By Naomi Foster, Healthcare WriterNeed a code fast? Search common ICD-10 and CPT codes free, right in your browser.
This is a reference guide, not billing advice; confirm any code against the official AMA CPT manual before you submit a claim.
The 99200-series office visit codes, a handful of lab panels, and a few imaging codes account for a large proportion of all outpatient claims. Knowing what these codes mean makes it much easier to read an EOB, verify a bill, or check that the right procedure was billed.
The E&M codes for office visits are determined by medical decision-making complexity (or time, as of 2021 guidelines). New patients are coded 99202 to 99205; established patients are coded 99211 to 99215.
| Code | Patient type | Complexity |
|---|---|---|
| 99202 | New | Straightforward |
| 99203 | New | Low |
| 99204 | New | Moderate |
| 99205 | New | High |
| 99211 | Established | Minimal (may not require physician) |
| 99212 | Established | Straightforward |
| 99213 | Established | Low |
| 99214 | Established | Moderate |
| 99215 | Established | High |
Annual wellness visits use different codes: 99381-99387 (new patients) and 99391-99397 (established), organized by age range. Medicare Annual Wellness Visits use G0438 (initial) and G0439 (subsequent). These are separate from and not interchangeable with sick-visit E&M codes.
80053 is a comprehensive metabolic panel (14 analytes including glucose, creatinine, electrolytes, and liver enzymes). 85025 is a complete blood count with differential. 83036 covers hemoglobin A1c. 87491 covers chlamydia and gonorrhea nucleic acid testing. Lab codes are often part of a larger order and may appear as multiple line items on a claim.
71046 is a two-view chest X-ray, one of the most frequently billed radiology codes. 73030 covers a shoulder X-ray (two views). 70553 is an MRI of the brain with and without contrast. 76700 is a complete abdominal ultrasound. Imaging codes often split into a professional component (-26) and a technical component (-TC) depending on who owns the equipment and who interprets.
A typical outpatient visit might bill 99214 (the E&M), 85025 (a CBC), and 80053 (a metabolic panel). Your EOB will list each line separately with its own billed amount, payer adjustment, and patient responsibility. Use the Code Lookup to identify any code on your EOB, and see how to read an EOB for how to interpret the full document.
Need a code fast? Search common ICD-10 and CPT codes free, right in your browser.
99213 and 99214 -- established-patient office visits of low and moderate complexity -- are consistently among the most billed CPT codes in the US. They cover the vast majority of routine outpatient physician visits.
Both are established-patient office visits. 99213 is for low medical decision-making complexity (or typically 20-29 minutes of total time). 99214 is for moderate complexity (or 30-39 minutes). The difference is the complexity of the problem addressed and the decisions made, not just the length of the visit.
A routine physical (preventive visit) uses codes 99381-99387 for new patients or 99391-99397 for established patients, organized by the patient's age range. These are distinct from sick-visit E&M codes and generally have separate deductible and copay rules under most insurance plans.
It depends on the test. A complete metabolic panel is 80053. A complete blood count with differential is 85025. A hemoglobin A1c is 83036. Individual tests each have their own code; a single lab order can generate several CPT codes on your claim.
