Urgent care coding and billing updates: What changed for 2025?

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.

Basic Blood Draw

36415

Venipuncture; bill separately if payer allows (not bundled).

Urinalysis (UA)

81002 (Dipstick, non-automated, no microscopy)
81003 (Automated)
81015 (Microscopic, manual)

Add QW if CLIA-waived. Part of urgent care labs.

Pregnancy Tests (Urine/Serum)

81025 (Urine qualitative)
84703 (Serum qualitative)
84702 (Quantitative serum)

QW for waived urine tests.

Glucose Tests

82947 (Blood glucose, quantitative)
82948 (Glucometer)
82962 (Glucose by glucose meter, whole blood)

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)
87635 (NAAT, PCR)

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)
87811 (Antigen combo)

Verify CLIA status for waived panels.

COVID Antibody

86769

For IgG/IgM antibodies.

CBC (Complete Blood Count)

85025 (Automated with diff)
85027 (Automated, no 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.

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.

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