CPT Code 99205: Billing Compliance and Audit Defense Guide [2026]
Fact Detail Code 99205 Short Description New patient office or other outpatient E/M visit Patient Type New patient; no professional services from the same provider, same specialty, or same group within the prior three years MDM Level Required High complexity Minimum Time 60 minutes of total provider time on the date of the encounter Two […]
CPT Code 99204: Complete Billing, Audit Defense and Claim Compliance Guide [2026]
CPT code 99204 is an evaluation and management code used for new patient office or other outpatient visits requiring moderate medical decision making or 45 to 59 minutes of total time on the date of the encounter. It’s also one of the most frequently audited new patient E/M codes by Medicare Recovery Audit Contractors. Documentation […]
CPT Code 99203: Complete Billing, Audit Defense and Claim Compliance Guide [2026]
What Is CPT Code 99203? CPT code 99203 is an evaluation and management (E/M) code used for new patient office or outpatient visits requiring a medically appropriate history and/or examination and low medical decision making complexity, with a total encounter time of 30 to 44 minutes. It’s also among the most frequently audited new patient […]
CPT Code 99202: Complete Billing, Audit Defense and Claim Compliance Guide [2026]
The HHS Office of Inspector General has flagged evaluation and management coding as a persistent payment integrity concern for years. Recovery Audit Contractors recovered more than $900 million in improper E/M payments across the most recent three-year audit cycle. CPT code 99202 sits near the top of that review list every single cycle. CPT code […]
CPT Code 97140: The Audit Defense, Denial Recovery, and Revenue Recapture Guide for 2026
CPT code 97140 is the billing code for manual therapy techniques, including mobilization, manipulation, manual lymphatic drainage, and manual traction, performed for one or more regions, each 15 minutes, as defined by the American Medical Association CPT Editorial Panel. For practices already billing this code, the more important question is not what it is. The […]
POS 22 in Medical Billing: The 2026 Complete Guide for Healthcare Providers
Table of Contents POS 22 in medical billing is the official CMS designation for On Campus-Outpatient Hospital. It identifies that a patient received care within the hospital’s main campus in an outpatient department without being formally admitted. This code goes in Item 24B of the CMS-1500 form for each service line, and it directly determines […]
Occupational Therapy CPT Codes 2026: Complete Billing Guide, Reimbursement Rates and Denial Prevention
Written by the Claimmax RCM Billing Specialists Team. Reviewed by a Certified Professional Coder (CPC). Last Updated: [April 2026]. Occupational therapy CPT codes are five-digit numeric codes used by occupational therapists and billing specialists to report services to Medicare, Medicaid, and commercial insurance payers. The most frequently used occupational therapy CPT codes fall into five […]
What Is an Entity Code in Medical Billing? Types, Errors and Fixes
You submitted a clean claim. Everything looked right: the diagnosis codes, the procedure codes, the patient information. Then it came back rejected with a message that said “this code requires use of an entity code.” No further explanation. Just a rejection sitting in your queue costing you time and money. That’s one of the most […]
CPT Code 93306: Payer-Specific Compliance, Audit Defense and Denial Recovery Playbook [2026]
The average cardiology practice bills CPT code 93306 between 40 and 80 times per week. At roughly $220 per claim, that’s $450,000 to $900,000 in annual echocardiogram revenue from a single CPT code. Yet CMS Recovery Audit Contractor data shows that transthoracic echocardiography ranks among the top 10 most audited diagnostic services in Medicare, with […]
Eligibility Verification & Prior Authorization: Key Differences Every Healthcare Practice Must Know [2026]
A billing coordinator at a busy orthopedic practice picks up the phone and calls the insurance company. “I need to verify the patient’s eligibility for an MRI,” she says. The rep on the other end pauses, then asks: “Do you need eligibility verification or prior authorization?” The coordinator hesitates. Aren’t those the same thing? That […]