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    Urget Care Superbill

    Uploaded by

    Mayer Rosenberg
    This document provides billing codes and descriptions for medical services provided at an urgent care facility. It lists codes for office visits, preventative exams, procedures, injections, supplies, x-rays, and other services. Codes are organized by category and include descriptions and fees. Standard supplies that can be sent home with patients are also listed along with their codes.

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    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd

    Urget Care Superbill

    Uploaded by

    Mayer Rosenberg
    7K views5 pages
    This document provides billing codes and descriptions for medical services provided at an urgent care facility. It lists codes for office visits, preventative exams, procedures, injections, supplies, x-rays, and other services. Codes are organized by category and include descriptions and fees. Standard supplies that can be sent home with patients are also listed along with their codes.

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    This document provides billing codes and descriptions for medical services provided at an urgent care facility. It lists codes for office visits, preventative exams, procedures, injections, supplies, x-rays, and other services. Codes are organized by category and include descriptions and fees. Standard supplies that can be sent home with patients are also listed along with their codes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    7K views5 pages

    Urget Care Superbill

    Uploaded by

    Mayer Rosenberg
    This document provides billing codes and descriptions for medical services provided at an urgent care facility. It lists codes for office visits, preventative exams, procedures, injections, supplies, x-rays, and other services. Codes are organized by category and include descriptions and fees. Standard supplies that can be sent home with patients are also listed along with their codes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 5

    URGENT CARE Provider # Fed

    LOCATION (CIRCLE ONE) 13


    15
    CPT DESCRIPTION FEE CPT DESCRIPTION FEE
    NEW PATIENTS X-RAY; (cont'd)
    99201 LEVEL 1, BRIEF; 10 min 73060 HUMERUS; 2+ VIEWS
    99202 LEVEL 2, LIMITED: 20 min 73560 KNEE; AP & LAT
    99203 LEVEL 3, EXPANDED; 30 min 72110 LS SPINE; COMPLETE W/OBLIQUES
    99204 LEVEL 4, COMPREHENSIVE; 45 min 70110 MANDIBLE; COMPLETE
    99205 LEVEL 5, COMPREHENSIVE; 60 min 70160 NASAL BONES; COMPLETE
    99025 NEW PT. INITIAL VISIT W/*PROC. 72190 PELVIS; 3+VIEWS
    ESTABLISHED PATIENTS 04209 POST REDUCTION
    90025 OFFICE VISIT, NO CHARGE N/C 71100 RIB, UNILATERAL, 2 VIEWS
    99211 LEVEL 1, BRIEF: 72220 SACRUM & COCCYX; 2+ VIEWS
    99212 LEVEL 2, LIMITED: 73050 SHOULDER AC JTS; BILATERAL
    99213 LEVEL 3, EXPANDED: 73030 SHOULDER; COMPLETE
    99214 LEVEL 4, COMPREHENSIVE: 70360 SOFT TISSUE
    99215 LEVEL 5, COMPREHENSIVE: 72070 THORACIC SPINE; AP&LAT
    99354 PROLONGED SERVICE 1st HOUR 73590 TIB-FIB; AP&LAT
    99355 PROLONGED SERV. EA ADD'L 30min 73110 WRIST; COMPLETE
    PROCEDURES LAB (POST CHARGES FROM LAB TICKET ONLY)
    46600 ANOSCOPY 36415 VENIPUNCTURE
    11730* AVULSION NAIL, SIMPLE 86308 MONO SCREEN (HETEROPHILE)
    16030* BURN CARE; LG, NO ANEST 81025 PREGNANCY TEST - URINE
    16025* BURN CARE, MED, NO ANEST 87880 RAPID STREP ANTIGEN
    16020* BURN CARE, SMALL, NO ANEST 81001 UA COMPLETE
    53670 CATHETERIZATION (ADD TRAY) 80100 Urine Drug Screen
    30903 EPISTAXIS CONTROL; COMPLEX
    30901 EPISTAXIS CONTROL, SIMPLE SUPPLIES (SENT HOME WITH PATIENT)
    10060* I&D ABSCESS; SIMPLE 02074 ACE WRAP 4"
    10140* I&D HEMATOMA/SEROMA/FLUID 02075 ACE WRAP 6"
    10120* REM. FB SUB Q; SIMPLE 02786 ADAPTIC DRESSING
    65222* REM. FB CORNEA W/SLIT LAMP 02019 ANKLE BRACE
    07008 REMOVE CONSTRICTING RING 02620 ANKLE BRACE: AIR CAST
    LACERATION REPAIRS 02604 ANKLE, E-Z WRAP; RIGID
    12001* REP LAC 2.5cm OR LESS 02686 BURN DRESSING, LARGE
    12002* REP LAC 2.6 - 7.5cm 02685 BURN DRESSING, SMALL
    12004* REP LAC 7.6 - 12.5cm 02066 CERVICAL COLLAR
    12011* FACIAL LAC 2.5cm OR LESS 02007 CLAVICLE STRAP
    12013* FACIAL LAC 2.6 - 5.0 cm 02077 DRESSINGS; LARGE
    12031* LAYER CLOS. SCALP/AXILLA/TRUNK ; <2.5CM 03201 DRESSINGS; MEDIUM
    12032* LAYER CLOS.SCALP/AXILLA/TRUNK 2.6-7.5CM 02076 DRESSINGS; SMALL
    12041* LAYER CLOSURE; NECK/HANDS/FEET <2.5CM 02011 ELBOW SUPPORT
    12042* LAYER CLOSURE;NECK/HANDS/ FEET 2.6-7.5CM 02082 FINGER SPLINT
    SPLINTS / SUPPLIES 02013 KNEE IMMOBILIZER
    29505 APPLY LONG LEG SPLINT 02087 KNEE SLEEVE
    29515 APPLY SHORT LEG SPLINT 02387 KWIK COLD
    29125 APPLY SHORT ARM SPLINT 02200 MALLET FINGER SPLINT
    29105 APPLY LONG ARM SPLINT 02127 ORTHO SHOE
    02222 ORTHOGLASS; ARM 02129 RIB BELT
    02223 ORTHOGLASS; LEG
    X-RAY
    74000 ABDOMEN (1 VIEW)
    74022 ABDOMINAL SERIES
    73610 ANKLE; COMPLETE
    72052 CERVICAL SPINE; COMPLETE
    71020 CHEST PA & LAT
    73000 CLAVICLE; COMPLELTE
    73080 ELBOW; COMPLETE
    70150 FACIAL BONES; COMPLETE
    73630 FOOT; COMPLETE
    73090 FOREARM; AP&LAT
    73130 HAND; 3+ VIEWS
    73510 HIP; COMPLETE, UNILATERAL
    Provider # Federal ID #

    INJURY DATE:

    CPT DESCRIPTION FEE


    SUPPLIES (SENT HOME WITH PATIENT)
    02110 SLING, ARM
    02084 UNIVERSAL THUMB SPLINT
    02150 WRIST BRACE, LIBERTY
    02010 WRIST SPLINT
    TRAYS AND OTHER SUPPLIES
    02534 EYE TRAY
    02111 SIMPLE TRAY
    02097 SMALL SUTURE TRAY W/ANES
    02033 SUTURE REMOVAL KIT
    02094 TRAY, PELVIC / SMALL W/ANESTHESIA
    02795 TRAY, SMALL W/O ANESTHESIA
    02101 INSERTION TRAY W/FOLEY W/O BAG
    02389 STRAIGHT TIP CATHETER
    02027 IV SUPPLIES
    02795 I&D TRAY
    J7030 INFUSION NORMAL SALINE: 1000 cc
    J7040 INFUSION N/S, STERILE; 500ml = 1 UNIT
    J7120 LACTATED RINGERS; 1000cc
    MISCELLANEOUS
    93000 EKG; COMPLETE
    99291 CRITICAL CARE; 1ST HOUR
    99292 CRITICAL CARE; EA ADD'L 30 MIN
    TOTAL TIME:________ to __________
    02474 DISPOSABLE CAUTERY UNIT
    69210 EAR IRRIGATION
    94640 NEBULIZER TREATMENT
    02026 OXYGEN SUPPLIES
    94760 OXIMETRY
    INJECTIONS AND ADMINISTRATIONS
    90780 IV INFUSION; UP TO 1 HOUR
    90781 IV INFUSION; EA ADD'L HR TO 8 HRS
    90782 THERAP/ DIAG INJECTION; SUB Q/ IM
    90784 THERAP/ DIAG INJECTION; IV
    90788 IM INJECTION OF ANTIBIOTIC

    J0150 ADENOSINE; 6mg X _____


    J1200 BENADRYL; 50mg
    03524 CARDIAZEM PER 25MG X ______
    J0702 CELESTONE; 3mg/ml X ______
    J2175 DEMEROL; PER 100mg X _____
    J1030 DEPOMEDROL 40mg X ______
    J1160 DIGOXIN UP TO 0.5mg
    J0170 EPINEPHRIN/SUSPHRINE; 1ml amp
    J3030 IMITREX 6mg
    J1940 LASIX UP TO 20mg X ______
    J2550 PHENERGAN 50mg X _____
    J0696 ROCEPHIN PER 250mg: X _________
    J2930 SOLUMEDROL; 125MG X _______
    J1885 TORADOL; PER 15mg: X ________

    OTHER:
    99211 ADMINISTER PPD W/NO MD VISIT
    86580 PPD
    90718 TETANUS; Td (V06.5 or Injury code)
    FAMILY PRACTICE
    CODE MOD DESCRIPTION CODE MOD DESCRIPTION CODE MOD DESCRIPTION
    OFFICE VISITS - NEW PATIENTS 10060 I&D ABSCESS/CYST, SIMPLE TRAYS (ADD TO SURGICAL PROCEDURES)
    99201 LEVEL 1, BRIEF; 10 min 10061* I&D ABSCESS, COMPL. OR MULT. 02094 TRAY, SMALL W/ANESTHESIA
    99202 LEVEL 2, LIMITED: 20 min 11200 SKIN TAG REMOVAL, UP TO 15 02097 SUTURE TRAY W/ANESTHESIA
    99203 LEVEL 3, EXPANDED; 30 min 11201 SKIN TAG REMOVAL, EA ADDL 10 02098 TRAY, MEDIUM W/SPEC. ROOM(SIG)
    99204 LEVEL 4, COMPREHENSIVE; 45 min 17000 DEST.BEN LESION,ANY METHD, 1st 02095 TRAY, LARGE + RM + SPEC. EQUIP
    99205 LEVEL 5, COMPREHENSIVE; 60 min 17003 2nd THROUGH 14th LESIONS EA SUPPLIES
    99025 NEW PT. INITIAL VISIT W/*PROC. 17004 DEST BEN LES. ANY METH. > 15 02113 CANVAS KNEE BRACE
    PREVENTIVE EXAM - NEW PATIENTS 93000 EKG, COMPLETE 02010 CANVAS WRIST SUPPORT
    99381 PREVENTIVE MEDICINE < 1 YEAR 93005 EKG, TRACING ONLY 02112 ELASTIC ANKLE WRAP
    99382 PREVENTIVE MEDICINE, 1 - 4 20550 INJ TENDON/LIGAMENT/CYST/TRIGGER PT 02018 ELASTIC ANKLET
    99383 PREVENTIVE MEDICINE, 5-11 20600* INJECT.SMALL JT/BURSA/CYST 02579 FINGER SPLING
    99384 PREVENTIVE MEDICINE, 12-17 20605* INJECT. INT. JOINT/BURSA/CYST 02129 RIB BELT
    99385 PREVENTIVE MEDICINE, 18-39 20610* INJECT.MAJOR JOINT/BURSA/CYST 02525 SLING
    99386 PREVENTIVE MEDICINE, 40-64 94150 VITAL CAPACITY; SEPARATE PROC 02488 STERI-STRIPS
    99387 PREVENTIVE MEDICINE, 65+ 69210 REMOVAL IMPACTED CERUMEN 02033 SUTURE REMOVAL KIT
    OFFICE VISITS - EST. PATIENTS 45330 SIGMOIDOSCOPY; FLEXIBLE 02011 TENNIS ELBOW SUPPORT
    99211 LEVEL 1, BRIEF: 5 min 94010 SPIROMETRY W/GRAPHIC RECORD 02084 UNIVERSAL THUMB SPLINT
    99212 LEVEL 2, LIMITED: 10 min DIAGNOSTICS OTHER: SPECIFY
    99213 LEVEL 3, EXPANDED: 15 min 87220 KOH
    99214 LEVEL 4, COMPREHENSIVE: 25 min 82270 OCCULT BLOOD
    99215 LEVEL 5, COMPREHENSIVE: 40min Q0091 PAP SMEAR HANDLING
    PREVENTIVE EXAM - EST. PATIENTS 86580 PPD CASTS/SPLINTS
    99391 PREVENTIVE MEDICINE < 1 YEAR 81000 URINALYSIS, ROUTINE 29065 LONG ARM CAST
    99392 PREVENTIVE MEDICINE, 1 - 4 87210 WET MOUNT 29075 SHORT ARM CAST
    99393 PREVENTIVE MEDICINE, 5-11 87880 QUICK STREP 29105 LONG ARM SPLINT
    99394 PREVENTIVE MEDICINE, 12-17 INJECTIONS UNITS 29125 SHORT ARM SPLINT
    99395 PREVENTIVE MEDICINE, 18-39 90782 SUB Q OR IM INJECTION OF MED 29405 SHORT LEG CAST
    99396 PREVENTIVE MEDICINE, 40-64 J3420 B-12 ; up to 1000 mcg 29515 SHORT LEG SPLINT
    99397 PREVENTIVE MEDICINE, 65+ J0702 CELESTONE SOLUSPAN 1cc 02220 CAST MATERIAL, PLASTER, ARM
    INITIAL NURSING FACILITY CARE J2175 DEMEROL PER 100mg 02221 CAST MATERIAL, PLASTER, LEG
    99301 LEVEL 1 , ANNUAL ASSESSMENT J1460 GAMMA GLOBULIN; IM 1cc 02222 CAST MATERIAL, FIBERG, ARM
    99302 LEVEL 2, NEW PROBLEM J2000 LIDOCAINE 02223 CAST MATERIAL, FIBERG, LEG
    99303 LEVEL 3, INITIAL ADMIT TO NH J2550 PHENERGAN UP TO 50 mg
    SUBSEQUENT NURSING FACILITY CARE J0696 ROCEPHIN 250 mg X ____ UNITS
    99311 LEVEL 1, STABLE NH VISIT J3030 IMITREX 6mg X _____ UNITS
    99312 LEVEL 2, MINOR PROBLEM J1055 DEPO-PROVERA 150mg (CONTRACEPTIVE)
    99313 LEVEL 3, MAJOR PROBLEM J1070 DEPO-TESTOSTERONE 100mg
    PROCEDURES J1080 DEPO-TESTOSTERONE 200mg
    94640 AIRWAY INHALATION TREATMENT J9215 INTERFERON .05cc
    46600 ANOSCOPY;DIAGNOSTIC J3301 KENALOG, PER 10mg
    92551 AUDIOMETRY AIR ONLY

    22022197.xls FAMILY PRACTICE 09/13/2009 FEES SUBJECT TO CHANGE WITHOUT NOTICE

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