Urgent Care CPT Codes Guide (2024)
Urgent Care Centers need to be operating at the elite level, ensuring accurate reimbursement and communication between healthcare providers and insurance companies for a start.
According to research, In 2024, urgent care clinics managed approximately 89 million patient visits, representing 29% of primary care visits and about 15% of outpatient visits in the U.S. The efficiency of these clinics is highlighted by the fact that over 70% of patients wait less than 20 minutes to see a provider, with 85% being treated within an hour.
So we’ve come up with a small guide on everything you need to know about Urgent Care CPT Coding.
Table of Contents
Understanding CPT Codes for Urgent Care
It is important to note that CPT codes are regularly updated to reflect advances in medical technology and changes in healthcare practices.
Staying up-to-date with these changes is crucial for accurate billing and avoiding potential reimbursement delays and for urgent care its no different.
CPT codes are a numerical system used for describing medical services and procedures. They are essential in urgent care settings for ensuring accurate and timely reimbursement from Medicare and private insurers. Correct application of these codes is critical to avoid denied claims and underpayment
Common Urgent Care CPT Codes
When it comes to urgent care CPT codes, there are specific codes that are commonly used to represent the services provided. These codes include but are not limited to:
- 99201-99205: Evaluation & Management of New Patients
- 99211-99215: Evaluation & Management of Established Patients
- 12001-13160: Wound Repair
- 10060-10180: Incision & Drainage
- 20525-20553: Foreign Body Removal
- 29000-29799: Splint and Cast Applications
These codes, along with many others, allow healthcare providers to accurately document the medical procedures performed in urgent care settings.
Exclusive ‘S’ Codes for Urgent Care
Both Urgent and Primary Care have been using Codes from Healthcare Common Procedure Coding System (HCPCS). These codes are denoted with the letter “S” and are as follows
The S9083 Code covers a fee for any services provided, operating on a global fee scale. This may require a hospital billing to use, the MCO’s playing a crucial part
The S9088 Code is used for the Evaluation & treatment of Medical conditions in conjunction with an E/M code. The code allows centers to be reimbursed for a portion of the increased cost of providing immediate care
Changes to Urgent Care CPT Codes in 2023
- Notable updates include a new prolonged services code 99417 for visits lasting over 59 minutes, revised office/outpatient E/M code descriptors, and changes in E/M code level selection based on medical decision-making or total time.
- Procedure code changes include revised wound repair codes, new codes for antibiotic and contrast injections, and updates for neurostimulator codes.
- In laboratory and diagnostic testing, new codes have been added for cell enumeration and genomic sequencing, along with revisions to microscopic urinalysis codes
Best Practices and Tips for Urgent Care Billing Codes
To optimize reimbursement and avoid denied claims, it’s essential to use the most specific and appropriate CPT codes. There may be cases that are extremely complex and require more knowledge as compared to more straightforward ones.
To save you money and do proper reimbursement, Using the most specific E/M code based on the case complexity is crucial. For instance, code 99205 for complex cases requiring comprehensive history, exams, and decision-making, and 99201 for minor conditions.
Another tip, would be the correct use of modifiers. Believe us, using the wrong ones can make claims extremely difficult. So we’d recommend the use of modifiers like 25 on E/M codes and 59 on procedure codes as essential to indicate distinct services.
Dr. Josh is a physician who's helping spread the knowledge about Telehealth and its advantages. At SmartClinix, he's providing his expertise and knowledge in the form of engaging articles on various health & tech related topics.