Specialties
Pick a specialty for top-billed codes, common visit scenarios, and modifier rules tailored to that practice setting.
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.
References for wellness visits, chronic care, transitions of care and cognitive assessment. Each service has its own eligibility, timing and documentation requirements.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
For Medicare prolonged hospital care, use G0316 with eligible time-selected 99223, 99233, or 99236 and current CMS thresholds. For payers recognizing CPT prolonged hospital services, check 99418. Deleted 99356/99357 codes are not current alternatives.
Imaging references organized by modality, anatomy and service components. Select codes from the examination actually performed, then verify coverage and current bundling rules.