Primary Care Procedure Code Guide

All Categories

Click any card to explore codes, billing rules, required diagnoses, and visual diagrams.

🩺

Office E&M

Outpatient evaluation & management visits. Core of primary care billing — time or MDM based.

99202–99215 · G2211

💉

Injections

Therapeutic drug injections — steroids, B12, NSAIDs, joint aspiration. Always J-code + admin.

J-codes · 96372 · 20610

🛡️

Vaccines

Influenza, PPD, allergy testing. Vaccine product code + administration code always required.

90653–90688 · G0008 · 90471

📋

Care Management

APCM ★2025, CCM, TCM, PCM, ACP — high-value monthly services. APCM tiered by # of chronic diagnoses — no time minimum.

G0556 · G0557 · G0558 APCM · 99490 CCM · 99495–99496 TCM

📅

Annual Wellness

Medicare AWV, IPPE, preventive counseling. 100% covered by Medicare Part B — no cost share.

G0402 · G0438 · G0439

🏃

Preventive Physicals

Age-stratified preventive exams for commercial insurance. NOT for Medicare patients.

99384–99387 · 99394–99397

🏥

Hospital E&M

Inpatient, nursing facility, critical care, discharge management, and ER visit codes.

99221–99239 · 99291–99292

🔬

Diagnostic Procedures

In-office diagnostics — EKG, PFT, POC labs, CGM, UA, pregnancy test, ear wax removal.

93000 · 94060 · 81000 · 87880+

❤️

Cardiology / Vascular

Echo, Holter, stress tests, Doppler studies, cath lab procedures, device interrogation/programming.

93000–93925 · 78452 · 92920+

⚙️

Misc & Admin

Telehealth audio-only, behavioral counseling, quality measures, ER visits, capitation.

98012 · G0447 · 99407 · QMs

MDM Level Quick Reference

E&M level is set by Total Time OR Medical Decision Making — 2 of 3 MDM elements must be met.

99202 / 99212

Straightforward MDM

1 self-limited/minor problem
Minimal or no data reviewed
Minimal risk (OTC meds only)
Example: URI, minor rash, refill

99203 / 99213

Low MDM

2+ self-limited OR 1 stable chronic
Limited data (order/review 1 test)
Low risk (Rx meds, no surgery)
Example: stable HTN, DM follow-up

99204 / 99214

Moderate MDM

1+ chronic w/ exacerbation or new Dx
Review external records, test results
Mod risk (Rx w/ intensive monitoring)
Example: uncontrolled DM, CHF flare

99205 / 99215

High MDM

1+ chronic with severe threat to life
Extensive data / independent interpretation
High risk (hospitalization, drug therapy)
Example: new cancer, PE, ACS, DKA

📂

All Procedure Codes

Every CPT/HCPCS code from your file — use filters and search to narrow down

Category: Type: 243 codes

Complete Procedure Code Reference

CPT / HCPCS	Description	Category	Patient Type	Payer	Admin Code Needed	Key Notes

🩺

Office E&M Visits

Outpatient evaluation and management — the most-billed category in primary care

📊 E&M Code Selection — Visual Decision Flow

📋 Billing Requirements

Bill by Total Time OR MDM — choose the one that supports the higher level
New patient = no professional relationship in past 3 years
Time = ALL face-to-face + non-face-to-face work on date of service
Document start/stop time if billing by time
Add G2211 for Medicare primary care continuity (not with AWV)

🚫 Common Denials

Upcoding without documented MDM elements
Billing new pt code for established patient
Same-day E&M + procedure without Modifier -25
Missing date or rendering provider signature
G2211 billed with AWV same day

Office E&M Codes

CPT	Description	Type	Time (min)	MDM Level	Diagnosis Examples	Key Note
99202	New Patient Level 2	New	15–29	Straightforward	Z00.00, N39.0, J06.9	Rarely used — very low complexity only
99203	New Patient Level 3	New	30–44	Low	I10, E11.9, J45.909	Stable chronic condition, first visit
99204	New Patient Level 4	New	45–59	Moderate	E11.65, I50.9, F32.9	Most common new pt code in primary care
99205	New Patient Level 5	New	60–74	High	C18.9, I26.99, E10.10	Complex multi-problem new patients
99211	Est. Patient Level 1	Est.	<10	None required	Z09, R03.0	BP check, nurse visit — PA typically should not bill
99212	Est. Patient Level 2	Est.	10–19	Straightforward	J06.9, L70.0, R05.9	Simple med refill, minor complaint
99213	Est. Patient Level 3	Est.	20–29	Low	I10, E11.9, E78.5	Stable chronic disease follow-up
99214	Est. Patient Level 4	Est.	30–39	Moderate	E11.65, I50.9, J44.1	Most common established pt code; multiple problems
99215	Est. Patient Level 5	Est.	40–54	High	I26.99, C18.9, E87.6	High complexity; drug therapy review, near hospitalization
G2211	Visit Complexity Add-on	Medicare	—	—	Any primary dx	Add to 99202–99215; Medicare only; ongoing relationship; cannot bill with AWV

💉

Injections

Always requires J-code (drug) + administration code — document both

📊 Injection Billing — What to Bill & When

📋 Billing Requirements

Always bill BOTH: J-code (drug) + admin code (96372 IM/SQ or 96374 IV)
Joint injections (20610/20612): NO separate admin code — it's included
Document: drug name, dose, route, site, lot #, expiration date
Prior auth often required for biologics (J0897 Prolia, J2785 Lexiscan)
Bill J-codes in UNITS as specified — J1010 = per 1 mg, bill 40 units for 40 mg dose

🚫 Common Denials

Missing J-code — billing admin 96372 without drug code
Wrong units on J-code (e.g., billing 1 unit of J1010 for 40 mg dose)
No prior auth for Prolia — requires DXA and osteoporosis diagnosis
E&M billed same day without Modifier -25
Drug not purchased/administered in-office (buy-and-bill issue)

Injection J-Codes & Admin Codes

Code	Drug / Procedure	Unit	Route	Admin Code	Diagnosis	Key Note
J1100	Dexamethasone sodium phosphate	per 1 mg	IM/IV	96372/96374	J30.9, M75.5	Anti-inflammatory; allergic reactions, respiratory
J1010	Methylprednisolone acetate (Depo-Medrol)	per 1 mg	IM	96372	M25.9, M79.3	Bill units = mg administered (40mg=40 units)
J1030	Methylprednisolone acetate 40 mg	40 mg vial	IM	96372	M25.9, M79.3	Fixed-dose; joint and soft tissue injections
J2919	Methylprednisolone sodium succinate (Solu-Medrol)	per 5 mg	IV/IM	96374	J45.9, M79.3	IV formulation; acute inflammatory/asthma
J1885	Ketorolac tromethamine (Toradol)	per 15 mg	IM/IV	96372/96374	G89.29, M79.3	NSAID; acute pain; avoid >5 consecutive days
J3420	Vitamin B12 (Cyanocobalamin) up to 1000 mcg	per injection	IM	96372	D51.9, D51.0	B12 deficiency, pernicious anemia
J0897	Denosumab (Prolia) 1 mg	per 1 mg	SQ	96372	M81.0, M85.80	Prior auth required; bill 60 units for 60 mg dose
J0280	Aminophylline	per injection	IV	96374	J45.9, J44.1	Bronchospasm; rarely used currently
J0696	Ceftriaxone sodium 250 mg	per 250 mg	IM	96372	A54.01, L03.011	STI treatment, cellulitis, wound infection
J2785	Lexiscan (Regadenoson) 0.1 mg	per 0.1 mg	IV	96374	Z13.6	Pharmacologic stress agent for nuclear stress test
J1245	Persantine (Dipyridamole) 10 mg	per 10 mg	IV	96374	Z13.6	Alternative pharmacologic stress agent
96372	Injection Admin — IM or SQ	per injection	IM/SQ	—	Any	Admin code only; always pair with J-code
96374	Injection Admin — IV push	per injection	IV	—	Any	Admin code only; always pair with J-code
20610	Aspiration/Injection — shoulder, hip, knee	per joint	Intra-articular	Included	M25.461, M25.511	Document joint, laterality, needle size
20612	Aspiration/Injection — ganglion cyst	per procedure	Percutaneous	Included	M67.441	Document cyst location, size, aspirated volume
86580	PPD Tuberculin Test	per test	Intradermal	—	Z11.1	Result read 48–72 hrs; document mm of induration

🛡️

Vaccines & Immunizations

Always bill product code + admin code — Medicare flu uses G0008 instead of 90471

📊 Vaccine Billing Structure

Vaccine & Immunization Codes

Code	Vaccine	Age	Admin Code	Payer	Diagnosis	Note
90653	Fluad High-Dose Adjuvanted Flu	65+	90471 or G0008	All	Z23	Preferred for Medicare 65+
90656	Afluria PFS (preservative-free)	≥3 yrs	90471 or G0008	All	Z23	Standard adult flu; no thimerosal
90658	Afluria Multi-dose vial	≥3 yrs	90471 or G0008	All	Z23	Contains thimerosal; lower cost
90661	Flucelvax (cell-based) PFS	≥4 yrs	90471 or G0008	All	Z23	Use for egg allergy patients
90686	Afluria Quadrivalent	≥3 yrs	90471 or G0008	All	Z23	4-strain coverage; standard adult
90688	Afluria Influenza Virus Vaccine	≥3 yrs	90471 or G0008	All	Z23	Quadrivalent alternative
Q2038	Fluzone (Medicare-specific)	≥3 yrs	G0008	Medicare only	Z23	Use with G0008 only; 100% covered
G0008	Medicare Flu Vaccine Administration	Any	—	Medicare only	Z23	Replaces 90471 for Medicare flu only
90471	Immunization Administration — 1st vaccine	Any	—	Commercial	Z23	+90472 for each additional same-visit vaccine
86580	PPD Tuberculin Skin Test	Any	Included	All	Z11.1	Read 48–72 hrs; document induration in mm
95004	Allergy Skin Testing (prick/puncture)	Any	Included	All	J30.1, L50.0	Bill per number of tests; document panel

📋

Care Management Services

CCM, TCM, PCM, APCM, ACP — high-value monthly services with strict documentation requirements

📊 Care Management Service Types — At a Glance

★ 2025 NEW CODE

Advanced Primary Care Management (APCM) — G0556, G0557, G0558

APCM is a new CMS program effective January 1, 2025 designed to replace and improve upon CCM for primary care settings. Unlike CCM, APCM is tiered by the number of chronic conditions, has no minimum monthly time requirement, requires no explicit patient consent (only notification), and allows electronic care plans. It rewards the value of primary care services rather than just time spent.

📊 APCM Code Selection — Based on Number of Chronic Diagnoses & QMB Status

📊 APCM vs. CCM — Side-by-Side Comparison

📋 APCM Billing Requirements — All Tiers

Patient must be attributed to the billing provider as their primary care provider (Medicare claims-based attribution)
Chronic condition(s) expected to last ≥12 months OR until death and place patient at significant risk
Electronic care plan created, accessible to care team and sharable with patient
24/7 access to care team for urgent care needs
Continuity of care with a designated member of the care team
Health IT used for care coordination (EHR with patient portal capability)
Transitional care management and follow-up after emergency visits
Patient notification only — no formal written consent required (unlike CCM)
Only ONE provider can bill APCM per patient per calendar month
Cannot bill APCM + CCM or APCM + PCM in same month

✅ APCM Chronic Condition Examples by Tier

G0556 — ≤1 chronic dx: Hypertension I10, Hypothyroidism E03.9, DM2 E11.9, GERD K21.0, Hyperlipidemia E78.5
G0557 — ≥2 chronic dx (non-QMB examples): HTN + DM, COPD + CHF, CKD + DM + HTN, Afib + HF + CKD
Conditions must be documented as active, ongoing problems — not resolved or historical
ICD-10 codes must be on the problem list in the EHR
Behavioral health counts: Depression F32.9, Anxiety F41.1, PTSD F43.10
Cancer (active), CKD N18.x, CHF I50.x, COPD J44.x all qualify

⚠️ APCM Decision-Making Tips

Count the number of active chronic conditions on the problem list to determine code tier
If patient has ≤1 chronic dx → G0556 | ≥2 chronic dx, not QMB → G0557 | ≥2 chronic dx + QMB → G0558
G0556/G0557/G0558 are monthly flat-rate codes — no add-on time codes exist for APCM
Document all care management activities: care coordination calls, care plan updates, referrals, medication reviews, patient outreach
APCM does NOT require documenting specific minutes — focus on documenting the services and activities performed
Can bill APCM and E&M in the same month — these are separate services
Can bill APCM and TCM in the same month if transitional event occurred
Review patient's attribution status — must be your attributed Medicare beneficiary

🚫 APCM Common Denial Reasons

Patient not attributed to billing provider as primary care — wrong provider billing
No electronic care plan documented in EHR or not accessible to patient
Billing G0557 or G0558 when patient only has ≤1 active chronic condition (should be G0556)
Billing G0556/G0557/G0558 + CCM (99490) in the same calendar month — mutually exclusive
Billing G0556/G0557/G0558 + PCM (99426) in the same calendar month — mutually exclusive
No documentation of care management activities performed during the month
Chronic conditions listed are resolved/historical — only active problems count
Two providers in same group both billing APCM for same patient same month

Care Management CPT Codes — Complete Reference

Code	Service	Time / Requirement	MDM	Chronic Dx Required	Reimbursement	Key Notes
G0556	APCMAPCM — ≤1 chronic condition	Monthly; no minimum time requirement	—	≤1 active chronic dx	Lower tier rate	Patient attributed as PCP; electronic care plan required; notification only (no written consent needed)
—	APCMNo add-on code — G0556 is a flat monthly rate	APCM G-codes are monthly flat rates; there are no separate add-on time codes for APCM
G0557	APCMAPCM — ≥2 chronic conditions (non-QMB)	Monthly; no minimum time requirement	—	≥2 active chronic dx, NOT QMB	Standard ≥2 dx rate	Document ≥2 active chronic conditions; verify patient is NOT a Qualified Medicare Beneficiary
G0558	APCM QMBAPCM — ≥2 chronic conditions + Qualified Medicare Beneficiary	Monthly; no minimum time requirement	—	≥2 active chronic dx + QMB status	Highest APCM rate	Patient must be verified QMB (Medicaid pays Medicare cost-sharing); confirm via eligibility check; highest reimbursement tier
CCM — Chronic Care Management
99490	Chronic Care Management — 20 min/month	20 min/mo clinical staff	—	≥2 chronic conditions	~$63/mo	Consent required; 1 provider/pt/month; structured care plan in EHR
99439	CCM Add-on — each additional 20 min	Each add'l 20 min same month	—	Same as 99490	Add-on	Add-on to 99490; up to 2 units per month; document additional time
99491	CCM — Physician/PA time 30 min	30 min physician/PA time	—	≥2 chronic conditions	~$84/mo	Physician or PA personally performs the 30 min (not delegated to staff)
G0506	CCM Enrollment / Initial Care Plan	Physician face-to-face	Moderate+	Same as CCM	One-time	One-time enrollment visit; comprehensive care plan creation
TCM — Transitional Care Management
99495	TCM — Face-to-face within 14 days	Contact <2 biz days; F2F ≤14 days	Moderate	Discharge diagnosis	~$165	Moderate MDM; medication reconciliation; bill month of F2F visit
99496	TCM — Face-to-face within 7 days	Contact <2 biz days; F2F ≤7 days	High	Discharge diagnosis	~$240	High MDM required; highest-value TCM; medication reconciliation
PCM — Principal Care Management
99426	Principal Care Management — 30 min/month (clinical staff)	30 min clinical staff/mo	—	1 complex chronic condition	~$75/mo	Specialist focus on 1 condition; cannot bill with CCM or APCM same month
99427	PCM Add-on — each additional 30 min	Each add'l 30 min same month	—	Same as PCM	Add-on	Add-on to 99426 (PCM); document additional clinical staff time
ACP & Other
99497	Advanced Care Planning — 30 min	30 min face-to-face	—	Z71.89 or principal dx	~$86	Voluntary; document discussion, patient wishes, surrogate decision maker
99498	ACP — each additional 30 min	Each add'l 30 min	—	Same as 99497	Add-on	Add-on to 99497; same visit; document additional discussion topics
99401	Preventive Counseling — 15 min	15 min face-to-face	—	Z71.89, Z13.88	~$27	Weight, tobacco, substance use risk reduction
99407	Tobacco Cessation — >10 min intensive	>10 min	—	F17.210	~$21	Medicare unlimited; document cessation plan, NRT/medications
99457	Remote Physiologic Monitoring — 20 min	20 min/mo interactive	—	I10, E11.9	~$50/mo	Device readings 16+ days/month required; interactive communication

🔀 APCM vs. CCM — Which Should I Bill?

1

Is the patient attributed to your practice as their primary care provider? If YES → APCM is an option. If NO → use CCM instead (APCM requires attribution)

↓

2

Count active chronic conditions on the problem list G0556 (≤1 chronic dx) | G0557 (≥2 dx, not QMB) | G0558 (≥2 dx + QMB status = highest rate)

↓

3

Do you have an electronic care plan in the EHR accessible to the patient? Required for APCM. Unlike CCM, can be any format — printed summary, patient portal access OK

↓

4

Does your practice provide 24/7 care team access and health IT? Patient must be able to reach care team at all times; EHR with patient communication tools required

↓

✓

Bill APCM — G0556, G0557, or G0558 — document care activities (no time tracking required) Examples: care coordination calls, care plan updates, specialist referrals, medication review, patient outreach, post-ED follow-up

📅

Annual Wellness Visits

Medicare-specific preventive visits — 100% covered, distinct from physicals

📊 Medicare Wellness Visit Progression

📋 Required AWV Components

Health Risk Assessment (HRA) questionnaire
Medical and family history review
Current providers and medications list
Height, weight, BMI, blood pressure
Cognitive assessment (Mini-Cog, MMSE, or equivalent)
Depression screening (PHQ-2 / PHQ-9)
Personalized Prevention Plan of Service (PPPS)
Referrals for age-appropriate screenings

🚫 Common Denials

G0438 billed too soon (<12 months after prior AWV)
Missing HRA or PPPS documentation
G0402 billed past first 12 months of Part B
E&M billed same day without Modifier -25 and separate diagnosis
G2211 billed on same date as AWV

Annual Wellness & Preventive Codes

Code	Service	Frequency	Patient	Diagnosis	Key Notes
G0402	Welcome to Medicare IPPE	Once (first 12 mo of Part B)	Medicare new	Z00.00	Includes EKG G0403; no cost-share
G0403	EKG for Medicare IPPE	Once (with G0402)	Medicare new	Z13.6	Performed and interpreted by physician at IPPE visit
G0438	Annual Wellness Visit — Initial	Once (after IPPE)	Medicare est.	Z00.00	First AWV; comprehensive PPPS required
G0439	Annual Wellness Visit — Subsequent	Annually (≥12 mo after prior)	Medicare est.	Z00.00	Every year; update PPPS; no cost-share
G0101	Cervical/Vaginal Screening Pelvic & Breast Exam	Every 2–3 years	Female Medicare	Z12.4	Medicare preventive; can be done with AWV
G0102	Prostate Cancer Screening (DRE)	Annually	Male Medicare 50+	Z12.5	DRE only; PSA billed separately
G0447	Obesity Behavioral Counseling — 15 min	Monthly	BMI ≥30	E66.09	Document BMI, counseling content, goals set
G0179	Home Health Re-certification	Per cert period	Medicare homebound	Homebound dx	Re-certifies home health plan of care
G0180	Home Health Initial Certification	Per new plan	Medicare homebound	Homebound dx	Initial certification; face-to-face encounter required

🏃

Preventive Physicals

Age-stratified for commercial insurance — NOT billable for Medicare patients

📊 Preventive Physical — Age Code Matrix

Preventive Physical Codes

CPT	Description	Age	Type	Payer	Diagnosis	Note
99384	Preventive Physical Exam	12–17 yrs	New	Commercial	Z00.129	Comprehensive H&P + age-appropriate counseling
99385	Preventive Physical Exam	18–39 yrs	New	Commercial	Z00.00	Reproductive health, STI screening, lifestyle
99386	Preventive Physical Exam	40–64 yrs	New	Commercial	Z00.00	Cancer screenings, cardiac risk, DM screening
99387	Preventive Physical Exam	65+ yrs	New	Commercial	Z00.00	Falls risk, cognitive, polypharmacy review
99394	Preventive Physical Exam	12–17 yrs	Est.	Commercial	Z00.129	Established adolescent; same components as 99384
99395	Preventive Physical Exam	18–39 yrs	Est.	Commercial	Z00.00	Most commonly billed physical in young adults
99396	Preventive Physical Exam	40–64 yrs	Est.	Commercial	Z00.00	Most common physical in primary care overall
99397	Preventive Physical Exam	65+ yrs	Est.	Commercial	Z00.00	For commercial seniors; use G0439 for Medicare
Q0091	Pap Smear Collection by Physician	Any female	Both	Medicare	Z12.4	Collection code; 88150 for cytology reading
88150	Pap Smear — Cytology	Any female	Both	All	Z12.4	Pathology reading; often sent to lab

🏥

Hospital & Facility E&M

Inpatient, nursing facility, critical care, discharge, and emergency department visits

📊 Hospital E&M — Setting & Code Map

Hospital & Facility E&M Codes

CPT	Service	Setting	Time/MDM	Diagnosis	Key Note
99221	Initial Hospital — Low	Inpatient	Low / 40 min	Admit dx	Comprehensive H&P required for all initial
99222	Initial Hospital — Moderate	Inpatient	Mod / 55 min	Admit dx	Most common initial hospital code
99223	Initial Hospital — High	Inpatient	High / 75 min	Admit dx	Sepsis, CHF exacerbation, DKA, PE
99231	Subsequent Hospital — Low	Inpatient	Low / 25 min	Admit dx	Stable, recovering patient rounds
99232	Subsequent Hospital — Moderate	Inpatient	Mod / 35 min	Admit dx	Most common subsequent code
99233	Subsequent Hospital — High	Inpatient	High / 50 min	Admit dx	Deteriorating patient; new significant problem
99238	Hospital Discharge — ≤30 min	Inpatient	≤30 min	Discharge dx	Document time; discharge instructions, follow-up
99239	Hospital Discharge — >30 min	Inpatient	>30 min	Discharge dx	Complex discharge; carefully document time
99291	Critical Care — 30–74 min	ICU/ED	30–74 min	Critical dx	Life-threatening; direct management only
99292	Critical Care — each add'l 30 min	ICU/ED	+30 min	Critical dx	List separately; document total time
99305	Initial NF — Moderate	SNF/NF	Mod / 35 min	NF dx	Comprehensive assessment; functional status
99306	Initial NF — High	SNF/NF	High / 45 min	NF dx	Complex NF admit; multi-problem
99308	Subsequent NF — Straightforward	SNF/NF	SF / 15 min	NF dx	Routine rounds; stable patient
99309	Subsequent NF — Low	SNF/NF	Low / 25 min	NF dx	Minor interval changes
99315	NF Discharge — ≤30 min	SNF/NF	≤30 min	Discharge dx	Short NF discharge
99316	NF Discharge — >30 min	SNF/NF	>30 min	Discharge dx	Complex NF discharge; extensive instructions
99283	ER Visit — Expanded Moderate	ED	Moderate MDM	Chief complaint	Mid-acuity; expanded H&P, moderate decision-making
99284	ER Visit — Detailed Moderate	ED	Mod-High MDM	Chief complaint	High acuity; detailed H&P, multi-problem

🔬

In-Office Diagnostic Procedures

EKG, PFT, POC labs, CGM — CLIA compliance required for laboratory testing

📊 EKG Billing (93000 vs 93010 vs G0403)

📊 CLIA Waiver Requirements

📊 PFT (94060) — What's Required & What It Shows

Diagnostic Procedure Codes

Code	Test	CLIA	Diagnosis	Key Billing Note
93000	EKG with Interpretation (12-lead)	None	R07.9, R00.2, I10	Both tracing AND interpretation; document findings in note
93010	EKG Interpretation Only	None	R07.9, R00.2	Use when EKG done elsewhere; you interpret the strip
93040	Rhythm Strip	None	R00.1, R55	Single-lead or telemetry strip; document indication and interpretation
94060	Pulmonary Function Test — Spirometry	None	J44.1, J45.909, R06.00	Pre + post-bronchodilator BOTH required; document tech quality grade
94664	Initial Inhalation Treatment (nebulizer)	None	J45.9, J44.1, R06.2	In-office nebulizer treatment; document pre/post assessment
87880	Rapid Strep Test	Waiver	J02.0, J02.9	CLIA waiver required; document result and clinical decision taken
87804	Rapid Influenza Antigen	Waiver	J11.1, R50.9	CLIA waiver; specify A vs B if result available
87428	COVID + Influenza A&B Combo	Waiver	J11.1, U07.1	Combo POC; document all individual test results
87811	SARS-CoV-2 Antigen (direct visual)	Waiver	U07.1, Z11.59	Direct visual observation method; CLIA waiver required
87426	COVID Antigen Test	Waiver	U07.1	Single pathogen; separate from 87428 combo
81000	Urinalysis with Microscopy	Moderate	N39.0, R31.9	Requires moderate complexity CLIA certificate — not waiver
81002	Urinalysis Dipstick (no microscopy)	Waiver	N39.0, R30.0	Most common UA in primary care; dipstick only
81025	Urine Pregnancy Test	Waiver	Z34.00, N91.0	Qualitative hCG; document result in note
82948	Blood Glucose (Finger Stick)	Waiver	E11.9, R73.09	In-office glucose check; document clinical reason
82962	Glucose Test Strip	Waiver	E11.9	Home monitoring strip; rarely billed as separate line
85610	Prothrombin Time (PT/INR)	Waiver	Z79.01, D68.9	Anticoag monitoring; document current dose and target INR range
36415	Venipuncture (routine blood draw)	None	Any lab indication	Blood draw for lab send-out; bundled by some payers with E&M
69210	Ear Wax Removal (Cerumen Impaction)	None	H61.20	Document impaction and removal method (irrigation, curette, suction)
95250	CGM Sensor Placement & Setup	None	E11.9, E10.9	72-hour minimum; patient training required; document calibration
95251	CGM Monitoring Analysis & Report	None	E11.9, E10.9	Physician interpretation of CGM data; document changes to management
83014	H. pylori Drug Administration (breath test)	None	K25.9, K29.30	Urea breath test; document pre-test preparation (off PPI 2 weeks)
88150	Pap Smear (cytology reading)	None	Z12.4	Pathology reading; often sent to external lab

❤️

Cardiology & Vascular Procedures

Echo, Holter, stress tests, Doppler, cardiac cath, device interrogation and programming

📊 Cardiac Monitoring Codes — Duration & Type

Cardiology & Vascular CPT Codes

Code	Procedure	Type	Diagnosis	Key Note
93000	EKG with Interpretation (12-lead)	Diagnostic	R07.9, R00.2, I10	Complete code — tracing + interpretation
93010	EKG Interpretation Only	Diagnostic	R07.9	Interpretation of tracing done elsewhere
93040	Rhythm Strip (Telemetry)	Monitoring	R00.1, R55	Single-lead; document interpretation
93224	Holter 24-hr monitoring (complete)	Monitoring	R00.2, I48.0	Hook-up + recording + scanning + interpretation
93225	Holter 24-hr recording only	Monitoring	R00.2	Recording component; pair with 93226/93227
93242	Ext ECG 48hr–7d recording	Monitoring	R00.2, I48.19	Recording phase of extended monitoring
93244	Ext ECG 48hr–7d review & interpretation	Monitoring	R00.2, I48.19	Physician review & report
93245	Ext ECG 7–15d recording & scan	Monitoring	R00.2, R55	Extended duration monitoring
93246	Ext ECG 7–15d recording only	Monitoring	R00.2	Recording component
93247	Ext ECG 7–15d scan & auto report	Monitoring	R00.2	Tech scan; no physician interpretation
93248	Ext ECG 7–15d review & interpretation	Monitoring	R00.2	Physician review & signed report
93306	Echocardiogram — Complete (with Doppler)	Imaging	I50.9, I11.9, I34.0	M-mode + 2D + spectral + color Doppler
93312	Transesophageal Echo (TEE)	Imaging	I34.0, Q23.1	Requires sedation; document informed consent
93320	Cardiac Doppler	Imaging	I50.9, I34.0	Spectral Doppler; typically added to echo
93325	Color Flow Doppler	Imaging	I34.0, I35.0	Color mapping; typically add-on to echo
93015	Cardiovascular Stress Test — Complete	Functional	R07.9, I25.10, Z13.6	Physician supervision + interpretation included
93018	Stress Test — Interpretation only	Functional	R07.9, I25.10	Physician interprets study done elsewhere
78452	SPECT Myocardial Perfusion Imaging	Nuclear	I25.10, R07.9	Rest + stress; requires nuclear medicine facility
93880	Duplex Scan — Extracranial (Carotid)	Vascular	G45.9, I63.9, I65.2	Bilateral carotid ultrasound; document laterality
93886	Transcranial Doppler — Complete	Vascular	G45.9, I63.9	Intracranial arteries; document all vessels interrogated
93922	Upper/Lower Extremity Arterial — 2 levels (ABI)	Vascular	I73.9, E11.51, I70.2	Ankle-brachial index; document resting + exercise if done
93923	Lower Arterial Doppler	Vascular	I73.9, I70.2	Lower extremity arterial study
93925	Duplex Scan — Lower Extremity Arteries	Vascular	I73.9, I70.209	Bilateral; document segmental pressures and waveforms
93970	Duplex Scan — Lower Extremity Veins	Vascular	I82.401, I83.90	DVT evaluation; bilateral unless clinical indication
33285	ILR Implant (subcutaneous cardiac monitor)	Procedure	R00.2, R55, I48.0	Loop recorder insertion; requires EP training
93279	Re-program Single Lead Pacemaker	Device	Z95.0, I49.9	Interrogation + programming; document device settings
93280	Re-program Dual Lead Pacemaker	Device	Z95.0	Dual chamber programming evaluation
93281	Re-program Multiple Lead Pacemaker	Device	Z95.0	CRT-P device programming
93282	ICD Programming — Single Lead	Device	Z95.810, I49.01	Includes sensing, pacing, shock therapy parameters
93283	ICD Programming — Dual Lead	Device	Z95.810	Dual chamber ICD programming
93284	ICD Programming — Multiple Lead	Device	Z95.810	CRT-D device programming
93291	ILR Interrogation — In Person	Device	R00.2, R55	In-office loop recorder review + report
93292	Wearable Defibrillator Interrogation	Device	I42.9, Z95.810	In-person; LifeVest evaluation
93294	Remote Pacemaker Interrogation (90-day)	Device remote	Z95.0	Remote transmission review; 90-day window
93295	Remote ICD Interrogation (90-day)	Device remote	Z95.810	Remote ICD monitoring; 90-day interval
93296	Remote Pacemaker/ICD Tech Support (90-day)	Device remote	Z95.0, Z95.810	Technical support; no physician required
93297	Remote ICM Interrogation (30-day)	Device remote	I50.9, I48.0	Implantable cardiovascular monitor remote review
93298	Remote ILR Interrogation (30-day)	Device remote	R00.2, R55	Loop recorder remote monitoring; 30-day window
92920	PTCA — Single Coronary Artery	Interventional	I25.10, I21.4	Balloon angioplasty without stent
92928	Coronary Stent Placement — Single	Interventional	I25.10, I21.4	PCI with stent; most common coronary intervention
92929	Additional Coronary Branch Stent	Interventional	I25.10	Add-on to 92928 for additional vessel
92960	Cardioversion — Elective (DCCV)	Procedure	I48.0, I48.11	Electrical cardioversion; sedation required (99152)
93454	Coronary Angiography only	Diagnostic cath	I25.10, R07.9	Diagnostic coronary cath without LHC
93458	Coronary Angio + Left Heart Cath	Diagnostic cath	I25.10, I50.9	Most common diagnostic cath code
93459	Cath + LHC + Bypass Graft Angio	Diagnostic cath	I25.10, Z95.1	Includes native + graft vessels in CABG patients
93460	Coronary Angio + Right & Left Heart Cath	Diagnostic cath	I25.10, I50.9	Biventricular pressures + coronary angiography
76700	Abdominal Sonogram	Imaging	R10.9, K57.30	Complete abdomen US; document all organs evaluated
76706	Abdominal Aorta Screening (AAA)	Imaging	Z13.6	Medicare covers once for qualified patients; one-time
76770	Renal Sonogram	Imaging	N18.3, R31.9	Bilateral kidneys + bladder; document sizes
76775	Retroperitoneal US — Limited	Imaging	R19.09	Limited study; document structures evaluated
76937	Ultrasound Guidance — Vascular Access	Guidance	Any vascular access dx	Add-on; requires permanent image documentation
36005	Injection — Extremity Venography	Vascular	I82.401	Contrast injection for venography
36475	Endovenous Ablation — First Vein	Vascular	I83.90, I83.012	Radiofrequency ablation; first vein per extremity
36476	Endovenous Ablation — Add'l Vein	Vascular	I83.90	Add-on to 36475; each additional vein same extremity
92960	Cardioversion Elective	Procedure	I48.0	DCCV; document pre/post rhythm, energy used
92972	Coronary Lithotripsy (PTCL)	Interventional	I25.10	Shockwave lithotripsy for calcified lesions
99152	Moderate Sedation — same provider	Anesthesia	Any procedure dx	First 15 min; for DCCV, TEE; requires independent observer
99153	Moderate Sedation — each add'l 15 min	Anesthesia	Any procedure dx	Add-on to 99152
A9502	Myoview (technetium radiopharmaceutical)	Nuclear med	I25.10, R07.9	Radiopharmaceutical for nuclear stress/SPECT

⚙️

Miscellaneous & Administrative

Telehealth, behavioral counseling, quality measures, and administrative codes

Misc & Administrative Codes

Code	Service	Type	Diagnosis	Key Notes
98012	Audio-Only Telehealth — Straightforward MDM	Telehealth	Principal dx	Est. pt only; >10 min; document time + decisions; POS 02 or 10
98013	Audio-Only Telehealth — Low MDM	Telehealth	Principal dx	Est. pt only; low complexity; many payers restrict — verify
G0447	Obesity Behavioral Counseling — 15 min	Preventive	E66.09	Medicare; BMI ≥30 required; monthly; document goals
99407	Tobacco Cessation — Intensive (>10 min)	Counseling	F17.210	Medicare unlimited; document cessation plan, NRT/meds prescribed
99401	Preventive Counseling — 15 min	Counseling	Z71.89	Weight, substance use, lifestyle risk reduction; document topics covered
3074F	SBP <130 mmHg — Quality Measure	Quality	I10, E11.9	Category II CPT; MIPS reporting only; $0 payment
3078F	DBP <80 mmHg — Quality Measure	Quality	I10, E11.9	Category II CPT; MIPS reporting only; $0 payment
3079F	DBP 80–89 mmHg — Quality Measure	Quality	I10, E11.9	Category II CPT; MIPS reporting only; $0 payment
1111F	Medication Reconciliation — Quality Measure	Quality	Any discharge dx	Geriatric quality measure; MIPS reporting
95251	CGM Ambulatory Analysis (report)	Monitoring	E11.9, E10.9	Physician review of CGM data; document management changes
CAP	Capitation Payment	Admin	—	Per-member per-month managed care; not fee-for-service billing
INC	Incentive Payment	Admin	—	Internal tracking only — not a billable CPT code