Urgent Care Billing and Coding Guidelines

Billing and Coding Guidelines for Urgent Care Practice

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Are you an urgent care provider in the United States looking to streamline your urgent care medical billing and coding practices? The world of healthcare reimbursement is complex, but mastering it is crucial for the financial health of your practice. In this comprehensive guide, we’ll address vital questions such as:

  • What are the CPT codes for urgent care visits?
  • How to ensure accuracy in urgent care billing and coding?
  • What are the essential urgent care coding and billing guidelines?

By the end of this article, you’ll have a clear understanding of the complexities involved in urgent care billing and coding, enabling you to optimize your practice’s revenue cycle.

Understanding Urgent Care CPT Codes

Selecting CPT Code Urgent Care Visit

To efficiently bill for urgent care services, you need to be familiar with the Current Procedural Terminology (CPT) codes specifically designed for this setting. CPT codes for urgent care visits fall into the Evaluation and Management (E/M) category, with the most common codes being 99201-99215.

These codes cover a range of services, from simple problem-focused visits to comprehensive examinations. The choice of code depends on the complexity of the patient’s condition and the extent of the evaluation.

Selecting CPT Code Urgent Care Visit

Choosing the correct urgent care billing codes is crucial for urgent care bills.

Here’s a simplified breakdown:


These codes are for new patient visits, with 99201 being the simplest and 99205 the most complex.


These CPT codes are for established patient visits, with 99211 being the simplest and 99215 the most complex.

You have to consider the patient’s medical history, the level of physical examination, and the complexity of medical decision-making to determine the appropriate code. Documenting these aspects thoroughly is essential to ensure accurate urgent care billing.

Key Elements for Urgent Care Billing and Coding Documentation 

Urgent Care Documentation Essentials

Accurate coding relies heavily on precise documentation. When documenting an urgent care visit, ensure you include the following key elements:

  • Chief Complaint

Clearly state the reason for the visit in the patient’s own words.

  • History of Present Illness

Provide a detailed description of the patient’s current symptoms, including their onset, duration, and any exacerbating or alleviating factors.

  • Review of Systems

Document the patient’s relevant symptoms or complaints in various body systems.

  • Physical Examination 

Perform a thorough examination and document your findings, focusing on the affected area or system.

  • Medical Decision-Making

Explain the thought process behind your diagnosis, any tests ordered, and the treatment plan.

  • Time

If time is a significant factor in the encounter, be sure to document the amount of time spent with the patient.

Urgent Care Billing Guidelines

Guidelines For Urgent Care Bills

Billing for urgent care services involves more than just coding. You must also follow specific guidelines to ensure accurate reimbursement. Here are some essential billing guidelines for urgent care practices:

  • Verify Insurance

Check the patient’s insurance coverage and eligibility before the visit to avoid billing issues later.

  • Collect Copayments

Collect any required copayments or deductibles at the time of the visit.

  • Use Modifiers

When necessary, apply modifiers to the CPT codes to indicate special circumstances or procedures performed.

  • Submit Clean Claims

Ensure that claims are error-free and submitted promptly to avoid delays in reimbursement.

  • Stay Updated

Keep up with changes in billing regulations and coding updates to remain compliant.

Billing and Coding Software

Urgent Care Practice Management Software

Using billing and coding software designed for urgent care practices will give you an edge. These tools can help streamline the medical billing and coding process, reduce errors, and improve billing accuracy. Many software solutions offer features like automatic code suggestions, claim tracking, and reporting, such as the one we offer at GreenSense Billing. These practice management software are no less than a life-saver for your urgent care practice.

The Role of Documentation in Audits

Proper documentation is your best defense in case of audits or billing disputes. It not only supports accurate coding but also demonstrates the medical necessity of the services provided.

Resources for Ongoing Learning

The field of healthcare billing and coding is dynamic, and it’s essential to stay informed. Take advantage of resources such as online courses, seminars, and professional organizations to keep your knowledge up-to-date.


Billing and coding for urgent care services require a solid understanding of CPT codes, accurate documentation, and adherence to urgent care billing guidelines. By following these guidelines, you can optimize your practice’s revenue cycle, reduce billing errors, and ensure proper reimbursement for the valuable care you provide to your patients.

As an urgent care provider, staying informed and continuously refining your urgent care billing and coding processes is essential to the financial success of your practice. By mastering these fundamentals, you’ll be better equipped to navigate the complexities of the healthcare reimbursement landscape in the United States.



Following are the common urgent care billing and coding questions we receive daily. Let’s see if they can help you out.

FAQs For Urgent Care Billing1: What are the essential CPT codes for billing urgent care services?

Common CPT codes for urgent care include 99201-99215. You have to select the appropriate code based on the complexity of the patient’s condition and evaluation.

2: How can I ensure accurate billing and coding for urgent care visits?

Accurate coding requires thorough documentation. Document the patient’s chief complaint, history, examination findings, medical decision-making, and any additional procedures performed.

3: What are modifiers in urgent care billing, and when should they be used?

Modifiers are two-digit codes added to CPT codes to provide additional information about a service. They should be used when needed to convey special circumstances or procedures performed during the visit.

4: How can I stay updated with changes in urgent care billing regulations?

To stay informed, subscribe to industry newsletters, join relevant professional organizations, and consider using billing and coding software like GreenSense Billing, which often incorporates updates and best practices.

5: What is the role of proper documentation in urgent care billing?

Proper documentation is crucial for accurate billing. It supports correct coding and justifies the medical necessity of services during audits or disputes.

6: How can I handle insurance verification for urgent care patients?

Verify insurance coverage and eligibility before the patient’s visit to prevent billing complications and to ensure timely reimbursement.

7: What are some common errors to avoid in urgent care bills?

Common errors include incorrect coding, failure to collect copayments, and submitting claims with missing or inaccurate patient information. You can reach out to our representatives at GreenSense Billing to learn more and reduce such errors.

8: Are there specific guidelines for billing procedures like sutures or X-rays in urgent care?

Yes, each procedure has its corresponding CPT code. Ensure that you use the appropriate code and document the procedure’s details to support billing.

9: How do I appeal denied claims in urgent care billing?

If a claim is denied, review the denial reason, correct any errors, and resubmit the claim with additional documentation if necessary. GreenSense Billing can help you track and manage claim appeals.

10: Can outsourcing urgent care billing and coding streamline the process?

Yes, outsourcing to a reliable medical billing service can save time, reduce errors, and improve revenue collection, allowing you to focus on patient care while maximizing your collections.

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