A–Z Index
All 326 wiki entries in one place.
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- CPT 10060: Incision and Drainage of Abscess, Simple
- CPT 11042: Debridement, Subcutaneous Tissue, First 20 sq cm
- CPT 11721: Debridement of Nails, 6 or More
- CPT 12001: Simple Repair, Scalp/Neck/Axilla/Trunk 2.5 cm or Less
- CPT 17000: Destruction of Premalignant Lesion, First Lesion
- CPT 20552: Trigger Point Injection, 1 or 2 Muscles
- CPT 20610: Major Joint Injection/Aspiration
- CPT 29881: Knee Arthroscopy with Meniscectomy
- CPT 43239: Upper Endoscopy (EGD) with Biopsy
- CPT 45378: Diagnostic Colonoscopy
- CPT 64483: Transforaminal Epidural Injection, Lumbar/Sacral
- CPT 66984: Cataract Removal with IOL Insertion
- CPT 70450: CT Head/Brain Without Contrast
- CPT 71046: Chest X-Ray, 2 Views
- CPT 72148: MRI Lumbar Spine Without Contrast
- CPT 73030: Shoulder X-Ray, Complete
- CPT 74177: CT Abdomen and Pelvis With Contrast
- CPT 76700: Abdominal Ultrasound, Complete
- CPT 76942: Ultrasound Guidance for Needle Placement
- CPT 77067: Screening Mammography, Bilateral
- CPT 80048: Basic Metabolic Panel (BMP)
- CPT 80053: Comprehensive Metabolic Panel (CMP)
- CPT 80061: Lipid Panel
- CPT 81003: Urinalysis, Automated, Without Microscopy
- CPT 82947: Glucose, Blood, Quantitative
- CPT 83036: Hemoglobin A1c (Glycosylated Hemoglobin)
- CPT 84443: Thyroid Stimulating Hormone (TSH)
- CPT 85025: Complete Blood Count (CBC) with Automated Differential
- CPT 85610: Prothrombin Time (PT/INR)
- CPT 88305: Surgical Pathology, Level IV (Tissue Exam)
- CPT 90471: Immunization Administration (First Vaccine)
- CPT 90686: Influenza Vaccine (IIV4, 0.5 mL)
- CPT 90715: Tdap Vaccine (Tetanus, Diphtheria, Pertussis)
- CPT 93000: Electrocardiogram, Complete
- CPT 93306: Transthoracic Echo With Doppler, Complete
- CPT 96372: Therapeutic, Prophylactic, or Diagnostic Injection (SC/IM)
- CPT 97010: Hot and Cold Packs (Bundled)
- CPT 97110: Therapeutic Exercise
- CPT 97112: Neuromuscular Reeducation
- CPT 97140: Manual Therapy Techniques
- CPT 97161: Physical Therapy Evaluation, Low Complexity
- CPT 97165: Occupational Therapy Evaluation, Low Complexity
- CPT 97530: Therapeutic Activities
- CPT 98940: Chiropractic Manipulative Treatment, 1-2 Regions
- CPT 99202: New Patient Office Visit, Straightforward
- CPT 99203: New Patient Office Visit, Low Complexity
- CPT 99204: New Patient Office Visit, Moderate Complexity
- CPT 99205: New Patient Office Visit, High Complexity
- CPT 99211: Established Patient Office Visit, Minimal
- CPT 99212: Established Patient Office Visit, Straightforward
- CPT 99213: Established Patient Office Visit, Low Complexity
- CPT 99214: Established Patient Office Visit, Moderate Complexity
- CPT 99215: Established Patient Office Visit, High Complexity
- CPT 99417: Prolonged Outpatient E/M, Each 15 Minutes
- CPT 99421: Online Digital E/M, 5-10 Minutes
- CPT 99422: Online Digital E/M, 11-20 Minutes
- CPT 99423: Online Digital E/M, 21 or More Minutes
- CPT 99439: Chronic Care Management, Each Additional 20 Minutes
- CPT 99453: Remote Patient Monitoring Setup and Education
- CPT 99454: Remote Patient Monitoring Device Supply, 16-30 Days
- CPT 99457: Remote Patient Monitoring Treatment Management, First 20 Minutes
- CPT 99458: Remote Patient Monitoring Treatment Management, Each Additional 20 Minutes
- CPT 99484: General Behavioral Health Integration Care Management
- CPT 99487: Complex Chronic Care Management, First 60 Minutes
- CPT 99489: Complex Chronic Care Management, Each Additional 30 Minutes
- CPT 99490: Chronic Care Management, First 20 Minutes
- CPT 99491: Chronic Care Management, Physician First 30 Minutes
- CPT 99492: Initial Psychiatric Collaborative Care Management
- CPT 99493: Subsequent Psychiatric Collaborative Care Management
- CPT 99494: Psychiatric Collaborative Care, Each Additional 30 Minutes
- CPT 99495: Transitional Care Management, Moderate Complexity
- CPT 99496: Transitional Care Management, High Complexity
A
- Accounts Receivable Days (A/R Days)
- ABN: Advance Beneficiary Notice of Noncoverage
- Aetna: Timely Filing, Appeals, and Billing Guide
- Aging Report (A/R Aging)
- Allowed Amount
- Anthem (Elevance Health): Timely Filing, Appeals, and Billing Guide
- Anti-Kickback Statute (AKS): Remuneration for Referrals
- Assignment of Benefits (AOB)
C
- Capitation
- CAQH ProView (DataSpring)
- CARC vs RARC: Group Codes, Reason Codes, and Remark Codes Explained
- CCS Certification (Certified Coding Specialist)
- Centene: Timely Filing, Appeals, and Billing Guide
- Charge Capture
- Charge Lag
- Chargemaster (CDM)
- Cigna (Cigna Healthcare): Timely Filing, Appeals, and Billing Guide
- Claim Scrubbing
- Clean Claim
- Clearinghouse: The EDI Intermediary Between Providers and Payers
- CMS 60-Day Overpayment Rule
- CO-4 Denial Code: Procedure Code Inconsistent With Modifier
- CO-6 Denial Code: Procedure/Revenue Code Inconsistent With Patient Age
- CO-11 Denial Code: Diagnosis Inconsistent With the Procedure
- CO-15 Denial Code: Missing, Invalid, or Inapplicable Authorization Number
- CO-16 Denial Code: Claim Lacks Information or Has Submission Errors
- CO-18 Denial Code: Exact Duplicate Claim or Service
- CO-19 Denial Code: Work-Related Injury, Liability of Workers' Compensation Carrier
- CO-22 Denial Code: Care May Be Covered by Another Payer (Coordination of Benefits)
- CO-23 Denial Code: Impact of Prior Payer(s) Adjudication
- CO-24 Denial Code: Charges Covered Under a Capitation Agreement or Managed Care Plan
- CO-27 Denial Code: Expenses Incurred After Coverage Terminated
- CO-29 Denial Code: The Time Limit for Filing Has Expired
- CO-31 / PR-31 Denial Code: Patient Cannot Be Identified As Our Insured
- CO-45 Denial Code: Charge Exceeds Fee Schedule / Maximum Allowable
- CO-50 Denial Code: Non-Covered Services Not Deemed Medically Necessary
- CO-59 Denial Code: Processed Based on Multiple or Concurrent Procedure Rules
- CO-96 Denial Code: Non-Covered Charge(s)
- CO-97 Denial Code: Benefit Included in Payment for Another Service
- CO-107 Denial Code: Related or Qualifying Claim/Service Not Identified
- CO-109 Denial Code: Claim/Service Not Covered by This Payer/Contractor
- CO-119 Denial Code: Benefit Maximum for This Time Period Reached
- CO-131 Denial Code: Claim Specific Negotiated Discount
- CO-140 / PR-140 Denial Code: Patient/Insured ID Number and Name Do Not Match
- CO-146 Denial Code: Diagnosis Was Invalid for the Date(s) of Service
- CO-151 Denial Code: Information Does Not Support This Many/Frequency of Services
- CO-167 Denial Code: Diagnosis(es) Not Covered
- CO-170 Denial Code: Payment Denied When Performed/Billed by This Type of Provider
- CO-181 Denial Code: Procedure Code Was Invalid on the Date of Service
- CO-183 Denial Code: Referring Provider Not Eligible to Refer the Service Billed
- CO-197 Denial Code: Precertification/Authorization/Notification Absent
- CO-198 Denial Code: Precertification/Notification/Authorization Exceeded
- CO-204 Denial Code: Service Not Covered Under the Patient's Benefit Plan
- CO-231 Denial Code: Mutually Exclusive Procedures Same Day or Setting
- CO-236 Denial Code: Procedure or Modifier Combination Not Compatible (NCCI)
- CO-252 Denial Code: Attachment or Other Documentation Required
- CO-B7 Denial Code: Provider Not Certified or Eligible on This Date of Service
- CO-B15 Denial Code: Qualifying Service Not Received or Adjudicated
- Coinsurance
- Contractual Adjustment
- Conversion Factor
- Coordination of Benefits (COB)
- Copay (Copayment)
- Cost to Collect
- CPC Certification (Certified Professional Coder)
- Credentialing vs Contracting
D
E
- EDI 270/271: Eligibility and Benefit Inquiry and Response
- EDI 276/277: Claim Status Request and Response
- EDI 277CA: Claim Acknowledgment
- EDI 278: Health Care Services Review (Authorization/Referral)
- EDI 835: Health Care Claim Payment/Advice (ERA)
- EDI 837I: Institutional Health Care Claim
- EDI 837P: Professional Health Care Claim
- EDI 999: Implementation Acknowledgment
- Electronic Remittance Advice (ERA / 835)
- Eligibility Verification
- ERA vs EOB: The Difference
- Explanation of Benefits (EOB)
F
G
- HCPCS G0402: Initial Preventive Physical Exam (Welcome to Medicare)
- HCPCS G0438: Initial Annual Wellness Visit
- HCPCS G0439: Subsequent Annual Wellness Visit
- HCPCS G2211: Visit Complexity Add-On for Longitudinal E/M Care
- HCPCS G2212: Prolonged Outpatient E/M for Medicare, Each 15 Minutes
- Global Period
- Gross Collection Rate
- Guarantor
H
J
M
- MACRA
- Medicaid: Timely Filing, Appeals, and Billing Guide
- Medical Biller (Role)
- Medical Billing and Coding Salary (2026)
- Medical Coder (Role)
- MUE: Medically Unlikely Edits
- Medical Necessity
- Medical Record Documentation: The Foundation of Compliant Billing
- Medicare (Original Medicare): Timely Filing, Appeals, and Billing Guide
- Medicare Provider Enrollment
- Medicare Part A
- Medicare Part B
- Medicare Part C (Medicare Advantage)
- Medicare Part D
- Medicare Redetermination (First-Level Appeal)
- Medicare Secondary Payer (MSP)
- Medigap (Medicare Supplement)
- MIPS (Merit-based Incentive Payment System)
- Modifier 24: An Unrelated E/M Visit During a Surgical Global Period
- Modifier 25: A Significant, Separate E/M Visit on the Same Day as a Procedure
- Modifier 26: Billing Only the Professional Component (the Interpretation)
- Modifier 50: The Same Procedure Done on Both Sides of the Body
- Modifier 51: Multiple Procedures Performed at the Same Session
- Modifier 52: A Procedure That Was Deliberately Reduced or Cut Short
- Modifier 53: A Procedure Stopped Because Continuing Would Endanger the Patient
- Modifier 57: The Visit Where the Decision for Major Surgery Was Made
- Modifier 59: A Distinct, Separate Procedure That Normally Bundles
- Modifier 76: The Same Provider Repeats the Same Procedure the Same Day
- Modifier 77: A Different Provider Repeats the Same Procedure the Same Day
- Modifier 78: An Unplanned Return to the OR for a Related Problem During the Global Period
- Modifier 79: An Unrelated Procedure by the Same Provider During the Global Period
- Modifier 91: The Same Lab Test Repeated on the Same Day for New Results
- Modifier 95: A Visit Delivered by Real-Time Audio and Video Telehealth
- Modifier GA: An ABN Is on File, So the Patient Accepts Liability
- Modifier GT: The Legacy Telehealth Modifier Most Payers Replaced
- Modifier GY: A Service Medicare Never Covers by Law
- Modifier GZ: You Expect a Denial and Have No ABN to Protect You
- Modifiers LT and RT: Telling the Payer Which Side of the Body Was Treated
- Modifier TC: Billing Only the Technical Component (the Equipment and Staff)
- Modifier XE: A Distinct Service Because It Happened at a Separate Encounter
- Modifier XP: A Distinct Service Because a Different Practitioner Performed It
- Modifier XS: A Distinct Service Because It Was a Separate Organ or Structure
- Modifier XU: A Distinct Service Because It Does Not Overlap the Main Procedure
- Molina Healthcare: Timely Filing, Appeals, and Billing Guide
O
P
- Patient Statements
- Payer ID: The Electronic Routing Number for Claims
- Payment Posting
- PECOS
- PI-204 Denial Code: Service Not Covered Under the Patient's Benefit Plan
- Point-of-Service Collections
- Place of Service Codes: How POS Changes What You Get Paid
- POS 02: Telehealth Provided Other Than in Patient's Home
- POS 10: Telehealth Provided in Patient's Home
- POS 11: Office
- POS 12: Home
- POS 19: Off Campus-Outpatient Hospital
- POS 20: Urgent Care Facility
- POS 21: Inpatient Hospital
- POS 22: On Campus-Outpatient Hospital
- POS 23: Emergency Room - Hospital
- POS 24: Ambulatory Surgical Center
- POS 31: Skilled Nursing Facility
- POS 32: Nursing Facility
- POS 49: Independent Clinic
- POS 50: Federally Qualified Health Center
- POS 60: Mass Immunization Center
- POS 65: End-Stage Renal Disease Treatment Facility
- POS 81: Independent Laboratory
- PR-1 Denial Code: Deductible Amount
- PR-2 Denial Code: Coinsurance Amount
- PR-3 Denial Code: Co-payment Amount
- PR-27 Denial Code: Expenses Incurred After Coverage Terminated
- PR-49 Denial Code: Non-Covered Routine / Preventive Exam or Screening
- PR-119 Denial Code: Benefit Maximum for This Time Period or Occurrence Reached
- PR-204 Denial Code: Service Not Covered Under the Patient's Benefit Plan
- Prior Authorization
R
- Remittance Advice Remark Codes (RARC): The Complete Overview
- RARC M15: Separately Billed Services Bundled Into the Same Procedure
- RARC M16: See Payer Website, Mailings, or Bulletins for Policy Details
- RARC M25: Information Does Not Substantiate This Level of Service
- RARC M27: Patient Relieved of Liability — Provider Holds the Charges
- RARC M51: Missing, Incomplete, or Invalid Procedure Code
- RARC M76: Missing, Incomplete, or Invalid Diagnosis or Condition
- RARC M77: Missing, Incomplete, Invalid, or Inappropriate Place of Service
- RARC M79: Missing, Incomplete, or Invalid Charge
- RARC M80: Not Covered With a Previously Processed Service, Same Session or Date
- RARC M86: Payment Already Made for Same or Similar Service Within Set Time Frame
- RARC M97: Not Paid to Practitioner in This Place of Service — Paid to Facility
- RARC M117: Not Covered Unless Submitted via Electronic Claim
- RARC M119: Missing, Incomplete, Invalid, Deactivated, or Withdrawn National Drug Code
- RARC M123: Missing, Incomplete, or Invalid Name, Strength, or Dosage of the Drug
- RARC M127: Missing Patient Medical Record for This Service
- RARC MA01: Appeal Rights Alert — 120 Days to Request Review
- RARC MA04: Secondary Payment Needs Primary Payer Identity or Payment Information
- RARC MA15: Claim Separated to Expedite Handling
- RARC MA18: Claim Information Forwarded to the Patient's Supplemental Insurer
- RARC MA27: Missing, Incomplete, or Invalid Entitlement Number or Name
- RARC MA63: Missing, Incomplete, or Invalid Principal Diagnosis
- RARC MA66: Missing, Incomplete, or Invalid Principal Procedure Code
- RARC MA83: Primary or Secondary Payer Not Indicated on the Claim
- RARC MA130: Unprocessable Claim — Resubmit New, No Appeal Rights
- RARC N4: Missing, Incomplete, or Invalid Prior Insurance Carrier EOB
- RARC N19: Procedure Code Incidental to Primary Procedure
- RARC N30: Patient Ineligible for This Service
- RARC N56: Procedure Code Billed Is Not Correct or Valid for the Services or Date
- RARC N58: Missing, Incomplete, or Invalid Patient Liability Amount
- RARC N95: This Provider Type or Specialty May Not Bill This Service
- RARC N115: Decision Based on a Local Coverage Determination (LCD)
- RARC N130: Consult Plan Benefit Documents for Restrictions on This Service
- RARC N180: Service Does Not Meet Criteria for the Category It Was Billed Under
- RARC N265: Missing, Incomplete, or Invalid Ordering Provider Primary Identifier
- RARC N286: Missing, Incomplete, or Invalid Referring Provider Primary Identifier
- RARC N290: Missing, Incomplete, or Invalid Rendering Provider Primary Identifier
- RARC N291: Missing, Incomplete, or Invalid Rendering Provider Secondary Identifier
- RARC N357: Time Frame Between This Service and a Related Service Not Met
- RARC N425: Statutorily Excluded Service(s)
- RARC N479: Missing Explanation of Benefits for COB or Medicare Secondary Payer
- RARC N522: Duplicate of a Claim Processed as a Crossover Claim
- RARC N598: Health Care Policy Coverage Is Primary
- RARC N706: Claim Held for Missing Documentation
- RCM KPIs
- Referral (Insurance)
- Remittance Advice
- Remote Medical Billing Jobs
- Revalidation
- Revenue Cycle Management (RCM)
- RHIA and RHIT Certifications
- RVU (Relative Value Unit)
