The Full MapEvery Specialty, Code by Code
Seventeen specialties. Categories, ranges, high-value codes, modifiers and bundling traps.
Cardiology
The highest-dollar procedural specialty in most RCM portfolios. Cath lab bundling rules are strict, and one wrong pair can cost thousands.
| Category | Code range | Notes |
|---|
| Diagnostic catheterization | 93451-93462 | Right heart cath, left heart cath, and coronary angiography add-ons. 93458 is left heart cath with coronary angiography. |
| PCI and interventions | 92920-92944 | Balloon angioplasty, stents, atherectomy, chronic total occlusion work. |
| Electrophysiology | 93600-93662 | Diagnostic EP studies, comprehensive evaluations, ablations. |
| Echocardiography | 93303-93356 | TTE, TEE, stress echo. Resting echo is bundled into stress echo protocols. |
| EKG and rhythm | 93000-93010 | 93000 global, 93005 tracing only, 93010 interpretation only. |
| Stress testing | 93015-93018 | Cardiovascular stress test, supervision, interpretation. |
High-value codes
| Code | Description |
|---|
| 92928 | Percutaneous stent placement, single vessel |
| 93458 | Left heart cath with coronary angiography |
| 93656 | AFib ablation, pulmonary vein isolation |
| 93306 | Transthoracic echo, complete |
| 33249 | ICD system insertion |
Typical modifiers: 25, 26, 59, LT, RT, TC
NCCI pitfalls:
- Coronary angiography add-ons (93454-93461) bundled into PCI (92928) unless a distinct diagnostic session is documented with a modifier.
- Resting echo (93306) is included in stress echo (93350) - never bill both for the same study.
- EKG interpretation (93010) bundled into E/M without modifier 25 and separately identifiable work.
Dermatology
High volume, small dollars per code - revenue comes from getting every lesion coded right and never leaving a biopsy unbilled.
| Category | Code range | Notes |
|---|
| Biopsies | 11102-11107 | Tangential (11102), punch (11104), incisional (11106), each with add-on codes for additional lesions. |
| Excisions | 11400-11646 | Benign (11400-11471) and malignant (11600-11646), coded by diameter plus margins. |
| Mohs surgery | 17311-17315 | Stage-based: 17311 first stage head/neck, 17312 each additional stage, 17314-17315 trunk/extremities. |
| Destructions | 17000-17286 | Premalignant destruction (17000-17004) and benign/malignant lesion destruction by size. |
| Shave removals | 11300-11313 | By body area and lesion diameter. |
| Repairs | 12001-13160 | Simple through complex closures, layered by length and location. |
High-value codes
| Code | Description |
|---|
| 17311 | Mohs micrographic surgery, first stage, head/neck |
| 11606 | Excision malignant lesion, over 4.0 cm |
| 11104 | Punch biopsy, single lesion |
| 17004 | Destruction of 15 or more premalignant lesions |
Typical modifiers: 25, 59, XS, LT, RT
NCCI pitfalls:
- Biopsy and excision of the same lesion at the same encounter are bundled - the biopsy is included in the excision decision.
- Mohs plus same-day repair needs modifier 59 only when the repair is truly separate work, documented as such.
- Multiple lesions: each lesion needs its own line with site documentation, or payers collapse them.
Orthopedics
Surgical volume plus long global periods. Fracture care and arthroscopy bundling are the two biggest leak points.
| Category | Code range | Notes |
|---|
| Arthroscopy | 29800-29999 | Diagnostic and surgical scopes by joint: knee 29880-29888, shoulder 29805-29828. |
| Fracture and dislocation care | 25500-27792 | Closed, open and percutaneous treatment by anatomic site, with global periods attached. |
| Joint replacement | 27125-27138 (hip), 27438-27447 (knee) | Total and partial arthroplasty. 27447 total knee and 27130 total hip anchor the category. |
| Spine | 22010-22899 | Exploration, fusion, instrumentation - some of the highest base units in surgery. |
| Casting and strapping | 29000-29799 | Applications coded separately from the fracture care global when done by a different provider. |
High-value codes
| Code | Description |
|---|
| 27447 | Total knee arthroplasty |
| 27130 | Total hip arthroplasty |
| 29881 | Knee arthroscopy with meniscectomy |
| 29827 | Arthroscopic rotator cuff repair |
Typical modifiers: 59, XS, LT, RT, 50, 25
NCCI pitfalls:
- Arthroscopy converted to an open procedure on the same joint: bill the open procedure, not both.
- Fracture care globals include follow-up visits - separate E/M during the global needs modifier 24 and unrelated diagnosis.
- Bilateral joints: use 50 or LT/RT per payer preference, never two full-fee lines without a modifier.
Physical Therapy
Timed-code math decides revenue here. The 8-minute rule and therapy caps punish sloppy unit counting.
| Category | Code range | Notes |
|---|
| Evaluations | 97161-97164 | Low, moderate and high complexity evals plus re-evaluation. Complexity is driven by history, examination and clinical presentation. |
| Therapeutic procedures | 97110-97116 | Therapeutic exercises (97110), neuromuscular re-education (97112), gait training (97116) - all timed in 15-minute units. |
| Manual therapy | 97140 | Mobilization and manipulation, timed. One of the most used - and most reviewed - PT codes. |
| Modalities | 97010-97039 | Hot/cold packs (97010, untimed), electrical stimulation (97014, G0283), ultrasound (97035). |
High-value codes
| Code | Description |
|---|
| 97110 | Therapeutic exercises, each 15 minutes |
| 97140 | Manual therapy, each 15 minutes |
| 97112 | Neuromuscular re-education, each 15 minutes |
| 97162 | PT evaluation, moderate complexity |
Typical modifiers: 59, KX, GP
NCCI pitfalls:
- The 8-minute rule: timed units are earned in 15-minute increments with at least 8 minutes of the first unit - short sessions lose units fast.
- KX modifier attests medical necessity above the therapy cap threshold; without it, claims over the threshold deny.
- GP modifier identifies services under an outpatient PT plan of care - missing GP is an instant technical denial.
Behavioral Health
Time-based codes with hard thresholds. A minute short changes the code - and the payment.
| Category | Code range | Notes |
|---|
| Diagnostic evaluation | 90791-90792 | 90791 without medical services, 90792 with. The gateway code for new patients. |
| Psychotherapy | 90832, 90834, 90837 | 30, 45 and 60 minutes: 16-37, 38-52 and 53+ minutes with the patient. |
| Family psychotherapy | 90846-90847 | Without (90846) or with (90847) the patient present. |
| Assessments | 96127, 96136-96137 | Brief behavioral assessments and psychological test administration. |
High-value codes
| Code | Description |
|---|
| 90837 | Psychotherapy, 60 minutes |
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Psychotherapy, 45 minutes |
Typical modifiers: 25, 59, 95
NCCI pitfalls:
- 90791 and 90834 on the same day have strict add-on rules - most payers will not pay both without distinct documentation.
- Time thresholds are absolute: 37 minutes is 90832, 38 minutes is 90834. Rounding up is upcoding.
- 96127 bundled into E/M by many payers unless separately identifiable with modifier 25.
Radiology
Professional/technical splits and contrast rules decide payment. The global code is not always the right choice.
| Category | Code range | Notes |
|---|
| Head and neck | 70010-70559 | CT head 70450-70470, MRI brain 70551-70553. |
| Chest | 71045-71555 | Chest X-ray 71045-71048, CT chest 71250-71275. |
| Abdomen and pelvis | 74018-74178 | CT abdomen/pelvis 74176-74178 - one code covers both with contrast. |
| Spine | 72020-72159 | X-ray and MRI by spinal region. |
| Ultrasound | 76700-76886 | Abdominal, pelvic, obstetric and vascular studies. |
| Breast imaging | 77046-77067 | Diagnostic mammography, tomosynthesis, MRI. |
High-value codes
| Code | Description |
|---|
| 74177 | CT abdomen and pelvis with contrast |
| 70553 | MRI brain without and with contrast |
| 76856 | Ultrasound, pelvic, complete |
Typical modifiers: 26, TC, 59, LT, RT
NCCI pitfalls:
- With-and-without contrast studies have single combination codes (e.g., 70553) - billing the with and without codes separately is unbundling.
- 3D rendering (76376/76377) is an add-on with strict medical-necessity rules, not an automatic add to every CT.
- Global vs split billing: know which payers want 26/TC split and which accept the global.
Laboratory and Pathology
Panel logic and molecular scrutiny. The lab section has the densest edit coverage in the fee schedule.
| Category | Code range | Notes |
|---|
| Organ and disease panels | 80047-80076 | Basic metabolic (80048), comprehensive metabolic (80053), lipid (80061), hepatic function (80076). |
| Hematology | 85004-85049 | CBC with differential (85025), without (85027). |
| Chemistry | 82000-84999 | Individual analytes: A1C (83036), TSH (84443), vitamin D (82306). |
| Molecular pathology | 81105-81479 | Tier 1 gene-specific codes through Tier 2 stacked codes and unlisted 81479. |
| Microbiology | 87003-87999 | Cultures, respiratory panels (87631-87633), SARS-CoV-2 (87635). |
| Surgical pathology | 88300-88309 | Levels I through VI by specimen complexity. |
High-value codes
| Code | Description |
|---|
| 80053 | Comprehensive metabolic panel |
| 87633 | Respiratory pathogen panel, 12-25 targets |
| 88305 | Surgical pathology, level IV |
| 85025 | CBC with auto differential |
Typical modifiers: 59, 91, QW
NCCI pitfalls:
- Bill the panel code, never the components - component stacking past a panel definition triggers unbundling edits.
- Modifier 91 (repeat lab, same day) is for repeated tests, not 59 or 76 - using the wrong repeat modifier denies the line.
- Molecular stacked codes need documented medical necessity per target - payers audit these heavily.
Gastroenterology
Endoscopy bundling is the specialty's signature trap: the diagnostic scope almost always includes the biopsy.
| Category | Code range | Notes |
|---|
| EGD | 43200-43278 | Diagnostic EGD (43235), with biopsy (43239), with lesion removal (43250-43251). |
| Colonoscopy | 45378-45398 | Diagnostic (45378), with biopsy (45380), with lesion removal (45385). |
| ERCP | 43260-43278 | Diagnostic through therapeutic, with sphincterotomy and stent work. |
| Liver | 47000-47147 | Percutaneous biopsy (47000) through partial hepatectomy. |
High-value codes
| Code | Description |
|---|
| 45385 | Colonoscopy with lesion removal |
| 43239 | EGD with biopsy |
| 45380 | Colonoscopy with biopsy |
Typical modifiers: 25, 33, 59, PT
NCCI pitfalls:
- 45378 (diagnostic colonoscopy) already includes biopsy - 45380 is the correct code when biopsy is performed, not both.
- Screening colonoscopy converts to diagnostic when a polyp is found: use 45385 with PT or 33 per payer, and know the patient's cost-share changes.
- EGD and colonoscopy same day need modifier 59/XS with distinct documentation - some payers reduce the second procedure.
OB/GYN
Global packages dominate obstetrics. Knowing what the global includes - and what escapes it - is the whole game.
| Category | Code range | Notes |
|---|
| Global OB packages | 59400-59622 | 59400 routine vaginal delivery global, 59510 routine cesarean global, 59610/59612 VBAC. |
| Antepartum only | 59425-59426 | 4-6 visits (59425) or 7+ visits (59426) when delivery is handled elsewhere. |
| OB ultrasound | 76801-76828 | First trimester (76801), anatomy scan (76805), follow-up (76816). |
| Gyn procedures | 56405-58999 | Colposcopy (57454), hysteroscopy (58555-58565), hysterectomy (58150-58573). |
High-value codes
| Code | Description |
|---|
| 59510 | Routine cesarean delivery, global |
| 59400 | Routine vaginal delivery, global |
| 58571 | Laparoscopic total hysterectomy |
Typical modifiers: 25, 59
NCCI pitfalls:
- The global package includes routine antepartum, delivery and postpartum - billing separate E/M inside the global without modifier 24 and an unrelated diagnosis will deny.
- Ultrasounds need their own indication beyond routine OB care to escape the global.
- Delivery plus repair: the global includes routine repair - extensive additional repair may justify separate billing with documentation.
Ophthalmology
Eye codes vs E/M codes, and bilateral logic on every paired-organ procedure.
| Category | Code range | Notes |
|---|
| Eye examinations | 92002-92014 | New (92002/92004) vs established (92012/92014), intermediate vs comprehensive. |
| Special ophthalmological services | 92025-92499 | Visual fields (92081-92083), OCT (92133/92134), fundus photography (92250). |
| Cataract | 66840-66990 | 66984 routine with IOL, 66982 complex. |
| Retina and glaucoma | 67005-67255, 65800-65880 | Vitrectomy, laser procedures, trabeculectomy. |
High-value codes
| Code | Description |
|---|
| 66984 | Cataract extraction with IOL |
| 92134 | OCT, retina |
| 92004 | Comprehensive eye exam, new patient |
Typical modifiers: 25, 50, LT, RT, 26
NCCI pitfalls:
- Bilateral: some payers want modifier 50 (1 unit, 150%), others want RT/LT on two lines - billing the wrong format denies or underpays.
- Eye exam codes (920xx) vs E/M (992xx) same day: pick the one that reflects the work, and use 25 only for separately identifiable E/M.
- Cataract surgery and YAG capsulotomy on the same eye need proper timing - YAG during the cataract global period needs modifier 58 or 78 with the right scenario.
Neurology
Diagnostics with strict bundling between EMG, nerve conduction and the visit itself.
| Category | Code range | Notes |
|---|
| EEG | 95812-95827 | Routine (95812-95813), extended monitoring, with specific time thresholds. |
| EMG | 95860-95870 | Needle EMG by extremity count and cranial nerve involvement. |
| Nerve conduction | 95905-95913 | Motor/sensory studies by count: 95907-95913 scale with number of studies. |
| Sleep studies | 95800-95811 | Home sleep tests through attended polysomnography (95810). |
| Chemodenervation | 64612-64617 | Botox for migraine (64615), dystonia, spasticity. |
| Lumbar puncture | 62270 | Diagnostic LP - often paired with E/M. |
High-value codes
| Code | Description |
|---|
| 95810 | Polysomnography, attended |
| 64615 | Chemodenervation, chronic migraine |
| 95913 | Nerve conduction, 13 or more studies |
Typical modifiers: 25, 59, 26
NCCI pitfalls:
- EMG and nerve conduction on the same day hit bundling edits - the NCS codes 95907-95913 already account for interpretation; know the pairs.
- EEG with same-day E/M needs modifier 25 and a note showing the E/M went beyond the EEG indication.
- Botox for migraine requires documented failure of conservative therapy and chronic migraine criteria - cosmetic-adjacent claims get reviewed.
Urology
Endoscopy-heavy with bilateral organs - laterality discipline matters on every kidney and testicular procedure.
| Category | Code range | Notes |
|---|
| Cystoscopy and urethroscopy | 52000-52356 | Diagnostic (52000) through therapeutic: stent insertion (52332), lithotripsy (52353). |
| Prostate | 52441-53899 | TURP (52601), laser vaporization (52648), UroLift (52441-52442). |
| Urodynamics | 51725-51798 | Complex cystometrogram (51728-51729), uroflowmetry (51736). |
| Stone procedures | 50060-50590 | Percutaneous nephrolithotomy through ESWL (50590). |
| Vasectomy | 55250 | Bilateral by definition - never bill two units. |
High-value codes
| Code | Description |
|---|
| 52601 | TURP |
| 50590 | Extracorporeal shock wave lithotripsy |
| 52332 | Cystoscopy with ureteral stent insertion |
Typical modifiers: 50, LT, RT, 59, 25
NCCI pitfalls:
- Diagnostic cystoscopy (52000) is bundled into any therapeutic cystoscopy done the same session - bill the therapeutic code only.
- Urodynamic components bundle: the complex codes (51728/51729) include what the simple ones measure separately.
- Vasectomy (55250) is inherently bilateral - modifier 50 or two units will deny.
Pulmonology
PFT math and bronchoscopy bundling. Pre/post spirometry is one code, not two.
| Category | Code range | Notes |
|---|
| Pulmonary function | 94002-94799 | Spirometry (94010), pre/post bronchodilator (94060), lung volumes (94200), DLCO (94729). |
| Bronchoscopy | 31615-31661 | Diagnostic (31622) through therapeutic: biopsy (31628), EBUS (31652-31654). |
| Smoking cessation | 99406-99407 | 3-10 minutes (99406), over 10 minutes (99407). |
| Exercise testing | 94618-94621 | Six-minute walk (94618), cardiopulmonary exercise testing (94621). |
High-value codes
| Code | Description |
|---|
| 31628 | Bronchoscopy with transbronchial biopsy |
| 94060 | Spirometry with bronchodilator |
| 94618 | Six-minute walk test |
Typical modifiers: 25, 59, 26
NCCI pitfalls:
- 94060 already includes pre and post measurements - billing 94010 plus 94060 for the same session is unbundling.
- Bronchoscopy with biopsy (31628) includes the diagnostic scope - never add 31622 for the same session.
- PFT with same-day E/M needs modifier 25 and documentation that the visit addressed more than the PFT indication.
Primary Care
E/M leveling is the revenue engine. New vs established, time vs medical decision making - every visit lives or dies here.
| Category | Code range | Notes |
|---|
| Office/outpatient E/M | 99202-99215 | New (99202-99205) vs established (99211-99215), leveled by MDM or total time. |
| Inpatient E/M | 99221-99233 | Initial, subsequent and discharge-day hospital care. |
| Preventive visits | 99381-99397 | Age-banded comprehensive preventive exams, new vs established. |
| Annual wellness | G0438/G0439 | Medicare AWV: initial (G0438) and subsequent (G0439) - no cost share, strict content rules. |
| Care management | 99490-99491, 99495-99496 | Chronic care management and transitional care management. |
High-value codes
| Code | Description |
|---|
| 99214 | Office visit, established, moderate complexity |
| 99215 | Office visit, established, high complexity |
| G0439 | Medicare annual wellness visit, subsequent |
Typical modifiers: 25, 59, 95
NCCI pitfalls:
- New vs established is a 3-year rule: no face-to-face with the physician or same-specialty group in 3 years means new.
- Preventive (9939x) plus problem-oriented E/M same day needs modifier 25 and a significant separate problem - the annual physical alone does not qualify.
- AWV (G0438/G0439) is not a physical exam - billing it as one, or missing required elements like the health risk assessment, invites takebacks.
Urgent Care
High-throughput E/M plus minor procedures. The global UC fee code and E/M cannot both be billed freely.
| Category | Code range | Notes |
|---|
| Office/outpatient E/M | 99202-99215 | The backbone of UC billing, leveled like any office visit. |
| ED E/M | 99281-99285 | Some UCs bill ED levels - payer contracts decide which code set applies. |
| Global UC fee | S9083 | Global urgent care facility fee - not recognized by all payers. |
| Minor procedures | 10060-11983 | I&D (10060/10061), lesion removals, foreign body removal. |
| Laceration repair | 12001-12007 | Simple repairs by length - the most common UC procedure add-on. |
| Splints and strapping | 29105-29799 | Application codes separate from the E/M. |
High-value codes
| Code | Description |
|---|
| 99214 | UC visit, moderate complexity |
| S9083 | Global urgent care fee |
| 12002 | Simple repair, 2.6-7.5 cm |
Typical modifiers: 25, 59
NCCI pitfalls:
- S9083 plus E/M: most payers that recognize S9083 will not also pay a full E/M - know the contract before billing both.
- Procedure plus E/M needs modifier 25 with documentation that the visit work exceeded the procedure itself.
- X-ray interpretation by the UC physician is separately billable with 26 only when a formal interpretation is documented - a glance does not count.
DME (HCPCS)
DME bills in HCPCS, not CPT - E, K, L and A codes with rental modifiers doing the heavy lifting.
| Category | Code range | Notes |
|---|
| Mobility | E0100-E0159, K0001-K0009 | Canes, crutches, walkers (E codes); wheelchairs K0001 standard through K0005 ultralightweight. |
| Oxygen | E0430-E0444, E1390-E1392 | Gaseous/liquid systems and concentrators - continuous rental. |
| Diabetic | E0607, A4253, E0784 | Glucose monitors, test strips, external insulin pumps. |
| Orthotics and prosthetics | L codes | L4360 walking boot, L1900 AFO, L3000+ foot orthotics. |
| Ostomy and urological | A4351-A4353, A4338 | Pouches, catheters - strict monthly quantity caps. |
| Wound care | A6196-A6406 | Dressings by size and type. |
High-value codes
| Code | Description |
|---|
| K0005 | Ultralightweight wheelchair |
| E1390 | Oxygen concentrator |
| E0784 | External insulin pump |
| L4360 | Pneumatic walking boot |
Typical modifiers: RR, KH, KI, KJ, NU, UE, KX, GA, EY
NCCI pitfalls:
- Capped rental sequencing: KH month 1, KI months 2-3, KJ months 4-13. One wrong letter and the month denies.
- KX without supporting records on file is an audit flag - the modifier certifies documentation exists.
- Same item from two suppliers in overlapping periods triggers duplicate investigations - coordinate delivery dates.
Anesthesia
Base units plus time units, no E/M, strict concurrency rules. Anesthesia has its own payment math.
| Category | Code range | Notes |
|---|
| Head | 00100-00222 | Anesthesia for head and neck procedures, by anatomic site. |
| Neck and thorax | 00300-00474 | Thyroid, thorax, breast procedures. |
| Spine and cord | 00600-00670 | Spinal procedures by region. |
| Abdomen | 00700-00882 | Intraperitoneal (00840) through lower abdominal procedures. |
| Lower extremity | 01112-01682 | Hip through foot, including total knee (01402). |
| Obstetric | 01958-01969 | Neuraxial labor analgesia (01967) through cesarean delivery. |
High-value codes
| Code | Description |
|---|
| 00840 | Anesthesia, intraperitoneal procedures |
| 01967 | Neuraxial labor analgesia |
| 01402 | Anesthesia, total knee arthroplasty |
Typical modifiers: P1-P6, AA, QK, QX, QY, AD
NCCI pitfalls:
- Payment is base units plus time units - there is no separate E/M on the same day as the anesthesia.
- Medical direction (QK) has concurrency limits, typically 1:4 - exceeding them changes payment for every case.
- QX/QY identify CRNA services with or without medical direction; AD is supervision - using the wrong one misrepresents who did the work.
