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CPT Code 99401 Billing Guide: Documentation, Medicare Rules, Modifiers, and Denials

CPT code 99401 preventive counseling billing 2026 hero banner: 15-minute individual risk-factor counseling with 8-minute midpoint threshold, Medicare benefit-specific code paths G0447 for obesity and G0443 for alcohol over general 99401, time and behavior-change plan documentation required, Modifier 25 on the E/M not on 99401, and bundling risk when billed with annual preventive visit codes, from One O Seven RCM.

Why CPT 99401 Is Harder to Bill Than It Looks A provider who orders preventive counseling usually knows the visit involved risk factor reduction, not treatment of an active illness. The 99401 cpt code itself is not the hard part. What is hard is whether the payer accepts it, whether the note proves a separate […]

Stress Test CPT Codes: The 2026 Billing Guide for Exercise, Echo, and Nuclear Cardiac Testing

Stress test CPT codes 2026 hero banner: 93015 global exercise ECG versus 93016, 93017, 93018 split components, 93351 stress echo with continuous ECG monitoring versus 93350 without, 78452 nuclear rest-and-stress SPECT, virtual direct supervision permanent January 2026, and LCD L38396 replacing the retired A57184, from One O Seven RCM.

What Is a Cardiac Stress Test, and Which CPT Code Applies to Each Type Stress test CPT codes fall into three distinct families, depending on how the heart is stressed and what the team measures: exercise or pharmacologic ECG monitoring under 93015 through 93018, stress echocardiography under 93350 through 93352, and nuclear myocardial perfusion imaging […]

CPT Code 77067: Screening Mammography Billing, the Complete Code Family, and 2026 Denial Prevention

CPT code 77067 bilateral screening mammography billing 2026 hero banner: 77067 with CAD versus 77065 and 77066 diagnostic codes, 77063 add-on for 3D tomosynthesis requiring 77067 on the same claim, Z12.31 only ICD-10 for screening, G0202 retired January 2018, Modifier GG for same-day conversion, and MQSA certification requirement, from One O Seven RCM.

What Is CPT Code 77067? CPT code 77067 is the American Medical Association code for bilateral screening mammography, a two-view study of each breast that includes computer-aided detection when performed. Radiologists and imaging facilities report it for routine, preventive breast cancer screening in women who have no symptoms. Every major payer recognizes procedure code 77067 […]

CPT Code 80053: Billing, Coding, and Denial Prevention for the Comprehensive Metabolic Panel (2026)

CPT code 80053 comprehensive metabolic panel billing 2026 hero banner: all 14 analytes required including BUN, creatinine, liver enzymes, electrolytes, glucose, and calcium, NCCI bundling rules blocking 80048 and 80076, CLFS rate of $10.56, no Modifier 26 or TC, and ICD-10 medical necessity pairing, from One O Seven RCM.

CPT code 80053 pays about $10.56 as the Medicare national rate, and one missing diagnosis code can turn that clean claim into a denial your practice never recovers. The comprehensive metabolic panel is one of the highest-volume lab codes you bill, so a small error repeats thousands of times a year. This guide walks a […]

CPT Code 93010: ECG Interpretation Billing, 2026 Rates, and Denial Prevention

CPT code 93010 ECG interpretation billing 2026 hero banner: interpretation-and-report-only over the tracing covered by 93005, the hospitalist upcoding trap when 93000 is billed alongside an already-billed 93005, the CO-234 bundling denial, no Modifier 26 by default, and the Medicare one-interpretation-per-ECG rule, from One O Seven RCM.

What CPT Code 93010 Covers, and the One Question That Determines Whether You Bill It CPT code 93010 bills the physician interpretation and signed written report of a routine 12-lead electrocardiogram. The AMA descriptor, paraphrased, reads: electrocardiogram, routine ECG with at least 12 leads, interpretation and report only. The code covers the read. It doesn’t […]

CPT 93880: Bilateral Carotid Duplex Billing, Medical Necessity, and Denial Prevention

What CPT 93880 Covers and What Makes a Study Complete and Billable CPT code 93880 is the code for a duplex scan of the extracranial arteries, complete bilateral study. The procedure evaluates blood flow in the common, internal, and external carotid arteries and the vertebral arteries on both sides of the neck. It combines B-mode […]

CPT Code 43235 Billing Guide: EGD, Modifiers, and Denial Prevention in 2026

CPT code 43235 EGD billing 2026 hero banner: diagnostic upper GI endoscopy with brushings included, biopsy flip to 43239, 43889 sleeve gastroplasty bundle new in 2026, Modifier XS for same-day colonoscopy, and 0-day global period, from One O Seven RCM.

CPT code 43235 is the billing code for a diagnostic esophagogastroduodenoscopy (EGD), a flexible upper GI endoscopy that examines the esophagus, stomach, and duodenum without tissue removal or therapeutic intervention. Procedure: CPT 43235 covers visual inspection of the upper GI tract, including specimen collection by brushing or washing when performed, but no biopsy and no therapeutic intervention. Exclusions: […]

CPT 55250 Vasectomy Billing: What Applies, What Doesn’t, and What Changed in 2026

CPT code 55250 vasectomy billing 2026 hero banner: one code for unilateral or bilateral with semen analysis bundled in the 90-day global, Z30.2 on the procedure claim not Z98.52, Modifier GA for Medicare ABN, no Modifier 50, and the 52597 prostate bundling rule new in 2026, from One O Seven RCM.

CPT 55250: The Code That Covers Every Standard Vasectomy CPT 55250 is the procedure code for vasectomy. The American Medical Association defines 55250 as vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s). One code applies whether your surgeon treats one side or both. The semen analyses that confirm sterility fall inside the code, […]

Cardiology CPT Codes 2026: Billing Guide and Cheat Sheet

Cardiology CPT codes 2026 hero banner: 93000 global EKG versus 93005 technical and 93010 professional, 93306 complete echo with Doppler, cath base codes 93451-93461 by chamber and angio, the six deleted PCI add-ons and new complex stenting codes, and the LD/LC/RC modifier requirement on every Medicare PCI claim, from One O Seven RCM.

The Cardiology CPT Code System: Ranges, Components, and How Claims Split Cardiology CPT codes fall primarily within the 92920-93799 range, maintained by the American Medical Association. These codes split into three billing components: the global service (one provider performs and interprets), the technical component (tracing or imaging only), and the professional component (interpretation and report […]

CPT Code 96365: IV Infusion Billing, Time Rules, and Hierarchy

CPT code 96365 IV infusion billing 2026 hero banner: the 16-minute floor over 96374 push, one initial code per encounter with 96413 chemo taking priority, 96366 add-on at 30 minutes past the hour, incidental hydration not separately billable as 96360, and start-stop time documentation required on every claim, from One O Seven RCM.

What CPT Code 96365 Is and When to Report It What Is CPT Code 96365? CPT code 96365 covers the initial hour of an intravenous infusion for therapeutic, prophylactic, or diagnostic purposes. The AMA short descriptor is ther/proph/diag IV inf init. The 96365 CPT code description applies to non-chemotherapy drugs and requires the infusion to […]

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