Specialty Billing Guides
Specialist-written playbooks for 54+ medical specialties. Common CPTs, NCCI bundling traps, modifier discipline, payer-specific rules, and 2026 revenue opportunities most practices leave on the table.
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Primary Care
5 specialtiesFamily, internal, pediatrics, geriatrics, preventive medicine.
Family Medicine
AWVs, chronic care management, transitional care management. The most-billed E/M family in the country.
Internal Medicine
High-acuity adult ambulatory care, level 4 and 5 E/M, MDM-driven coding under the 2021 office visit revision.
Pediatrics
Well-child visits 99381-99395, immunization administration, developmental screening 96110.
Geriatric Medicine
Annual Wellness Visits, advance care planning, polypharmacy MTM, transitional care after discharge.
Preventive Medicine
IBT, alcohol screening, obesity counseling. The G-codes most practices forget to bill.
Surgery
10 specialtiesGlobal periods, modifier 24/57/58/78/79, co-surgeon and assist coding.
Orthopaedic Surgery
Global surgery package, modifier 24/57/58/78/79, fracture care vs E/M billing rules.
General Surgery
90-day global periods, multi-procedure pricing, mod 51 vs 59 vs X{EPSU}, OR co-surgeon and assist rules.
Plastic Surgery
Cosmetic vs reconstructive determination, ABN handling, GA vs GY modifier, photographic documentation.
Neurological Surgery
High-RVU spine and cranial procedures, co-surgeon (62), assistant (80/82), monitoring (95940/95941).
Vascular Surgery
Endovascular interventions, arterial vs venous coding, post-op complications inside global.
Otolaryngology
ENT scopes vs office E/M, sinus procedures with NCCI bundling, allergy testing series.
Oral & Maxillofacial Surgery
CDT vs CPT crosswalk, medical necessity for medical insurance billing, TMD coding.
Obstetrics & Gynecology
Global OB package, antepartum/postpartum care, LARC insertions, well-woman 99385-99397.
Urology
Cystoscopy series, prostate procedures, lithotripsy, in-office dispensed drugs J-code workflow.
Ophthalmology
Eye-code (920XX) vs E/M decision tree, intraocular lens billing, glaucoma diagnostic series.
Medical Specialty
11 specialtiesCardiology, GI, pulm, endo, heme/onc, derm, neuro, rheum, ID.
Cardiovascular Disease
Echo, stress, cath lab, EP studies. Highest dollar-per-claim cardiology coding with strict NCCI rules.
Gastroenterology
Screening colonoscopy 0-pay vs diagnostic conversion, modifier 33/PT, biopsy bundling.
Pulmonology
PFT series 94010-94070, sleep studies G0398-G0400, bronchoscopy with endobronchial ultrasound.
Endocrinology
Diabetes management, CGM 95249-95251, thyroid biopsies, HCC capture for E11.x and I10.
Hematology & Oncology
Chemotherapy administration 96401-96549, J-code drugs, prolonged infusion units, JW waste.
Nephrology
ESRD MCP coding 90951-90970, dialysis access management, AV fistula maintenance.
Rheumatology
Biologic infusions J-codes, joint injections 20600-20611, prior-auth burden for high-cost drugs.
Infectious Disease
Inpatient consult vs subsequent care, antimicrobial stewardship, OPAT home infusion coding.
Allergy & Immunology
Allergen extract preparation 95165, immunotherapy injection 95115/95117, allergy testing panels.
Dermatology
Lesion destruction sizing, biopsy 11102-11107 vs 17000-17004, MOHS staged excision.
Neurology
EEG 95812-95830, EMG/NCS, neuropsych testing, level 5 E/M for complex MDM cases.
Emergency & Hospital
5 specialtiesED, hospitalist, critical care, anesthesia, pain medicine.
Emergency Medicine
ED E/M 99281-99285, critical care 99291/99292, observation, fracture and laceration care.
Hospital Medicine
Initial hospital 99221-99223, subsequent 99231-99233, admission/discharge same day, transitional care.
Critical Care Medicine
Critical care time-based 99291/99292, ventilator management, central line placement.
Anesthesiology
ASA crosswalk, base + time + modifier units, monitored anesthesia care, regional blocks.
Pain Medicine
Trigger point, facet/MBB, ESI, RFA, intrathecal pumps. NCCI bundling and modifier 50/RT/LT discipline.
Behavioral Health
4 specialtiesPsychiatry, psychology, substance use, family therapy.
Psychiatry
Psychotherapy 90832-90838 add-on to E/M, medication management, telehealth POS 02 vs 10.
Clinical Psychology
Psychological testing 96130-96139, intake assessment, group vs individual psychotherapy.
Substance Use Counseling
SBIRT G-codes, MAT (Suboxone, Vivitrol) initiation, IOP/PHP H-code billing for Medicaid.
Marriage & Family Therapy
Family psychotherapy 90847, conjoint sessions, Medicare coverage expansion 2024 forward.
Diagnostics
4 specialtiesRadiology, pathology, nuclear medicine, cardiology diagnostics.
Radiology
Professional (26) vs technical (TC) component split, contrast administration, IR procedures.
Pathology
Surgical path 88300-88309 specimen rules, cytology, IHC stains, molecular pathology.
Nuclear Medicine
PET/CT, SPECT, radiopharmaceutical A-codes, theranostics billing for new approved isotopes.
Cardiology Diagnostics
Holter, event monitor, MCT, echo with strain, stress with imaging modifier 26.
Therapy & Rehab
5 specialtiesPT, OT, SLP, chiropractic, PM&R.
Physical Therapy
Time-based units 8-minute rule, KX modifier above cap, evaluation 97161-97163 by complexity.
Occupational Therapy
OT eval 97165-97167, therapeutic activities, ADL training, modifier GO for OT plan of care.
Speech-Language Pathology
Eval and treatment 92507/92521-92524, swallowing studies, modifier GN for SLP plan.
Chiropractic
CMT 98940-98942 spinal regions, AT modifier for active treatment, secondary diagnosis required.
Physical Medicine & Rehabilitation
Inpatient rehab admit, EMG/NCS in PM&R setting, prosthetic management coding.
Women & Family
3 specialtiesReproductive endocrinology, MFM, midwifery.
Reproductive Endocrinology
IVF cycle billing, oocyte retrieval, embryo transfer, fertility preservation coding.
Maternal-Fetal Medicine
Detailed OB ultrasound, biophysical profile, antepartum surveillance for high-risk pregnancy.
Midwifery
Global midwifery package, home birth attendance, postpartum visits, modifier SB for midwife rendering.
Other Specialties
7 specialtiesPodiatry, optometry, audiology, sleep, sports, wound care, hospice.
Podiatry
Routine foot care exclusions, Q7/Q8/Q9 modifiers for at-risk feet, nail debridement coverage.
Optometry
Vision exam vs medical eye exam decision, spectacle/contact lens fitting, V-codes for materials.
Audiology
Audiogram 92557, tympanometry, hearing aid fitting V-codes (most non-covered by Medicare).
Sleep Medicine
PSG 95810, home sleep study G0399, CPAP titration 95811, follow-up E/M for adherence.
Sports Medicine
Joint injections, ortho consults, fitness-for-duty exams, in-office DME like braces.
Wound Care
Debridement 11042-11047 by depth and size, HBO therapy, skin substitutes Q-codes.
Hospice & Palliative Care
Advance care planning 99497, hospice consult vs concurrent care, GV/GW modifiers.
Side-by-side comparison
Snapshot stats from PayerReady dataset
Built for working coders, not marketers.
Every guide is grounded in real CMS data, NCCI edits, and the specific traps that drive denials in that specialty.
Top CPTs by claim volume
Each guide leads with the codes you actually bill, with current MPFS work RVUs and global periods.
NCCI bundling traps
The exact code pairs that auto-bundle to CO-97, and the modifier rationale that legitimately bypasses them.
Modifier discipline
When 25 vs 57 vs X{EPSU} actually applies, with denial-pattern context from CERT and OIG audits.
2026 revenue opportunities
New codes, expanded coverage, and high-margin services most practices in your specialty are under-billing.
Tools, information, and resources for medical billing teams
Free coding and billing tools built on CMS 2026 data, available to every PayerReady credentialing customer alongside a dedicated specialist handling your enrollment end-to-end.
Live code search
Type-as-you-search across CPT, ICD-10, HCPCS, modifiers, and denial codes.
NCCI bundle checker
Paste two CPTs. Get the bundling verdict and modifier bypass rationale.
Medicare fee calculator
2026 allowable amounts with real RVUs and the current conversion factor.
Denial appeal library
1,506 CARC + RARC codes with curated appeal templates for the top denials.
Compliance monitoring
HCC + MEAT requirements, OIG audit patterns, and RADV defense.
Dedicated specialist
A named credentialing coder handling your enrollment and payer follow-up.
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Verified against the CMS 2026 code set on May 31, 2026.
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