives radiation therapy planning and dosimetry; includes treatment devices and calculation of therapy. This service is billed using CPT code 77300/77301/77332.

Modifiers and tips

• −59 when administering multiple chemotherapy drugs sequentially; ensures each infusion is reimbursed appropriately.
• Use −25 when evaluation and management services are distinct from chemotherapy administration.
• Document drug name, dose, route, infusion time and patient reaction to support codes.

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21. Ophthalmology

Ophthalmologists diagnose and treat eye disorders and perform surgery on the eye and adnexa.

Common CPT codes

• 92002/92004 – Comprehensive ophthalmological services for new patients; 92002 covers intermediate exam; 92004 covers comprehensive exam with dilation.
• Case example: A patient receives comprehensive ophthalmological services for new patients; 92002 covers intermediate exam; 92004 covers comprehensive exam with dilation. This service is billed using CPT code 92002/92004.
• 92012/92014 – Comprehensive ophthalmological services for established patients; 92014 includes detailed evaluation and management.
• Case example: A patient receives comprehensive ophthalmological services for established patients; 92014 includes detailed evaluation and management. This service is billed using CPT code 92012/92014.
• 92134 – Scanning computerized ophthalmic diagnostic imaging of retina and optic nerve (e.g., OCT). Use −26/−TC for professional/technical components.
• Case example: A patient receives scanning computerized ophthalmic diagnostic imaging of retina and optic nerve (e.g., OCT). Use −26/−TC for professional/technical components. This service is billed using CPT code 92134.
• 65435 – Removal of corneal foreign body; nonperforating.
• Case example: A patient receives removal of corneal foreign body; nonperforating. This service is billed using CPT code 65435.
• 66984 – Cataract surgery, extracapsular, with insertion of intraocular lens. Use 66982 for complex cataract surgery.
• Case example: A patient receives cataract surgery, extracapsular, with insertion of intraocular lens. Use 66982 for complex cataract surgery. This service is billed using CPT code 66984.
• 65756 – Keratoplasty (corneal transplant), including removal of corneal tissue.
• Case example: A patient receives keratoplasty (corneal transplant), including removal of corneal tissue. This service is billed using CPT code 65756.
• 65205 – Removal of foreign body from conjunctival surface; use when not requiring a slit lamp.
• Case example: A patient receives removal of foreign body from conjunctival surface; use when not requiring a slit lamp. This service is billed using CPT code 65205.

Modifiers and tips

• −50 for bilateral procedures (e.g., bilateral cataract surgery performed on separate days; ensure payer policy permits bilateral billing).
• −25 when E/M service is separate from procedure such as foreign body removal.
• Use −79 to indicate unrelated procedure during postoperative period of another surgery.

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22. Orthopedics

Orthopedic surgeons and specialists treat musculoskeletal injuries and diseases. Coding covers fractures, joint replacement and arthroscopic procedures.

Common CPT codes

• 99212–99215 – Office visits, often for evaluation of musculoskeletal complaints.
• Case example: A patient receives office visits, often for evaluation of musculoskeletal complaints. This service is billed using CPT code 99212–99215.
• 23650 – Closed treatment of shoulder dislocation; includes closed reduction.
• Case example: A patient receives closed treatment of shoulder dislocation; includes closed reduction. This service is billed using CPT code 23650.
• 29881/29882/29883 – Knee arthroscopy with meniscectomy, meniscus repair or both.
• Case example: A patient receives knee arthroscopy with meniscectomy, meniscus repair or both. This service is billed using CPT code 29881/29882/29883.
• 29888 – Arthroscopically aided anterior cruciate ligament (ACL) reconstruction.
• Case example: A patient receives arthroscopically aided anterior cruciate ligament (ACL) reconstruction. This service is billed using CPT code 29888.
• 27130 – Total hip arthroplasty; includes acetabular and femoral components.
• Case example: A patient receives total hip arthroplasty; includes acetabular and femoral components. This service is billed using CPT code 27130.
• 27447 – Total knee arthroplasty.
• Case example: A patient receives total knee arthroplasty. This service is billed using CPT code 27447.
• 25605 – Closed treatment of distal radial fracture (Colles fracture) with or without manipulation.
• Case example: A patient receives closed treatment of distal radial fracture (Colles fracture) with or without manipulation. This service is billed using CPT code 25605.
• 20610 – Arthrocentesis (joint aspiration and/or injection) of major joint or bursa (e.g., shoulder, hip, knee). When performed bilaterally, add −50.
• Case example: A patient receives arthrocentesis (joint aspiration and/or injection) of major joint or bursa (e.g., shoulder, hip, knee). When performed bilaterally, add −50. This service is billed using CPT code 20610.

Modifiers and tips

• −50 for bilateral joint injections or procedures.
• −54/−55 split billing for co‑management of surgical procedures (−54: surgical care only, −55: postoperative management only).
• Document imaging findings, fracture type and whether open or closed treatment to justify code selection.

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23. Otorhinolaryngology (ENT)

Otolaryngologists diagnose and manage diseases of the ear, nose and throat.

Common CPT codes

• 99203–99215 – Office visits for ear, nose and throat conditions.
• Case example: A patient receives office visits for ear, nose and throat conditions. This service is billed using CPT code 99203–99215.
• 92502 – Otolaryngologic examination under general anesthesia (e.g., for young children with suspected foreign body).
• Case example: A patient receives otolaryngologic examination under general anesthesia (e.g., for young children with suspected foreign body). This service is billed using CPT code 92502.
• 31231 – Nasal endoscopy, diagnostic, unilateral or bilateral. Add 31233 for with biopsy.
• Case example: A patient receives nasal endoscopy, diagnostic, unilateral or bilateral. Add 31233 for with biopsy. This service is billed using CPT code 31231.
• 30140 – Submucous resection of inferior turbinate, partial or complete. Use 30520 for septoplasty with or without cartilage graft.
• Case example: A patient receives submucous resection of inferior turbinate, partial or complete. Use 30520 for septoplasty with or without cartilage graft. This service is billed using CPT code 30140.
• 69436 – Tympanostomy (insertion of ventilating tube) under general anesthesia.
• Case example: A patient receives tympanostomy (insertion of ventilating tube) under general anesthesia. This service is billed using CPT code 69436.
• 31575 – Laryngoscopy, flexible fiberoptic, diagnostic; includes potential with stroboscopy (31579).
• Case example: A patient receives laryngoscopy, flexible fiberoptic, diagnostic; includes potential with stroboscopy (31579). This service is billed using CPT code 31575.
• 42821 – Tonsillectomy and adenoidectomy, under age 12; 42826/42836 for age 12 or older.
• Case example: A patient receives tonsillectomy and adenoidectomy, under age 12; 42826/42836 for age 12 or older. This service is billed using CPT code 42821.

Modifiers and tips

• −50 for bilateral sinus surgery (e.g., bilateral turbinate reduction). Some sinus codes are inherently bilateral.
• −52 for reduced services (e.g., partial inferior turbinate reduction).
• Use −78 when unplanned return to the operating room for related procedure during postoperative period.

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24. Pathology

Pathologists interpret tissue specimens and perform laboratory testing. Many codes include professional and technical components.

Common CPT codes

• 88305 – Surgical pathology, gross and microscopic examination of a tissue specimen (e.g., biopsy of skin, colon). Use 88302–88309 for less or more complex specimens.
• Case example: A patient receives surgical pathology, gross and microscopic examination of a tissue specimen (e.g., biopsy of skin, colon). Use 88302–88309 for less or more complex specimens. This service is billed using CPT code 88305.
• 88341/88342/88344 – Immunohistochemistry or immunocytochemistry, each antibody; code selection based on number of antibodies performed per specimen.
• Case example: A patient receives immunohistochemistry or immunocytochemistry, each antibody; code selection based on number of antibodies performed per specimen. This service is billed using CPT code 88341/88342/88344.
• 88360/88361 – Morphometric analysis; includes tumor grading and digital image analysis.
• Case example: A patient receives morphometric analysis; includes tumor grading and digital image analysis. This service is billed using CPT code 88360/88361.
• 88141 – Cytopathology, cervical or vaginal smear (Papanicolaou smear), requiring interpretation by physician.
• Case example: A patient receives cytopathology, cervical or vaginal smear (Papanicolaou smear), requiring interpretation by physician. This service is billed using CPT code 88141.
• 88230–88299 – Chromosome analysis and molecular cytogenetics; used in hematologic malignancies and prenatal diagnosis.
• Case example: A patient receives chromosome analysis and molecular cytogenetics; used in hematologic malignancies and prenatal diagnosis. This service is billed using CPT code 88230–88299.
• 89060 – Sperm morphology evaluation; used in fertility evaluations.
• Case example: A patient receives sperm morphology evaluation; used in fertility evaluations. This service is billed using CPT code 89060.

Modifiers and tips

• −26/−TC identify professional and technical components. Laboratories often bill technical component; pathologists bill professional interpretation.
• Use −59 when billing multiple pathologic procedures on the same specimen (e.g., immunohistochemistry and in situ hybridization).
• Document quality assurance measures and maintain CLIA (Clinical Laboratory Improvement Amendments) certification.

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25. Pediatrics

Pediatricians care for infants, children and adolescents. Coding includes well‑child visits, acute care, immunizations and developmental screening.

Common CPT codes

• 99381–99395 – Well‑child preventive visits for new and established patients from birth through age 21.
• Case example: A patient receives well‑child preventive visits for new and established patients from birth through age 21. This service is billed using CPT code 99381–99395.
• 99202–99215 – Problem‑oriented office visits; choose code based on complexity.
• Case example: A patient receives problem‑oriented office visits; choose code based on complexity. This service is billed using CPT code 99202–99215.
• 90460/90461 – Immunization administration through 18 years of age; includes counseling by physician or other qualified health‑care professional. Report one unit per vaccine/toxoid component.
• Case example: A patient receives immunization administration through 18 years of age; includes counseling by physician or other qualified health‑care professional. Report one unit per vaccine/toxoid component. This service is billed using CPT code 90460/90461.
• 96372 – Therapeutic injection; often used for medications like antibiotics or steroids.
• Case example: A patient receives therapeutic injection; often used for medications like antibiotics or steroids. This service is billed using CPT code 96372.
• 36416 – Collection of capillary blood specimen (e.g., finger, heel or ear stick).
• Case example: A patient receives collection of capillary blood specimen (e.g., finger, heel or ear stick). This service is billed using CPT code 36416.
• 96110 – Developmental screening (e.g., Ages and Stages Questionnaire); use 96127 for brief emotional/behavioral assessments.
• Case example: A patient receives developmental screening (e.g., Ages and Stages Questionnaire); use 96127 for brief emotional/behavioral assessments. This service is billed using CPT code 96110.
• 94640 – Airway inhalation treatment; used for nebulizer therapy in asthma exacerbations.
• Case example: A patient receives airway inhalation treatment; used for nebulizer therapy in asthma exacerbations. This service is billed using CPT code 94640.

Modifiers and tips

• Use −25 with E/M visits when performing procedures like immunizations or ear lavage.
• Document vaccine counseling, lot numbers and patient/guardian consent to support immunization administration codes.
• For multiple vaccine components, use separate units of 90461.

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26. Physical Medicine & Rehabilitation (PM&R)

Physiatrists and rehabilitation specialists focus on restoring function after injury or illness. Services range from therapeutic exercises to neuropsychiatric testing.

Common CPT codes

• 97110 – Therapeutic exercises; direct one‑on‑one patient contact, per 15 minutes.
• Case example: A patient receives therapeutic exercises; direct one‑on‑one patient contact, per 15 minutes. This service is billed using CPT code 97110.
• 97112 – Neuromuscular reeducation; movement, balance, coordination and posture.
• Case example: A patient receives neuromuscular reeducation; movement, balance, coordination and posture. This service is billed using CPT code 97112.
• 97140 – Manual therapy techniques (e.g., mobilization, manipulation) per 15 minutes.
• Case example: A patient receives manual therapy techniques (e.g., mobilization, manipulation) per 15 minutes. This service is billed using CPT code 97140.
• 97530 – Therapeutic activities; direct patient contact, use of dynamic activities to improve functional performance (e.g., transfer training).
• Case example: A patient receives therapeutic activities; direct patient contact, use of dynamic activities to improve functional performance (e.g., transfer training). This service is billed using CPT code 97530.
• 97035 – Ultrasound therapy; treat soft‑tissue injuries.
• Case example: A patient receives ultrasound therapy; treat soft‑tissue injuries. This service is billed using CPT code 97035.
• 97750 – Physical performance test or measurement; e.g., gait analysis, range of motion measurements.
• Case example: A patient receives physical performance test or measurement; e.g., gait analysis, range of motion measurements. This service is billed using CPT code 97750.
• 95851/95852 – Range of motion measurements and report; each extremity and/or trunk.
• Case example: A patient receives range of motion measurements and report; each extremity and/or trunk. This service is billed using CPT code 95851/95852.

Modifiers and tips

• Use −59 when multiple therapy modalities are provided on the same day (e.g., 97110 and 97140) if payer policies require distinct modifiers.
• Document time in units of 15 minutes per CPT requirements; multiple units can be billed when more time is spent.
• Evaluation/management visits are separate from therapy codes; use 99202–99215 with −25 if necessary.

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27. Plastic and Reconstructive Surgery

Plastic surgeons perform reconstructive and cosmetic procedures. Medical necessity must be documented for reconstructive procedures to secure payment.

Common CPT codes

• 19303 – Mastectomy, simple, complete; used in breast cancer treatment.
• Case example: A patient receives mastectomy, simple, complete; used in breast cancer treatment. This service is billed using CPT code 19303.
• 19301 – Partial mastectomy (lumpectomy). Document margin status.
• Case example: A patient receives partial mastectomy (lumpectomy). Document margin status. This service is billed using CPT code 19301.
• 30420 – Rhinoplasty, primary; including major septal repair. Use 30465 for repair of nasal valve collapse.
• Case example: A patient receives rhinoplasty, primary; including major septal repair. Use 30465 for repair of nasal valve collapse. This service is billed using CPT code 30420.
• 30520 – Septoplasty; can be performed with rhinoplasty and requires −51 for multiple procedures.
• Case example: A patient receives septoplasty; can be performed with rhinoplasty and requires −51 for multiple procedures. This service is billed using CPT code 30520.
• 15832 – Excision of excessive skin and fat following weight loss (panniculectomy). Medical necessity should document rashes or hygiene issues.
• Case example: A patient receives excision of excessive skin and fat following weight loss (panniculectomy). Medical necessity should document rashes or hygiene issues. This service is billed using CPT code 15832.
• 15847 – Excision of excessive skin and fat; abdomen (abdominoplasty). Many payers consider this cosmetic unless medically justified.
• Case example: A patient receives excision of excessive skin and fat; abdomen (abdominoplasty). Many payers consider this cosmetic unless medically justified. This service is billed using CPT code 15847.
• 67904 – Repair of blepharoptosis; documentation must show visual field obstruction.
• Case example: A patient receives repair of blepharoptosis; documentation must show visual field obstruction. This service is billed using CPT code 67904.

Modifiers and tips

• −59 when performing distinct procedures on different anatomical sites (e.g., abdominoplasty and blepharoplasty).
• −50 for bilateral procedures (e.g., bilateral blepharoplasty). Note that some eyelid codes are inherently bilateral.
• Provide pre‑operative photos, surgeon notes and patient symptoms to support reconstructive claims.

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28. Podiatry

Podiatrists treat foot and ankle conditions. Many services involve routine foot care, debridement and orthopedic procedures.

Common CPT codes

• 99212–99215 – Office visits for evaluation of foot problems such as plantar fasciitis, neuropathy or diabetic foot ulcers.
• Case example: A patient receives office visits for evaluation of foot problems such as plantar fasciitis, neuropathy or diabetic foot ulcers. This service is billed using CPT code 99212–99215.
• 11720/11721 – Debridement of nail (nail trimming), one to five nails (11720) or six or more nails (11721). These codes are covered only when medical necessity criteria are met (e.g., painful nails, thickened nails associated with fungus or diabetes).
• Case example: A patient receives debridement of nail (nail trimming), one to five nails (11720) or six or more nails (11721). These codes are covered only when medical necessity criteria are met (e.g., painful nails, thickened nails associated with fungus or diabetes). This service is billed using CPT code 11720/11721.
• 11055 – Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus). 11056/11057 for multiple lesions.
• Case example: A patient receives paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus). 11056/11057 for multiple lesions. This service is billed using CPT code 11055.
• 11200 – Removal of skin tags; used on the feet when causing pain or irritation.
• Case example: A patient receives removal of skin tags; used on the feet when causing pain or irritation. This service is billed using CPT code 11200.
• 11420–11426 – Excision of benign lesions on foot; select code based on lesion size and location.
• Case example: A patient receives excision of benign lesions on foot; select code based on lesion size and location. This service is billed using CPT code 11420–11426.
• 28008 – Incision and drainage of bursa, foot. 28005 for incisional drainage of hematoma.
• Case example: A patient receives incision and drainage of bursa, foot. 28005 for incisional drainage of hematoma. This service is billed using CPT code 28008.
• 28820 – Amputation of toe; procedures vary based on level of amputation.
• Case example: A patient receives amputation of toe; procedures vary based on level of amputation. This service is billed using CPT code 28820.

Modifiers and tips

• −59 when performing debridement of multiple distinct lesions or nails.
• Routine foot care is generally not covered by Medicare unless the patient has systemic conditions (e.g., diabetes) and meets specific criteria; document neurologic and vascular findings.

Learn more about Podiatry billing or credentialing services

29. Psychiatry

Psychiatrists and mental health professionals diagnose and treat mental disorders. Codes differentiate initial evaluations, psychotherapy duration and crisis services.

Common CPT codes

• 90791 – Psychiatric diagnostic evaluation; without medical services. 90792 includes medical services and is used by physicians or advanced practice providers.
• Case example: A patient receives psychiatric diagnostic evaluation; without medical services. 90792 includes medical services and is used by physicians or advanced practice providers. This service is billed using CPT code 90791.
• 90832 – Psychotherapy, 30 minutes with patient and/or family member; 90834 for 45 minutes and 90837 for 60 minutes.
• Case example: A patient receives psychotherapy, 30 minutes with patient and/or family member; 90834 for 45 minutes and 90837 for 60 minutes. This service is billed using CPT code 90832.
• 90839 – Psychotherapy for crisis, first 60 minutes; 90840 for each additional 30 minutes.
• Case example: A patient receives psychotherapy for crisis, first 60 minutes; 90840 for each additional 30 minutes. This service is billed using CPT code 90839.
• 99205/99215 – High‑complexity E/M visits when managing psychiatric patients with medical co‑morbidities.
• Case example: A patient receives high‑complexity E/M visits when managing psychiatric patients with medical co‑morbidities. This service is billed using CPT code 99205/99215.
• 96127 – Brief emotional/behavioral assessment, per standardized instrument (e.g., PHQ‑9 for depression). Bill separately from E/M services.
• Case example: A patient receives brief emotional/behavioral assessment, per standardized instrument (e.g., PHQ‑9 for depression). Bill separately from E/M services. This service is billed using CPT code 96127.
• 99408/99409 – Alcohol and/or substance abuse structured screening and brief intervention; 15 and 30 minutes respectively.
• Case example: A patient receives alcohol and/or substance abuse structured screening and brief intervention; 15 and 30 minutes respectively. This service is billed using CPT code 99408/99409.

Modifiers and tips

• Use −25 when billing E/M codes with psychotherapy codes on the same day; documentation must show a separately identifiable service.
• Time‑based psychotherapy codes must meet or exceed time thresholds (e.g., at least 16 minutes for 90832). Do not include time spent on non‑face‑to‑face activities.
• For crisis psychotherapy (90839/90840), document the nature of the crisis, risk assessment and counseling provided.

Learn more about Psychiatry billing or credentialing services

30. Pulmonology

Pulmonologists treat respiratory diseases such as asthma, COPD and sleep apnea. Services include diagnostic testing and therapeutic procedures.

Common CPT codes

• 94010 – Spirometry, including graphic record, total and timed vital capacity and expiratory flow; evaluation of airway obstruction.
• Case example: A patient receives spirometry, including graphic record, total and timed vital capacity and expiratory flow; evaluation of airway obstruction. This service is billed using CPT code 94010.
• 94760 – Noninvasive ear or pulse oximetry; single determination. 94761 for continuous monitoring.
• Case example: A patient receives noninvasive ear or pulse oximetry; single determination. 94761 for continuous monitoring. This service is billed using CPT code 94760.
• 94640 – Pressurized or nonpressurized inhalation treatment for acute airway obstruction; includes nebulizer therapy.
• Case example: A patient receives pressurized or nonpressurized inhalation treatment for acute airway obstruction; includes nebulizer therapy. This service is billed using CPT code 94640.
• 94664 – Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device.
• Case example: A patient receives demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device. This service is billed using CPT code 94664.
• 95805 – Multiple sleep latency or maintenance of wakefulness testing, daytime only.
• Case example: A patient receives multiple sleep latency or maintenance of wakefulness testing, daytime only. This service is billed using CPT code 95805.
• 95810 – Polysomnography; sleep study with six or more parameters recorded; used to diagnose sleep apnea.
• Case example: A patient receives polysomnography; sleep study with six or more parameters recorded; used to diagnose sleep apnea. This service is billed using CPT code 95810.
• 99406/99407 – Smoking cessation counseling services (3–10 minutes or >10 minutes). Suitable for pulmonology clinics.
• Case example: A patient receives smoking cessation counseling services (3–10 minutes or >10 minutes). Suitable for pulmonology clinics. This service is billed using CPT code 99406/99407.

Modifiers and tips

• Use −25 with E/M codes when performing spirometry or nebulizer treatment during the same visit.
• Sleep studies require documentation of indications (e.g., snoring, witnessed apneas) and adherence to guidelines for scoring and interpretation.

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31. Radiation Oncology

Radiation oncologists deliver ionizing radiation to treat cancer. Codes cover planning, simulation and treatment delivery.

Common CPT codes

• 77261–77263 – Radiation therapy clinical treatment planning; simple to complex. Document tumor size, location and complexity to select correct level.
• Case example: A patient receives radiation therapy clinical treatment planning; simple to complex. Document tumor size, location and complexity to select correct level. This service is billed using CPT code 77261–77263.
• 77280–77290 – Therapeutic radiology simulation-aided field setting; includes establishing field arrangements.
• Case example: A patient receives therapeutic radiology simulation-aided field setting; includes establishing field arrangements. This service is billed using CPT code 77280–77290.
• 77295 – Three‑dimensional radiotherapy plan, including dose‑volume histograms; used for conformal therapy planning.
• Case example: A patient receives three‑dimensional radiotherapy plan, including dose‑volume histograms; used for conformal therapy planning. This service is billed using CPT code 77295.
• 77300 – Basic radiation dosimetry calculation, separate from treatment planning.
• Case example: A patient receives basic radiation dosimetry calculation, separate from treatment planning. This service is billed using CPT code 77300.
• 77332–77334 – Brachytherapy source application; high dose rate (HDR) or low dose rate (LDR) depending on technique.
• Case example: A patient receives brachytherapy source application; high dose rate (HDR) or low dose rate (LDR) depending on technique. This service is billed using CPT code 77332–77334.
• 77427 – Radiation treatment management, five treatments; covers weekly treatment supervision during a course of external beam radiation therapy.
• Case example: A patient receives radiation treatment management, five treatments; covers weekly treatment supervision during a course of external beam radiation therapy. This service is billed using CPT code 77427.
• 77402–77416 – Delivery of external beam radiotherapy; simple (77402), intermediate (77407) or complex (77412/77416). Code selection is based on number of treatment ports and blocking.
• Case example: A patient receives delivery of external beam radiotherapy; simple (77402), intermediate (77407) or complex (77412/77416). Code selection is based on number of treatment ports and blocking. This service is billed using CPT code 77402–77416.

Modifiers and tips

• −26/−TC for professional and technical components of radiation planning (e.g., 77295‑26 for professional plan; 77295‑TC for technical execution).
• Document simulation and treatment fields thoroughly; include physician review and signature to support billing.
• Use −77 for repeat procedures on the same day by a different physician or qualified health‑care professional.

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32. Radiology

Radiologists interpret imaging studies and perform interventional procedures. Many codes are separated into professional and technical components.

Common CPT codes

• 71046 – Radiologic examination, chest, two views. Use 71045 for single view.
• Case example: A patient receives radiologic examination, chest, two views. Use 71045 for single view. This service is billed using CPT code 71046.
• 71260 – Computed tomography (CT) of chest with contrast. 71250 for without contrast; 71270 for both with and without.
• Case example: A patient receives computed tomography (CT) of chest with contrast. 71250 for without contrast; 71270 for both with and without. This service is billed using CPT code 71260.
• 73721 – Magnetic resonance imaging (MRI) of lower extremity joint without contrast; 73722 with contrast.
• Case example: A patient receives magnetic resonance imaging (MRI) of lower extremity joint without contrast; 73722 with contrast. This service is billed using CPT code 73721.
• 73030 – X‑ray of shoulder, two or more views.
• Case example: A patient receives x‑ray of shoulder, two or more views. This service is billed using CPT code 73030.
• 74177 – CT abdomen and pelvis with contrast.
• Case example: A patient receives cT abdomen and pelvis with contrast. This service is billed using CPT code 74177.
• 77067 – Screening mammography, bilateral (2‑view study). Note that national coverage for screening mammography is typically once a year starting at age 40.
• Case example: A patient receives screening mammography, bilateral (2‑view study). Note that national coverage for screening mammography is typically once a year starting at age 40. This service is billed using CPT code 77067.
• 76805/76815 – Obstetric ultrasound (see OB‑GYN section). Radiologists may interpret for obstetricians.
• Case example: A patient receives obstetric ultrasound (see OB‑GYN section). Radiologists may interpret for obstetricians. This service is billed using CPT code 76805/76815.

Modifiers and tips

• −26/−TC to differentiate professional interpretation from technical imaging performance.
• −59 when performing multiple imaging studies during the same session with separate protocols (e.g., CT abdomen and CT pelvis on separate scanners).
• Document clinical indications, technique, findings and impression for each study.

Learn more about Radiology billing or credentialing services

33. Rheumatology

Rheumatologists treat autoimmune and musculoskeletal diseases such as rheumatoid arthritis, lupus and gout.

Common CPT codes

• 99202–99215 – Office E/M visits for acute flares and chronic disease management.
• Case example: A patient receives office E/M visits for acute flares and chronic disease management. This service is billed using CPT code 99202–99215.
• 20610 – Joint or bursa aspiration/injection; major joint or bursa (e.g., knee, shoulder). For small joints, use 20600/20605.
• Case example: A patient receives joint or bursa aspiration/injection; major joint or bursa (e.g., knee, shoulder). For small joints, use 20600/20605. This service is billed using CPT code 20610.
• 96372 – Therapeutic injection; used for biologic agents administered in clinic.
• Case example: A patient receives therapeutic injection; used for biologic agents administered in clinic. This service is billed using CPT code 96372.
• 96401 – Chemotherapy administration (e.g., methotrexate injection) for rheumatologic conditions.
• Case example: A patient receives chemotherapy administration (e.g., methotrexate injection) for rheumatologic conditions. This service is billed using CPT code 96401.
• 76942 – Ultrasonic guidance for needle placement; imaging supervision and interpretation. Used for ultrasound‑guided injections.
• Case example: A patient receives ultrasonic guidance for needle placement; imaging supervision and interpretation. Used for ultrasound‑guided injections. This service is billed using CPT code 76942.
• 36415 – Venipuncture for labs such as rheumatoid factor, anti‑CCP antibodies and CRP.
• Case example: A patient receives venipuncture for labs such as rheumatoid factor, anti‑CCP antibodies and CRP. This service is billed using CPT code 36415.
• 86580 – Tuberculin skin test; often required before initiating biologic therapy.
• Case example: A patient receives tuberculin skin test; often required before initiating biologic therapy. This service is billed using CPT code 86580.
• 86803 – Autoantibody screen (ANA); may be repeated when screening for lupus.
• Case example: A patient receives autoantibody screen (ANA); may be repeated when screening for lupus. This service is billed using CPT code 86803.

Modifiers and tips

• −25 with E/M when performing joint injections during the same visit.
• −51 for multiple injections in different joints; list the highest RVU code first.
• Document injection site, medication, dose, route and patient response.

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34. Sleep Medicine

Sleep medicine physicians diagnose and treat sleep disorders including sleep apnea, insomnia and narcolepsy.

Common CPT codes

• 95800 – Sleep study (e.g., unattended home sleep apnea test) with portable monitoring devices; simultaneous recording of heart rate, oxygen saturation, respiratory analysis and sleep time.
• Case example: A patient receives sleep study (e.g., unattended home sleep apnea test) with portable monitoring devices; simultaneous recording of heart rate, oxygen saturation, respiratory analysis and sleep time. This service is billed using CPT code 95800.
• 95806 – Sleep study; simultaneously records airflow, respiratory effort and oxygen saturation without EEG. Typically used for unattended home studies.
• Case example: A patient receives sleep study; simultaneously records airflow, respiratory effort and oxygen saturation without EEG. Typically used for unattended home studies. This service is billed using CPT code 95806.
• 95810 – Polysomnography with six or more channels including EEG, EOG, chin EMG, ECG, airflow, respiratory effort, oxygen saturation and limb movement. Used for diagnosing sleep apnea and other disorders.
• Case example: A patient receives polysomnography with six or more channels including EEG, EOG, chin EMG, ECG, airflow, respiratory effort, oxygen saturation and limb movement. Used for diagnosing sleep apnea and other disorders. This service is billed using CPT code 95810.
• 95811 – Polysomnography with CPAP/BiPAP titration. Conducted overnight in a sleep lab.
• Case example: A patient receives polysomnography with CPAP/BiPAP titration. Conducted overnight in a sleep lab. This service is billed using CPT code 95811.
• 94660 – Continuous positive airway pressure (CPAP) ventilation initiation and management. Used to initiate therapy for sleep apnea.
• Case example: A patient receives continuous positive airway pressure (CPAP) ventilation initiation and management. Used to initiate therapy for sleep apnea. This service is billed using CPT code 94660.
• 99453 – Remote monitoring of physiologic parameters; set‑up and patient education on use of equipment (e.g., home sleep apnea test devices).
• Case example: A patient receives remote monitoring of physiologic parameters; set‑up and patient education on use of equipment (e.g., home sleep apnea test devices). This service is billed using CPT code 99453.
• 99457 – Remote physiologic monitoring treatment management services, requiring 20 minutes or more of clinical staff/physician time per calendar month.
• Case example: A patient receives remote physiologic monitoring treatment management services, requiring 20 minutes or more of clinical staff/physician time per calendar month. This service is billed using CPT code 99457.

Modifiers and tips

• −26/−TC may apply for interpretation and technical components of polysomnography.
• Home sleep apnea tests require documentation of medical necessity (e.g., snoring, excessive daytime sleepiness) and ruling out other causes.
• Use remote monitoring codes (99453/99457) to bill for chronic management of CPAP adherence.

Learn more about Sleep Medicine billing or credentialing services

35. Sports Medicine

Sports medicine focuses on prevention, diagnosis and treatment of injuries related to athletic activities. It encompasses aspects of orthopedics, physical medicine and primary care.

Common CPT codes

• 99212–99215 – Office E/M visits for acute injuries or chronic conditions like tendinopathy.
• Case example: A patient receives office E/M visits for acute injuries or chronic conditions like tendinopathy. This service is billed using CPT code 99212–99215.
• 97110 – Therapeutic exercises; for rehabilitation and strengthening.
• Case example: A patient receives therapeutic exercises; for rehabilitation and strengthening. This service is billed using CPT code 97110.
• 97116 – Gait training therapy; used for athletes recovering from lower extremity injuries.
• Case example: A patient receives gait training therapy; used for athletes recovering from lower extremity injuries. This service is billed using CPT code 97116.
• 97140 – Manual therapy techniques; includes soft tissue and joint mobilization.
• Case example: A patient receives manual therapy techniques; includes soft tissue and joint mobilization. This service is billed using CPT code 97140.
• 97014/97010 – Application of hot or cold packs; may be part of physical therapy modalities.
• Case example: A patient receives application of hot or cold packs; may be part of physical therapy modalities. This service is billed using CPT code 97014/97010.
• 20610 – Aspiration/injection of major joint (e.g., knee), often used for viscosupplementation or corticosteroid injection.
• Case example: A patient receives aspiration/injection of major joint (e.g., knee), often used for viscosupplementation or corticosteroid injection. This service is billed using CPT code 20610.
• 23412 – Repair of pectoralis major muscle; used for tendon ruptures.
• Case example: A patient receives repair of pectoralis major muscle; used for tendon ruptures. This service is billed using CPT code 23412.

Modifiers and tips

• −25 with E/M visits when injections or other minor procedures are performed.
• Document injury mechanism, functional limitations and therapy goals to support therapy codes.

Learn more about Sports Medicine billing or credentialing services

36. Thoracic Surgery

Thoracic surgeons operate on organs inside the chest (e.g., lungs, esophagus, mediastinum). Accurate coding reflects complexity and surgical approach.

Common CPT codes

• 32480 – Removal of lung (pneumonectomy). 32482 for completion pneumonectomy after prior partial resection.
• Case example: A patient receives removal of lung (pneumonectomy). 32482 for completion pneumonectomy after prior partial resection. This service is billed using CPT code 32480.
• 32607 – Thoracoscopy (video‑assisted thoracic surgery) with diagnostic evaluation of lung or pleura; includes simple biopsy.
• Case example: A patient receives thoracoscopy (video‑assisted thoracic surgery) with diagnostic evaluation of lung or pleura; includes simple biopsy. This service is billed using CPT code 32607.
• 32666 – Thoracoscopy with lobectomy (removal of a lobe); performed minimally invasively.
• Case example: A patient receives thoracoscopy with lobectomy (removal of a lobe); performed minimally invasively. This service is billed using CPT code 32666.
• 32555 – Percutaneous biopsy of lung or mediastinum using imaging guidance; includes placement of marker when required.
• Case example: A patient receives percutaneous biopsy of lung or mediastinum using imaging guidance; includes placement of marker when required. This service is billed using CPT code 32555.
• 32557 – Pleurodesis, with or without use of talc through thoracoscope.
• Case example: A patient receives pleurodesis, with or without use of talc through thoracoscope. This service is billed using CPT code 32557.
• 31240 – Endoscopic excision or destruction of lesion of trachea or bronchus.
• Case example: A patient receives endoscopic excision or destruction of lesion of trachea or bronchus. This service is billed using CPT code 31240.

Modifiers and tips

• −62 for co‑surgeon if cardiothoracic surgery is performed jointly by a thoracic surgeon and a cardiac surgeon.
• −22 for increased procedural services when dealing with dense adhesions or re‑operative chest.
• Document whether surgery is open, thoracoscopic or robotic to select the correct code.

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37. Transplant Surgery

Transplant surgeons perform organ transplants, including kidney, liver, heart and pancreas. Billing is complex and often involves global periods.

Common CPT codes

• 33945 – Transplantation of heart (cardiac allograft); donor cardiectomy and recipient cardiectomy with orthotopic heart transplant.
• Case example: A patient receives transplantation of heart (cardiac allograft); donor cardiectomy and recipient cardiectomy with orthotopic heart transplant. This service is billed using CPT code 33945.
• 47135 – Liver allotransplantation, cadaver donor, orthotopic. 47143 for living donor hepatectomy (left lateral segment); 47146 for living donor hepatectomy (right lobe).
• Case example: A patient receives liver allotransplantation, cadaver donor, orthotopic. 47143 for living donor hepatectomy (left lateral segment); 47146 for living donor hepatectomy (right lobe). This service is billed using CPT code 47135.
• 48554 – Transplantation of pancreas, whole organ, any age.
• Case example: A patient receives transplantation of pancreas, whole organ, any age. This service is billed using CPT code 48554.
• 50300 – Donor nephrectomy (unilateral) for transplant; used to remove kidney from donor.
• Case example: A patient receives donor nephrectomy (unilateral) for transplant; used to remove kidney from donor. This service is billed using CPT code 50300.
• 50360 – Kidney transplant, with unilateral nephrectomy of recipient.
• Case example: A patient receives kidney transplant, with unilateral nephrectomy of recipient. This service is billed using CPT code 50360.
• 35541/35621 – Creation of arteriovenous fistula for dialysis (surgically or percutaneously) when performed by transplant surgeons.
• Case example: A patient receives creation of arteriovenous fistula for dialysis (surgically or percutaneously) when performed by transplant surgeons. This service is billed using CPT code 35541/35621.

Modifiers and tips

• −80 for assistant surgeon; transplant surgeries require multi‑physician teams.
• −99 multiple modifiers may be necessary (e.g., −62 for co‑surgeon, −80 for assistant, −Q0 for investigational procedure in clinical trial).
• Transplant codes often include preoperative, intraoperative and postoperative services; check payer policies for global periods.

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38. Urgent Care

Urgent care centers handle non‑life‑threatening illnesses and injuries that require prompt attention.

Common CPT codes

• 99202–99215 – E/M visits for new and established patients; urgent care visits are coded similarly to primary care visits based on complexity and time.
• Case example: A patient receives e/M visits for new and established patients; urgent care visits are coded similarly to primary care visits based on complexity and time. This service is billed using CPT code 99202–99215.
• 12001–12007 – Simple wound repair of superficial wounds less than 2.5 cm to greater than 7.5 cm. Use when closing lacerations without layered closure.
• Case example: A patient receives simple wound repair of superficial wounds less than 2.5 cm to greater than 7.5 cm. Use when closing lacerations without layered closure. This service is billed using CPT code 12001–12007.
• 29540 – Strapping of ankle and/or foot; used for sprains. 29515 for strapping knee.
• Case example: A patient receives strapping of ankle and/or foot; used for sprains. 29515 for strapping knee. This service is billed using CPT code 29540.
• 96372 – Therapeutic injections such as antibiotics or steroids.
• Case example: A patient receives therapeutic injections such as antibiotics or steroids. This service is billed using CPT code 96372.
• 36415 – Venipuncture for lab draw.
• Case example: A patient receives venipuncture for lab draw. This service is billed using CPT code 36415.
• 87804 – Rapid influenza test; often used during cold and flu season.
• Case example: A patient receives rapid influenza test; often used during cold and flu season. This service is billed using CPT code 87804.

Modifiers and tips

• −25 when performing minor procedures (e.g., wound repair) during the same visit.
• Document vital signs, medical decision‑making and time spent for each urgent care visit.

Learn more about Urgent Care billing or credentialing services

39. Urology

Urologists manage urinary tract and male reproductive system disorders. They perform diagnostic procedures, minimally invasive surgery and office procedures.

Common CPT codes

• 99213–99215 – Office visits for management of urinary tract infections, kidney stones, erectile dysfunction and prostate issues.
• Case example: A patient receives office visits for management of urinary tract infections, kidney stones, erectile dysfunction and prostate issues. This service is billed using CPT code 99213–99215.
• 52000 – Cystourethroscopy, diagnostic; includes urethral catheterization when performed.
• Case example: A patient receives cystourethroscopy, diagnostic; includes urethral catheterization when performed. This service is billed using CPT code 52000.
• 52332 – Cystourethroscopy with insertion of indwelling ureteral stent (e.g., J stent).
• Case example: A patient receives cystourethroscopy with insertion of indwelling ureteral stent (e.g., J stent). This service is billed using CPT code 52332.
• 52601 – Transurethral resection of prostate (TURP), including control of postoperative bleeding.
• Case example: A patient receives transurethral resection of prostate (TURP), including control of postoperative bleeding. This service is billed using CPT code 52601.
• 51798 – Measurement of post‑voiding residual urine, simple (e.g., bladder scan). Often performed at each visit for patients with urinary retention.
• Case example: A patient receives measurement of post‑voiding residual urine, simple (e.g., bladder scan). Often performed at each visit for patients with urinary retention. This service is billed using CPT code 51798.
• 54405 – Insertion of multi‑component, inflatable penile prosthesis. 54410 for removal and replacement.
• Case example: A patient receives insertion of multi‑component, inflatable penile prosthesis. 54410 for removal and replacement. This service is billed using CPT code 54405.
• 55700 – Prostate biopsy; perineal or transrectal approach. Use 76942 (ultrasound guidance) if performed.
• Case example: A patient receives prostate biopsy; perineal or transrectal approach. Use 76942 (ultrasound guidance) if performed. This service is billed using CPT code 55700.

Modifiers and tips

• −50 for bilateral procedures (e.g., bilateral vasectomy if payer policy accepts; however, vasectomy is coded as 55250 and considered bilateral by definition).
• Use −25 when performing diagnostic cystoscopy in addition to an E/M visit for separate urinary complaints.
• Document symptoms, imaging findings and risk factors to justify procedures.

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40. Vascular Surgery

Vascular surgeons treat diseases of arteries, veins and lymphatic systems outside the heart and brain.

Common CPT codes

• 37221 – Percutaneous transluminal angioplasty with stent placement, iliac artery. Additional codes (37223) for multiple vessels.
• Case example: A patient receives percutaneous transluminal angioplasty with stent placement, iliac artery. Additional codes (37223) for multiple vessels. This service is billed using CPT code 37221.
• 35301 – Thromboendarterectomy, with patch graft, carotid artery. For lower extremity arteries, use 35371/35372.
• Case example: A patient receives thromboendarterectomy, with patch graft, carotid artery. For lower extremity arteries, use 35371/35372. This service is billed using CPT code 35301.
• 36821 – Arteriovenous fistula formation for dialysis; anastomosis of artery and vein.
• Case example: A patient receives arteriovenous fistula formation for dialysis; anastomosis of artery and vein. This service is billed using CPT code 36821.
• 35476 – Transluminal balloon angioplasty (PTA), venous. Use 75978 for radiological supervision and interpretation.
• Case example: A patient receives transluminal balloon angioplasty (PTA), venous. Use 75978 for radiological supervision and interpretation. This service is billed using CPT code 35476.
• 35661 – Bypass graft, with vein, femoral artery to above‑knee popliteal artery.
• Case example: A patient receives bypass graft, with vein, femoral artery to above‑knee popliteal artery. This service is billed using CPT code 35661.
• 93970 – Duplex scan of extremity veins, complete bilateral study; used to evaluate deep vein thrombosis (DVT).
• Case example: A patient receives duplex scan of extremity veins, complete bilateral study; used to evaluate deep vein thrombosis (DVT). This service is billed using CPT code 93970.

Modifiers and tips

• −50 when performing bilateral vascular procedures (e.g., bilateral iliofemoral bypass). However, some codes specify when bilateral is inherent.
• Use −59 to indicate distinct procedures when performing diagnostic angiography followed by therapeutic angioplasty or stenting.
• Document limb ischemia stage, imaging findings and operative details to support code selection.

41. Pain Management

Pain management physicians treat acute and chronic pain using medications, injections and implantable devices.

Common CPT codes

• 99202–99215 – E/M visits for pain evaluation and medication management.
• Case example: A patient receives e/M visits for pain evaluation and medication management. This service is billed using CPT code 99202–99215.
• 20610 – Joint injection (e.g., intra‑articular corticosteroid injection for osteoarthritis).
• Case example: A patient receives joint injection (e.g., intra‑articular corticosteroid injection for osteoarthritis). This service is billed using CPT code 20610.
• 64483 – Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level. 64484 for each additional level.
• Case example: A patient receives injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level. 64484 for each additional level. This service is billed using CPT code 64483.
• 64490/64491 – Injection, facet joint nerve block; cervical or thoracic, single and additional levels. 64493/64494 for lumbar or sacral.
• Case example: A patient receives injection, facet joint nerve block; cervical or thoracic, single and additional levels. 64493/64494 for lumbar or sacral. This service is billed using CPT code 64490/64491.
• 64635/64636 – Radiofrequency ablation (RFA) of facet joint nerves; used for chronic back pain.
• Case example: A patient receives radiofrequency ablation (RFA) of facet joint nerves; used for chronic back pain. This service is billed using CPT code 64635/64636.
• 95873 – Electrical stimulation for guidance in needle placement (e.g., for RFA). Bill along with injection or ablation codes.
• Case example: A patient receives electrical stimulation for guidance in needle placement (e.g., for RFA). Bill along with injection or ablation codes. This service is billed using CPT code 95873.
• 95886 – Needle electromyography, each extremity, when evaluating radiculopathy.
• Case example: A patient receives needle electromyography, each extremity, when evaluating radiculopathy. This service is billed using CPT code 95886.

Modifiers and tips

• −50 for bilateral injections (e.g., bilateral facet joint blocks). Many payers require separate units and −RT/−LT for each side instead of −50.
• Use −59 to denote separate procedures when injecting multiple levels or multiple regions.
• Document pain intensity, previous therapies, imaging guidance and patient response.

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42. Dermatopathology (a subspecialty of pathology and dermatology)

Dermatopathologists interpret skin biopsies and correlate clinical information with histology.

Common CPT codes

• 88305 – Surgical pathology examination of skin biopsy. Use 88304 for less complex specimens (e.g., nail plate) and 88307 for complex specimens (e.g., skin flap).
• Case example: A patient receives surgical pathology examination of skin biopsy. Use 88304 for less complex specimens (e.g., nail plate) and 88307 for complex specimens (e.g., skin flap). This service is billed using CPT code 88305.
• 88341–88344 – Immunohistochemistry; each antibody. Used to identify markers for melanoma or inflammatory dermatoses.
• Case example: A patient receives immunohistochemistry; each antibody. Used to identify markers for melanoma or inflammatory dermatoses. This service is billed using CPT code 88341–88344.
• 88346/88350 – Frozen section during Mohs surgery to evaluate margins.
• Case example: A patient receives frozen section during Mohs surgery to evaluate margins. This service is billed using CPT code 88346/88350.
• 88360/88361 – Morphometric analysis using digital techniques for melanoma staging.
• Case example: A patient receives morphometric analysis using digital techniques for melanoma staging. This service is billed using CPT code 88360/88361.

Modifiers and tips

• −26/−TC for professional and technical components; labs may bill technical component separately.
• Coordinate with dermatologists to ensure correlation between clinical and histologic findings.

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43. Occupational Medicine

Occupational medicine physicians focus on work‑related injuries, illnesses and disability management.

Common CPT codes

• 99202–99215 – E/M visits for work‑related illnesses or injuries.
• Case example: A patient receives e/M visits for work‑related illnesses or injuries. This service is billed using CPT code 99202–99215.
• 99455/99456 – Work related or medical disability evaluation services; includes evaluation of claimant, history, exam and completion of documentation for workers’ compensation. 99456 includes impairment rating.
• Case example: A patient receives work related or medical disability evaluation services; includes evaluation of claimant, history, exam and completion of documentation for workers’ compensation. 99456 includes impairment rating. This service is billed using CPT code 99455/99456.
• 99358/99359 – Prolonged services without direct patient contact; used for reviewing extensive records for occupational evaluations.
• Case example: A patient receives prolonged services without direct patient contact; used for reviewing extensive records for occupational evaluations. This service is billed using CPT code 99358/99359.
• 96110/96160 – Developmental or risk assessments for workers (e.g., baseline mental health screening).
• Case example: A patient receives developmental or risk assessments for workers (e.g., baseline mental health screening). This service is billed using CPT code 96110/96160.
• 97535 – Self‑care/home management training; used for ergonomic and safety training.
• Case example: A patient receives self‑care/home management training; used for ergonomic and safety training. This service is billed using CPT code 97535.

Modifiers and tips

• Document employer information, incident reports and work restrictions to support workers’ compensation claims.
• Use −25 when performing procedures like joint injections or wound suturing in addition to evaluation.

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44. Addiction Medicine

Addiction medicine specialists manage substance use disorders and provide medication‑assisted treatment (MAT).

Common CPT codes

• 99202–99215 – E/M visits for assessment, induction and maintenance of MAT.
• Case example: A patient receives e/M visits for assessment, induction and maintenance of MAT. This service is billed using CPT code 99202–99215.
• 99408/99409 – Alcohol and/or substance abuse structured screening and brief intervention services; 15 and 30 minutes respectively.
• Case example: A patient receives alcohol and/or substance abuse structured screening and brief intervention services; 15 and 30 minutes respectively. This service is billed using CPT code 99408/99409.
• H0020 (HCPCS) – Alcohol and/or drug services, methadone administration and/or counseling. Often billed in addition to evaluation services.
• 80305/80306/80307 – Drug test(s), presumptive, by direct optical observation or instrumented chemistry analyzers. Bill per patient encounter; includes sample validation.
• Case example: A patient receives drug test(s), presumptive, by direct optical observation or instrumented chemistry analyzers. Bill per patient encounter; includes sample validation. This service is billed using CPT code 80305/80306/80307.
• G2086/G2087/G2088 – Office‑based treatment for opioid use disorder; covers monthly treatment (70 minutes initial, 60 minutes subsequent and 120 minutes group sessions).
• Case example: A patient receives office‑based treatment for opioid use disorder; covers monthly treatment (70 minutes initial, 60 minutes subsequent and 120 minutes group sessions). This service is billed using CPT code G2086/G2087/G2088.
• H0015 (HCPCS) – Alcohol and/or drug services, intensive outpatient treatment.

Modifiers and tips

• Use −25 with E/M codes when billing for substance use screening or counseling separately.
• Document patient consent, treatment plan, urine drug screens and counseling sessions to support MAT billing.

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45. Chiropractic Medicine

Chiropractors diagnose and treat neuromusculoskeletal disorders using manual adjustments and manipulative therapy.

Common CPT codes

• 98940 – Chiropractic manipulative treatment (CMT); one to two spinal regions. 98941 for three to four regions and 98942 for five regions.
• Case example: A patient receives chiropractic manipulative treatment (CMT); one to two spinal regions. 98941 for three to four regions and 98942 for five regions. This service is billed using CPT code 98940.
• 97140 – Manual therapy techniques (e.g., myofascial release) per 15 minutes.
• Case example: A patient receives manual therapy techniques (e.g., myofascial release) per 15 minutes. This service is billed using CPT code 97140.
• 97014/97035 – Electrical stimulation/ultrasound therapy; modalities used adjunctively.
• Case example: A patient receives electrical stimulation/ultrasound therapy; modalities used adjunctively. This service is billed using CPT code 97014/97035.
• 97124 – Massage therapy; one or more areas, per 15 minutes.
• Case example: A patient receives massage therapy; one or more areas, per 15 minutes. This service is billed using CPT code 97124.
• 99202–99215 – E/M codes when chiropractors perform evaluation beyond manipulation (depending on scope of practice in state). Many payers restrict E/M billing by chiropractors.
• Case example: A patient receives e/M codes when chiropractors perform evaluation beyond manipulation (depending on scope of practice in state). Many payers restrict E/M billing by chiropractors. This service is billed using CPT code 99202–99215.

Modifiers and tips

• Use AT modifier (Acute Treatment) for spinal manipulations deemed medically necessary by Medicare.
• −59 for distinct procedures when manual therapy is provided separately from chiropractic adjustment.
• Document subluxation and objective findings (e.g., range of motion, palpation) to justify manipulation.

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46. Hospice and Palliative Medicine

Providers in palliative care and hospice manage symptoms and improve quality of life for patients with serious illnesses.

Common CPT codes

• 99324–99337 – Domiciliary or rest home visits; appropriate when patients reside in assisted living facilities.
• Case example: A patient receives domiciliary or rest home visits; appropriate when patients reside in assisted living facilities. This service is billed using CPT code 99324–99337.
• 99341–99350 – Home visits for palliative care; code selection based on time and complexity.
• Case example: A patient receives home visits for palliative care; code selection based on time and complexity. This service is billed using CPT code 99341–99350.
• 99497/99498 – Advance care planning; includes counseling about end‑of‑life decisions and completion of advance directives.
• Case example: A patient receives advance care planning; includes counseling about end‑of‑life decisions and completion of advance directives. This service is billed using CPT code 99497/99498.
• 99358/99359 – Prolonged services without direct patient contact; covers review of records and coordination with other providers.
• Case example: A patient receives prolonged services without direct patient contact; covers review of records and coordination with other providers. This service is billed using CPT code 99358/99359.
• 99483 – Cognitive assessment and care planning; can apply for dementia or other neurologic conditions requiring palliative management.
• Case example: A patient receives cognitive assessment and care planning; can apply for dementia or other neurologic conditions requiring palliative management. This service is billed using CPT code 99483.
• 99377/99378 – Supervision of hospice care, 15–29 minutes (99377) or 30 minutes or more (99378) per month.
• Case example: A patient receives supervision of hospice care, 15–29 minutes (99377) or 30 minutes or more (99378) per month. This service is billed using CPT code 99377/99378.
• G0181/G0182 (HCPCS) – Home health and hospice supervision by a physician; covers certification and care plan oversight.

Modifiers and tips

• Use −25 when performing procedures such as paracentesis or wound debridement during palliative visits.
• Document goals of care, symptom management and family meetings to support advance care planning codes.
• Hospice supervision codes (G0182) require at least 30 minutes of care plan oversight per month.

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47. Preventive Medicine / Public Health

Preventive medicine specialists work on population health, disease prevention and health promotion. In clinical practice, preventive medicine codes often overlap with family medicine.

Common CPT codes

• 99381–99387 – Preventive visit for new patients; age‑specific (infant to 65+). 99391–99397 for established patients.
• Case example: A patient receives preventive visit for new patients; age‑specific (infant to 65+). 99391–99397 for established patients. This service is billed using CPT code 99381–99387.
• 99401–99404 – Preventive counseling or risk factor reduction interventions; 15 to 60 minutes. Examples include smoking cessation, exercise counseling or nutritional counseling.
• Case example: A patient receives preventive counseling or risk factor reduction interventions; 15 to 60 minutes. Examples include smoking cessation, exercise counseling or nutritional counseling. This service is billed using CPT code 99401–99404.
• 99406/99407 – Smoking and tobacco cessation counseling; may be used in preventive visits.
• Case example: A patient receives smoking and tobacco cessation counseling; may be used in preventive visits. This service is billed using CPT code 99406/99407.
• 96160/96161 – Risk assessment instruments; used to screen for depression, substance use or social determinants of health.
• Case example: A patient receives risk assessment instruments; used to screen for depression, substance use or social determinants of health. This service is billed using CPT code 96160/96161.
• 99490 – Chronic care management; important for public health programs managing high‑risk populations.
• Case example: A patient receives chronic care management; important for public health programs managing high‑risk populations. This service is billed using CPT code 99490.
• G0442/G0443 (HCPCS) – Annual alcohol misuse screening (15 minutes) and counseling (15 minutes) for Medicare beneficiaries.

Modifiers and tips

• Preventive visits should not be billed on the same day as problem‑oriented visits unless both services are documented separately and justify using −25 on the E/M code.
• Risk assessments (96160/96161) require documentation of instrument used and results.

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48. Oral and Maxillofacial Surgery

Oral and maxillofacial surgeons treat diseases, injuries and defects involving the mouth, jaw and face. They perform both dentoalveolar and facial surgeries.

Common CPT codes

• 21470 – Open treatment of mandibular fracture; including internal fixation. 21465 for closed treatment.
• Case example: A patient receives open treatment of mandibular fracture; including internal fixation. 21465 for closed treatment. This service is billed using CPT code 21470.
• 21195 – Reconstruction of mandibular rami and/or body, sagittal split; can be part of orthognathic surgery.
• Case example: A patient receives reconstruction of mandibular rami and/or body, sagittal split; can be part of orthognathic surgery. This service is billed using CPT code 21195.
• 21246 – Reconstruction of midface fractures (Le Fort I) with bone grafts.
• Case example: A patient receives reconstruction of midface fractures (Le Fort I) with bone grafts. This service is billed using CPT code 21246.
• 21248/21249 – Reconstruction of mandible or maxilla, endosteal implant, partial or complete.
• Case example: A patient receives reconstruction of mandible or maxilla, endosteal implant, partial or complete. This service is billed using CPT code 21248/21249.
• 41899 – Unlisted procedure, dentoalveolar structures; used when there is no specific code for dental surgery (requires detailed description and documentation).
• Case example: A patient receives unlisted procedure, dentoalveolar structures; used when there is no specific code for dental surgery (requires detailed description and documentation). This service is billed using CPT code 41899.
• 21031/21032 – Excision of benign tumor or cyst of maxilla; partial or complete.
• Case example: A patient receives excision of benign tumor or cyst of maxilla; partial or complete. This service is billed using CPT code 21031/21032.

Modifiers and tips

• −51 for multiple facial bone procedures during the same session.
• Provide operative reports, radiographs and pathology results to substantiate unlisted code 41899.
• Coordinate benefits with dental insurance when procedures are dental in nature; some codes may fall under CDT (dental codes) rather than CPT.

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49. Otolaryngic Allergy (Subspecialty combining ENT and allergy)

This subspecialty focuses on allergic conditions affecting the ear, nose and throat. Codes overlap with ENT and allergy/immunology.

Common CPT codes

• 95004/95024 – Percutaneous and intradermal allergy tests (see Allergy section). Used to diagnose allergic rhinitis and food allergies.
• Case example: A patient receives percutaneous and intradermal allergy tests (see Allergy section). Used to diagnose allergic rhinitis and food allergies. This service is billed using CPT code 95004/95024.
• 95165 – Preparation of allergen immunotherapy; multidose vials.
• Case example: A patient receives preparation of allergen immunotherapy; multidose vials. This service is billed using CPT code 95165.
• 95115/95117 – Injection of allergenic extracts.
• Case example: A patient receives injection of allergenic extracts. This service is billed using CPT code 95115/95117.
• 31231 – Nasal endoscopy to evaluate chronic rhinosinusitis or nasal polyps.
• Case example: A patient receives nasal endoscopy to evaluate chronic rhinosinusitis or nasal polyps. This service is billed using CPT code 31231.
• 30140 – Turbinate reduction for chronic nasal obstruction.
• Case example: A patient receives turbinate reduction for chronic nasal obstruction. This service is billed using CPT code 30140.

Modifiers and tips

• Use −25 when performing E/M visits along with allergy testing.
• Document testing results, allergen mix and dosing schedule when preparing immunotherapy vials.

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50. Critical Care Medicine

Critical care physicians manage patients with life‑threatening illness or injury requiring intensive care and high complexity decision‑making.

Common CPT codes

• 99291 – Critical care, first 30–74 minutes. Use when providing direct bedside care to unstable patients requiring continuous monitoring and high complexity decision‑making.
• Case example: A patient receives critical care, first 30–74 minutes. Use when providing direct bedside care to unstable patients requiring continuous monitoring and high complexity decision‑making. This service is billed using CPT code 99291.
• 99292 – Each additional 30 minutes of critical care beyond the first 74 minutes.
• Case example: A patient receives each additional 30 minutes of critical care beyond the first 74 minutes. This service is billed using CPT code 99292.
• 99466/99467 – Critical care services for pediatric patients transported by ambulance; includes initial and subsequent 30 minutes.
• Case example: A patient receives critical care services for pediatric patients transported by ambulance; includes initial and subsequent 30 minutes. This service is billed using CPT code 99466/99467.
• 94060 – Evaluation of ventilatory response to hypercapnia or hypoxia; used in mechanical ventilation management.
• Case example: A patient receives evaluation of ventilatory response to hypercapnia or hypoxia; used in mechanical ventilation management. This service is billed using CPT code 94060.
• 36556 – Insertion of non‑tunneled centrally inserted central venous catheter (CVC) for patients requiring vasopressors.
• Case example: A patient receives insertion of non‑tunneled centrally inserted central venous catheter (CVC) for patients requiring vasopressors. This service is billed using CPT code 36556.
• 36620 – Arterial line insertion for continuous blood pressure monitoring.
• Case example: A patient receives arterial line insertion for continuous blood pressure monitoring. This service is billed using CPT code 36620.
• 92950 – Cardiopulmonary resuscitation (CPR) as part of critical care services.
• Case example: A patient receives cardiopulmonary resuscitation (CPR) as part of critical care services. This service is billed using CPT code 92950.
• 94002/94004 – Ventilator management for patients under one year and over one year of age.
• Case example: A patient receives ventilator management for patients under one year and over one year of age. This service is billed using CPT code 94002/94004.

Modifiers and tips

• Critical care time must be continuous or aggregated over the same date of service; do not count time spent on separately billable procedures.
• Procedures performed during critical care (e.g., central line insertion, intubation) should be billed separately and not included in critical care time.
• Document start and stop times, condition of patient and interventions to support critical care billing.

Summary and Best Practices for New Providers

CPT coding is a language that communicates the services provided by health‑care professionals. Mastery of CPT codes requires understanding both the specific procedures performed and the context in which they occur. New providers should follow these best practices:

1. Know your specialty’s common codes – Each field has a handful of high‑volume codes. Familiarize yourself with them and consult specialty billing guides or mentors.

1. Document thoroughly – Payers require documentation of history, examination, medical decision‑making, time spent and procedures performed. Proper documentation supports the CPT code selected and any modifiers attached.

1. Use modifiers wisely – Modifiers such as −25, −59 and −51 explain unusual circumstances or multiple procedures. Incorrect modifier usage can result in claim denials or underpayment.

1. Stay updated – CPT codes and guidelines change annually. The AAFP notes that the CPT Editorial Panel revised E/M guidelines in 2021 and expanded changes in 2023. Keep current with updates to avoid coding based on outdated rules.

1. Check payer policies – Insurance carriers and government programs have specific billing policies. For example, CMS guidance on allergy immunotherapy limits the number of doses billed under CPT 95165 and requires separate injection codes.

1. Seek expert help – Medical billing and coding organizations, such as the AAFP and specialty societies, publish detailed guides and FAQs (e.g., the AAFP’s evaluation and management FAQs). These resources help new providers avoid common pitfalls and reduce audit risk.

By understanding these fundamentals and referring back to this guide for specialty‑specific codes, providers can accurately bill for services, reduce claim denials and keep their practices financially healthy.

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