2025 Urgent Care CPT Code Guidelines: Updates and More!

Urgent care centers operate in a completely different environment from primary or specialty care centers. Patients visiting these facilities must receive medical attention within 24 hours of arrival, with many clinics exceeding expectations by providing care within 30 minutes to an hour.

However, operating in a fast-paced environment, urgent care centers often encounter unique challenges, particularly in coding, billing, and insurance verification. While primary care providers may have the time to pre-authorize procedures or cross-verify CPT codes for insurance coverage, urgent care facilities often lack this luxury.

Adding to the complexity, CPT coding guidelines for urgent care closely resemble those of primary care. But, despite their similarities, insurance companies, in many instances, apply different policies. An insurance company may accept a code that another insurer rejects, leading to inconsistencies in claim processing. This results in frequent claim denials, delayed payments, and revenue loss.

Staying updated with CPT code changes, understanding the most commonly used urgent care codes, and following the best practices can be crucial for ensuring timely reimbursement. This article explores the most commonly used CPT codes for urgent care, recent updates, and effective strategies providers can implement to ensure accurate billing and coding. Let’s get started.

What Are the CPT Codes for Urgent Care?

Current Procedural Terminology (CPT) codes are standardized five-digit alphanumeric codes designed to ensure flawless communication between healthcare providers, insurance companies, and regulatory agencies. Providers use these codes to document medical procedures and services, while insurers rely on them to verify coverage and process reimbursements. The American Medical Association (AMA) classifies CPT codes into three main categories:

Category I: Represents the most commonly performed procedures, such as Evaluation and Management (E/M), radiology, laboratory tests, and diagnostic services.

Category II: Used for tracking patient progress and quality of care. These optional, supplementary codes are not primarily intended for reimbursement but help monitor adherence to best practices.

Category III: Assigned to emerging medical technologies and procedures that require further research before qualifying for Category I status.

Which CPT Codes Are Most Common in Urgent Care?

Urgent care centers frequently bill the following codes for their services:

1. Evaluation and Management (E/M) Codes

Primarily defined by medical decision-making (MDM) and time spent with the patient for documentation, reviewing lab results, and coordinating care. The complexity of MDM is influenced by the number of problems addressed, the risk of complications, and the need for additional tests or treatments.

This code distinguishes between new and established patients:

New Patients: 99202-99205

Established Patients: 99212-99215

2. Procedure Codes

Document procedures used while rendering medical services, such as:

Wound Repair (12001-12018): Covers the repair of superficial wounds involving the epidermis, dermis, and subcutaneous tissue.

Incision and Drainage (10060-10180): Used for documenting the surgical drainage of abscesses, cysts, hematomas, and other fluid collections.

Foreign Body Removal (20525-20553): Apply to the removal of foreign objects embedded in soft tissues, joints, or muscles.

Splint and Cast Applications (29000-29799): Covers the application, maintenance, and removal of casts and splints for fractures, dislocations, or musculoskeletal injuries.

3. Diagnostic Testing Codes

Help providers bill for tests accurately. Each code corresponds to a specific test, such as:

Chest X-ray (single view) – 71045: A radiographic imaging test used to examine the lungs, heart, and chest cavity. Single-view X-ray means the image is captured from one angle.

Lipid Panel – 80061: A blood test that measures different cholesterol and lipid levels in the bloodstream.

Rapid Strep Test – 87804: A diagnostic test that detects the presence of Group A Streptococcus bacterium, the causative agent of strep throat.

4. Injection and Infusion Codes

Critical for accurately billing therapeutic drug administration in healthcare settings, these codes differentiate between various methods of delivering medications. Two common codes in this category are:

Therapeutic Injection – 96372: This applies when a healthcare provider administers a drug using a syringe and needle into a muscle or the fatty tissue beneath the skin.

IV Push Injection – 96374: Used when medication is administered directly into a vein, either through a syringe or an existing IV line.

5. Immunization Administration Codes

Report vaccination services provided in healthcare settings. Two key categories in this are:

First Vaccine – 90471: Applies only to the first vaccine given during a visit.

Each Additional Vaccine – 90472: Used for each additional vaccine or toxoid administered after the first one during the same patient encounter.

How Are Services Without Direct CPT Codes Handled in Urgent Care?

For services lacking a direct CPT code, Exclusive ‘S’ codes are used. They refer to HCPCS Level II S-Codes, which are specified by private payers rather than Medicare or Medicaid. These codes are designed for services that are commonly used across various healthcare settings, including urgent care, but don’t have CPT codes assigned to them.

However, it is important to note that not all insurers cover ‘S’ codes and some ‘S’ codes may be denied by Medicare/Medicaid, requiring conversion to standard CPT codes. Our experts recommend using ‘S’ codes only:

If the insurance payer explicitly requires S-codes for certain urgent care services.

If the urgent care center operates on a flat-rate reimbursement model (S9083).

If a service does not have a direct CPT equivalent but is commonly performed in urgent care.

The most commonly used ‘S’ codes for urgent care are:

S9083: Global fee for urgent care centers, covering all services provided during a visit under a single fee.

S9088: Services rendered in an urgent care center, used alongside E/M codes to account for the increased cost of immediate care.

How Have the Latest Updates Impacted CPT Codes for Urgent Care?

To keep pace with evolving medical practices and innovations, the American Medical Association (AMA) updates CPT codes annually. In 2025, it introduced 270 new CPT codes, revised 38, and removed 112.

Some of the key changes include:

Remote Therapeutic Monitoring (RTM) services have been revised to include digital therapeutic interventions. Codes 98976–98978 now cover device supplies for data access or transmissions supporting RTM.
Category III CPT codes have been expanded to classify AI medical services and procedures as assistive, augmentative, or autonomous. Seven new codes have been added to support AI-augmented data analysis in areas such as electrocardiogram measurements and medical chest imaging.
New codes have been introduced to reflect novel approaches in skin grafts for wound care and advancements in surgical techniques for tumor elimination within the abdomen.

Here’s a broader overview of relevant, urgent care CPT codes and their status after revision.

Category	CPT Codes	Description	Status
Telemedicine Services	98000-98007	Synchronous audio-video visits for new and established patients.	New
Telemedicine Services	98008-98015	Synchronous audio-only visits for new and established patients.	New
Telemedicine Services	98016	Virtual check-in for established patients.	New
General Surgery	49186-49190	Excision or destruction of intra-abdominal tumors or cysts, categorized by size.	New
Skin Replacement Surgery	15011-15018	Skin cell suspension autograft procedures for burn treatment and skin trauma.	New
AI-Augmented Procedures	0877T-0880T	AI-augmented analysis of chest imaging data.	New
AI-Augmented Procedures	0902T, 0932T	AI-augmented electrocardiogram measurements.	New
AI-Augmented Procedures	0898T	AI-augmented image-guided prostate biopsy.	New
Remote Therapeutic Monitoring (RTM)	98975	Now includes digital therapeutic intervention.	Revised
Remote Therapeutic Monitoring (RTM)	98976-98978	Updated to encompass device supply for data access or transmissions supporting RTM.	Revised
Carpometacarpal (CMC) Suspension Arthroplasty	25447	Descriptor revised to specify interposition (e.g., tendon) without suspension.	Revised
Intra-Abdominal Tumor Procedures	49203-49205	Deleted, replaced by codes 49186-49190.	Deleted and Replaced
Telephone Services	99441-99443	Deleted, replaced by new audio-only telemedicine codes 98008-98015.	Deleted and Replaced
Carpometacarpal (CMC) Procedures	25447, 26480	Deleted, replaced by code 25448 for combined procedures.	Deleted and Replaced

To Conclude…

Maintaining financial stability amid the challenges of a high-pressure urgent care environment, coupled with government regulations, payer requirements, and increasing patient demand, can feel as demanding as juggling flaming torches. However, with a well-structured, time-tested strategy, the process becomes far more manageable. To conclude, here are five proven strategies providers can implement to ensure accurate billing and coding:

Ensure complete, accurate, and timely documentation for every patient encounter.

Leverage AI-driven coding tools and automation to secure correct CPT, ICD-10, and HCPCS code selection.

Regularly review payer policies, including Medicare, Medicaid, and private insurers, to comply with evolving coding regulations and reimbursement guidelines.

Conduct internal audits and compliance checks to identify billing errors, minimize claim rejections, and establish an effective denial management process.

Provide ongoing training and certification programs for billing and coding staff to keep them updated on regulatory changes, best practices, and new coding guidelines.

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2025 Urgent Care CPT Code Guidelines: Updates and More!

What Are the CPT Codes for Urgent Care?

Which CPT Codes Are Most Common in Urgent Care?

1. Evaluation and Management (E/M) Codes

2. Procedure Codes

3. Diagnostic Testing Codes

4. Injection and Infusion Codes

5. Immunization Administration Codes

How Are Services Without Direct CPT Codes Handled in Urgent Care?

How Have the Latest Updates Impacted CPT Codes for Urgent Care?

To Conclude…

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