Urgent care coding and billing updates: What changed for 2025?
The urgent care coding updates for 2025 bring critical changes in urgent care CPT codes, urgent care procedures, and ICD-10 coding. Practices must follow the latest medical coding updates, maintain proper urgent care documentation, and ensure urgent care compliance to align with risk adjustment coding models.
Commonly Billable in Urgent Care Procedure
E/M visits (99202–99205, 99212–99215)
- Level by MDM or time (same framework as 2023+ rules).
- For urgent care coding, MDM usually fits better than time. Document problem acuity, data reviewed (tests, records), and risk (e.g., Rx with side-effects, minor vs. major procedures with risk).
- Do not add G2211 unless your UC provider (or group) maintains ongoing care with the patient (rare for urgent care procedure). If it’s episodic—no G2211
Wound Care & Minor Surgery in urgent care billing
Service | CPT Examples (2025) | Notes |
Laceration repair (simple, intermediate, complex) | 12001–13160 | Code by location, length, and complexity. Bundle supplies unless the payer allows urgent care HCPCS supply billing. |
Incision & drainage (I&D) | 10060–10061 (abscess), 10080–10081 (pilonidal cyst) | Document anesthesia, site, drainage, and packing. |
Foreign body removal | 10120 (subcutaneous), 30300 (nose), 65205–65222 (eye) | Bill for complexity, include X-ray if performed. |
Nail procedures | 11730 (avulsion), 11750 (matrixectomy) | Bill supplies separately if payer allows. |
Burn care/debridement | 16020–16030 | Size and depth matter for urgent care procedure. |
Proper coding ensures both urgent care billing compliance and supports urgent care ICD-10 coding accuracy while keeping up with the latest medical coding updates.
Urgent Care CPT Codes and Lab Documentation 2025
The urgent care coding update for 2025 brings critical changes in urgent care CPT codes, urgent care procedures, and ICD-10 coding. Practices must follow the latest medical coding updates, maintain proper urgent care documentation, and ensure urgent care compliance to align with risk adjustment coding models.
Lab / Test | CPT Code(s) | Notes |
Basic Blood Draw | 36415 | Venipuncture; bill separately if payer allows (not bundled). |
Urinalysis (UA) | 81002 (Dipstick, non-automated, no microscopy) | Add QW if CLIA-waived. Part of urgent care labs. |
Pregnancy Tests (Urine/Serum) | 81025 (Urine qualitative) | QW for waived urine tests. |
Glucose Tests | 82947 (Blood glucose, quantitative) | 82962 is most common in urgent care CPT codes. (waived). |
HbA1c | 83036 | Waived device = QW modifier. |
Rapid Strep Test | 87880 | CLIA-waived; QW. |
Rapid Flu Test | 87804 (per type) | Bill 87804 x2 if A & B tested. |
COVID-19 Tests (POC) | 87426 (Antigen, EIA, direct) | QW for waived antigen tests. |
RSV Rapid Test | 87807 | QW. |
Mono Test | 86308 | QW. |
COVID/Flu Combo | 87636 (Flu A/B + SARS-CoV-2, NAAT) | Verify CLIA status for waived panels. |
COVID Antibody | 86769 | For IgG/IgM antibodies. |
CBC (Complete Blood Count) | 85025 (Automated with diff) | Requires moderate complexity; not waived. |
Basic Metabolic Panel | 80048 | Moderate complexity. |
Comprehensive Metabolic Panel (CMP) | 80053 | Moderate complexity. |
Lipid Panel | 80061 | Moderate complexity. |
Rapid HIV | 87806 | QW for waived rapid test. |
Urine Drug Screen | 80305 (Presumptive, per drug class) | QW if waived kit. |
Fluorescent Treponemal Antibody (FTA-ABS) | 86780 | STD screening; moderate complexity. |
Throat Culture | 87070 (Bacterial culture) | Send-out test (facility may bill globally or reference lab may bill). |
Urine Culture | 87086 | Bill if performed in-house. |
Wound/Abscess Culture | 87070–87075 | Include specimen site documentation. |
Rapid RSV Antigen | 87807 | QW if waived. |
Rapid Influenza A/B Antigen | 87804 | Per type. |
Stool Occult Blood (FOBT) | 82270 (Guaiac, single test) | QW if waived. |
RSV + Flu + COVID Combo Panels | 0241U, 0242U (Molecular panels) | Proprietary codes; verify payer coverage. |
POC Creatinine | 82565 | Waived if on CLIA-waived device. |
Proper use of urgent care coding labs and CPT coding reduces denials and aligns with urgent care ICD-10 documentation for risk adjustment coding, ensuring that every urgent care coding update is accurately implemented.
Smoking & Tobacco Cessation Coding
Code | Description | Time / Unit | Use Case |
99406 | Smoking & tobacco use cessation counseling, intermediate | >3 minutes, up to 10 minutes | For brief counseling in urgent care visits and urgent care procedure. |
99407 | Smoking & tobacco use cessation counseling, intensive | >10 minutes | Bill when you spend more time on counselling in urgent care documentation. |
G0436 | Smoking/tobacco cessation counseling, 3–10 minutes, initial attempt, Medicare | Initial cessation attempt; Medicare Part B only. | |
G0437 | Smoking/tobacco cessation counseling, >10 minutes, subsequent attempt, Medicare | Subsequent attempt; Medicare Part B only. | |
G0442 | Annual alcohol misuse screening, 15 min | Related preventive; sometimes paired with cessation counseling. | |
G0443 | Alcohol misuse counselling, 15 min | Use if counselling both tobacco & alcohol. |
Billable DME HCPCS Codes
Category | HCPCS Code(s) | Description | Notes |
Splints / Cast Supplies | Q4001–Q4051 | Cast supplies (per type, size, material) | Bill with casting application CPT (e.g., 29075). Not all payers reimburse separately. |
L3908 | Wrist-hand orthosis, prefabricated, off-the-shelf | Often billed when a splint is dispensed. | |
L3807 | Elbow-wrist-hand orthosis, prefab, off-the-shelf | Document medical necessity. | |
L3984 | Wrist-hand-finger orthosis, prefab, off-the-shelf | ||
L4386 | Walking boot, pneumatic (CAM boot) | Bill if dispensed. | |
L4361 | Walking boot, non-pneumatic | ||
L1832 | Knee orthosis, adjustable knee brace, off-the-shelf | Common for sprains. | |
Arm & Shoulder | A4565 | Slings (arm, shoulder) | Off-the-shelf; usually paid separately. |
L3670 | Shoulder orthosis, prefab, off-the-shelf | ||
Ankle & Foot | L4350 | Ankle control orthosis, lace-up (ASO brace) | Document injury (sprain, fracture). |
L1902 | Ankle-foot orthosis, prefabricated, off-the-shelf | ||
Finger & Hand | L3923 | Finger orthosis, static | Often billed for mallet finger, fractures. |
L3809 | Wrist-hand-finger orthosis, static, prefab | ||
Crutches & Walkers | E0110 | Crutches, forearm, pair | |
E0111 | Crutches, forearm, each | ||
E0112 | Crutches, underarm, pair | ||
E0113 | Crutches, underarm, each | ||
E0143 | Walker, folding, wheeled | For urgent care injury management. | |
Canes | E0100 | Cane, includes tip | |
E0105 | Cane, quad or three-prong | ||
Cervical Collars | L0120 | Cervical, flexible, off-the-shelf | |
L0170 | Cervical-thoracic, prefab |
Compliance and Risk Adjustment Coding
Following urgent care compliance protocols, proper CPT coding, and urgent care ICD-10 coding reduces denials and ensures accurate risk adjustment coding. Proper urgent care documentation supports urgent care billing and overall healthcare billing compliance.
Conclusion
Staying up-to-date with urgent care coding updates and urgent care billing is crucial for accurate reimbursement and healthcare billing compliance. Leveraging the latest urgent care CPT codes, urgent care labs, and urgent care ICD-10 documentation ensures that providers capture every risk factor accurately for risk adjustment coding and urgent care risk adjustment models.
By integrating proper urgent care HCPCS, maintaining meticulous urgent care documentation, and adhering to medical coding updates, clinics can optimize operational efficiency, reduce denials, and enhance patient care quality. Implementing these strategies positions your urgent care practice at the forefront of compliance, precision, and coding excellence in 2025.
