2026 Urgent Care CPT Code Guidelines: Updates and More

Urgent care centers operate in a distinctly fast paced clinical environment in comparison to primary or specialty care. Patients must be followed by medical attention within 24 hours of arrival, with many facilities delivering care in under an hour.

This speed, while essential to patient satisfaction, establishes operational challenges, particularly in coding, billing, and insurance verification. Contrasting primary care, urgent care providers often lack time for pre authorization or detailed coverage checks before treatment. As a result, even accurate CPT coding may face inconsistent payer interpretations.

Although urgent care CPT guidelines closely imitate those of primary care, insurers frequently apply different reimbursement rules. A CPT code accepted by one payer may be denied by another, resulting in claim rejections, delayed payments, and revenue leakage.

Staying current with CPT updates, understanding commonly used urgent care codes, and following payer aware best practices is critical for timely reimbursement. This article outlines the most frequently used urgent care CPT codes, highlights key updates, and shares proven strategies to improve billing accuracy.

2026 CPT Code Updates for Urgent Care & Telehealth

Category	CPT Codes	Description	Status
E/M Visits	99202–99205, 99212–99215	New & established patients; MDM-based	Standard
Wound Repair	12001–12018	Superficial closures	Standard
Incision & Drainage	10060–10180	Abscess/cyst drainage	Standard
Foreign Body Removal	20525–20553	Embedded object removal	Standard
Splints & Casts	29000–29799	Musculoskeletal stabilization	Standard
Chest X-ray	71045	Single-view imaging	Standard
Lipid Panel	80061	Cholesterol/lipid test	Standard
Rapid Strep Test	87804	Group A Streptococcus	Standard
Medications	96372, 96374	IM, SC, or IV administration	Standard
Vaccines	90471–90472	First & additional vaccines	Standard
Telemedicine: Video	98000–98007	Audio-video visits	New
Telemedicine: Audio	98008–98015	Audio-only visits	New
Telemedicine: Check-in	98016	Virtual check-in	New
AI Chest Imaging	0877T–0880T	AI-assisted analysis	New
AI ECG	0902T, 0932T	AI-assisted measurements	New
AI Prostate Biopsy	0898T	AI-assisted image-guided biopsy	New
RTM Digital Therapy	98975	Includes digital therapeutic interventions	Revised
RTM Device Supply	98976–98978	Data access/transmission updates	Revised
Intra-Abdominal Tumor Surgery	49186–49190	Tumor/cyst excision by size	New
Skin Replacement Surgery	15011–15018	Autografts for burns/trauma	New
CMC Arthroplasty	25447	Interposition without suspension	Revised
Deleted/Replaced Codes	49203–49205, 99441–99443, 25447, 26480	Replaced by new tumor, telemedicine, and CMC codes	Deleted/Replaced

Why CPT Accuracy Matters in Urgent Care

• High claim denial variability across payers
• Faster reimbursement depends on first pass accuracy
• Increased payer scrutiny in high volume, short visit settings

What Are CPT Codes for Urgent Care?

Current Procedural Terminology (CPT) codes are standardized five digit alphanumeric codes used to document medical services and procedures. They ensure consistent communication between providers, payers, and regulators.

The American Medical Association (AMA) classifies CPT codes into three categories:

• Category I: Commonly performed services such as Evaluation and Management (E/M), radiology, laboratory, and diagnostic procedures
• Category II: Optional tracking codes used for quality measurement and performance improvement
• Category III: Temporary codes for emerging technologies and procedures under evaluation

Which CPT Codes Are Most Common in Urgent Care?

1. Front Door Evaluation (E/M Codes)

Defined primarily by Medical Decision Making (MDM) and total provider time, including documentation and care coordination.

• New Patients: 99202–99205
• Established Patients: 99212–99215

2. Point of Care Procedure Codes

Used for services frequently performed during urgent care visits:

• Wound Repair (12001–12018): Superficial wound closures
• Incision and Drainage (10060–10180): Abscesses, cysts, fluid collections
• Foreign Body Removal (20525–20553): Embedded objects in tissue or joints
• Splints and Casts (29000–29799): Musculoskeletal stabilization

3. On Site Diagnostic Testing Codes

Accurate test coding is essential for reimbursement:

• Chest Xray (71045): Single view imaging
• Lipid Panel (80061): Cholesterol and lipid analysis
• Rapid Strep Test (87804): Group A Streptococcus detection

4. Medication Administration Codes

Used to report therapeutic drug delivery:

• 96372: Intramuscular or subcutaneous injection
• 96374: IV push administration

5. Preventive and Immunization Administration Codes

• 90471: First vaccine administered
• 90472: Each additional vaccine during the same encounter

How Are Services Without Direct CPT Codes Handled?

For services lacking a direct CPT equivalent, HCPCS Level II S-Codes may be used when required by private payers. These codes are not universally accepted and carry higher denial risk.

Use S-codes only when:

• The payer explicitly requires them
• The clinic operates under a flat rate model (e.g., S9083)
• No CPT alternative exists for a commonly performed urgent care service

Common Urgent Care S-Codes:

• S9083: Global urgent care visit fee
• S9088: Additional urgent care service cost, billed with E/M codes

2026 CPT Updates Urgent Care Providers Must Watch

The AMA introduced 270 new CPT codes, revised 38, and removed 112 in 2025 to reflect advances in digital health, AI, and procedural care.

Key updates affecting urgent care include:

• Expanded Remote Therapeutic Monitoring (RTM):
  Codes 98976–98978 now include digital therapeutic interventions and device data transmission.
• AI Augmented Procedures (Category III):
  New codes support AI assisted analysis for chest imaging and ECG interpretation, signaling increased documentation expectations.
• Updated Surgical and Wound Care Codes:
  New CPTs reflect advances in skin grafting and intra abdominal tumor procedures.

The table below highlights CPT changes most relevant to urgent care workflows and reimbursement.

Managing reimbursement in urgent care, amid rising patient volume, payer scrutiny, and regulatory change, can be demanding. However, a structured, technology enabled approach makes accurate coding achievable.

Five proven strategies for future ready urgent care billing:

1. Ensure complete, timely, and accurate documentation for every encounter
2. Leverage AI driven coding tools for CPT, ICD-10, and HCPCS selection
3. Stay current with Medicare, Medicaid, and payer specific policies
4. Conduct regular audits to reduce denials and strengthen compliance
5. Invest in ongoing staff training and certification

Urgent care centers that leverage real time documentation, payer aware coding, and automation gain a significant advantage in efficiency and revenue. Capturing patient encounters as they happen minimizes errors and expands claim approvals. Understanding payer specific rules ensures coding is accurate, reducing denials and delays. Automation streamlines repetitive tasks, freeing staff to focus on patient care while maintaining compliance. Together, these strategies help urgent care centers boost cash flow, adapt to changing regulations, and position themselves for sustainable growth in the years ahead.