Billing & Coding · 2026 CMS PFS

Find every dollar your coding misses.

Every code that drives outpatient internal medicine and medicine subspecialty revenue. When to use it, what to document, what gets denied, and how much it pays at your bonus rate.

2026 Medicare conversion factor: $33.4009 · National GPCI = 1.000 · Non-facility rates · 196 codes · 12 specialties

By specialty

Top codes, common visit patterns, and modifier rules per medicine specialty.

See all 12
Outpatient IM
Internal Medicine

The bread and butter: established office visits, new-patient workups, complex chronic disease bundles, and wellness add-ons. The codes that move primary care RVUs are E/M time/MDM, G2211, and the wellness stack.

9921399214992159920499205
Geri / CCM
Geriatrics & Care Management

Heavy on Medicare wellness, chronic care management, transitional care, advance care planning, cognitive assessment, and SDOH. These are time-based codes with strict documentation; getting the documentation right turns 20 minutes of phone work into real RVUs.

G0438G0439994909943999495
Cardiology
Cardiology

Mixed E/M plus high-volume diagnostic procedures: EKGs, echos, stress tests, Holters, device interrogations, vascular ultrasound. Most cardiology procedures split into professional, technical, and global components.

9921499215G22119300093010
Endo
Endocrinology

Cognitive specialty, mostly E/M. Procedural revenue comes from CGM interpretation, thyroid ultrasound and biopsy, and MNT supervision. CGM coding is a regulatory layer cake — get the time, sensor source, and patient setup right or the claim gets denied.

9921499215G22119524995250
GI
Gastroenterology

Procedure-heavy. Most outpatient GI revenue comes from upper and lower endoscopy with modifier-driven add-ons (biopsy, polypectomy, dilation). Screening vs diagnostic coding has different patient cost shares and modifier rules.

9921499215453784538045385
Pulm
Pulmonology

Office spirometry, pulmonary function testing, bronchoprovocation, sleep medicine. Spirometry is one of the most under-coded ancillaries in primary-care-adjacent practices because the bronchodilator add-on gets forgotten.

9921499215940109406094375
Nephro
Nephrology

ESRD monthly capitation drives outpatient nephrology revenue (MCP, 90951-90970), plus CKD E/M, vascular access procedures, and home dialysis training. MCP coding is age-stratified and visit-frequency stratified.

9921499215909519095490957
Rheum
Rheumatology

Cognitive specialty with high-yield joint and soft tissue injections, plus chronic infusion management. Joint injection coding is anatomic-site stratified, and ultrasound guidance is its own bundled code.

9921499215G22112061020611
ID
Infectious Disease

Almost entirely cognitive. Revenue depends on accurate complexity coding (99214/99215 with G2211), outpatient infusion management, and prolonged service coding for long visits. Antimicrobial stewardship rounds are not billable.

99204992059921499215G2211
Heme/Onc
Hematology / Oncology

Infusion-driven revenue dominates: chemotherapy administration codes are time-stratified and drug-type stratified, with strict hierarchy rules. Cognitive E/M with G2211 is critical for survivorship and chronic disease management.

9920599215G22119641396415
Neurology
Neurology

Cognitive specialty with high-RVU diagnostic procedures: EEG, EMG/NCS, evoked potentials, cognitive assessment. Most procedures split into professional and technical components. Cognitive assessment care plan (99483) is one of the highest-RVU outpatient codes in medicine.

99204992059921499215G2211
Allergy
Allergy / Immunology

Three revenue pillars: percutaneous and intradermal allergy testing (per-test billing), immunotherapy preparation and administration (95115-95170), and biologic injection management. Testing codes are billed per-test, so unit counts matter.

9920499214950049502495044
Educational reference, not billing or legal advice. RVU and CF values reflect the 2026 CMS Physician Fee Schedule (national, non-facility, GPCI = 1). Payer policies vary; verify against your contracts and your compliance team before final coding. Coverage of codes is curated, not exhaustive. New content quarterly.