CPT codes for urgent care services

Quick Reference Table: Common Urgent Care CPT Codes (2025)

Category	Code(s)	Short description	When to use	Common pairs/modifiers
E/M – New	99202–99205	Office/outpatient new patient	Bill the visit itself; choose level by MDM or time	Often with minor procedures, add -25 if a significant, separately identifiable E/M service is performed on the same day.
E/M – Established	99212–99215	Office/outpatient established patient	As above for returning patients	-25 as appropriate.
I&D (abscess)	10060 / 10061	Simple/single vs. complicated/multiple I&D	Paronychia, skin abscess, etc. Complicated = multiple incisions, packing/drain	Often with local anesthesia; E/M + -25 when both are warranted. (AAPC)
Laceration repair	12001–12021 (simple) / 12031–12057 (intermediate) / 13100–13160 (complex)	Closure by sutures/staples/adhesive; class by complexity & site	Use length + complexity rules	Do not bill 9920x/9921x unless E/M is significant & separate (-25). (ACEP)
Foreign body removal (skin/subcutaneous)	10120 (simple) / 10121 (complicated)	Removal via incision from subcutaneous tissue	Thorns, glass, fishhook, etc.	If extensive exploration/complexity is required, use 10121. (AAPC)
Nail trephination	11740	Evacuate subungual hematoma (“trephination”)	Small hole through nail to relieve pressure	May pair with E/M (-25) if also evaluating new problem. (AAPC)
Splint application (forearm/hand)	29125–29126 (+ others per site)	Application of short-arm static/dynamic splint	Immobilization/support before/without definitive fracture tx	Don’t double bill with restorative fracture care; supplies may be separate per payer. (AAPC)
POCT – Influenza antigen	87804 (often QW if CLIA-waived)	Rapid flu A/B antigen by visual read	Same-day results in clinic	-QW if waived; -59 may apply when multiple tests. (AAPC)
POCT – COVID-19 antigen (visual)	87811	Rapid SARS-CoV-2 antigen (direct visual)	Same-day results in clinic	Check payer CLIA requirements. (American Medical Association)
COVID-19 NAAT (PCR)	87635	SARS-CoV-2 nucleic acid detection	When molecular testing is performed	Often sent-out lab; check payer policy. (Centers for Medicare & Medicaid Services)
Urinalysis (dipstick)	81002 (non-automated, no microscopy) / 81003 (automated, no microscopy)	UA screen in clinic	Choose code by method (manual vs. machine)	Don’t add microscopy unless performed (81000/81001). (AAPC)
Immunization admin (adult)	90471 (+ 90472 each additional)	Initial vaccine admin; add-on for each additional	Flu, Tdap, etc.	Pediatrics with counseling often 90460/90461. (NC Medicaid)
Key modifier	-25	Significant, separately identifiable E/M same day as minor procedure	When E/M is beyond the usual pre/post-op of the procedure	Must be supported in documentation. (American Medical Association)

Urgent Care CPT Codes: Fast Lookup Table

The most common Evaluation and Management (E/M) CPT codes used in urgent care are:

For new patient visits:

- 99202: Problem-focused visit, straightforward decision-making
- 99203: Expanded problem-focused visit, moderate complexity
- 99204: Detailed visit, intermediate complexity
- 99205: Comprehensive visit, high complexity

For established patient visits:

- 99212: Focused visit with straightforward decision-making
- 99213: Expanded problem-focused visit, low to moderate complexity
- 99214: Detailed visit, moderate to high complexity
- 99215: Comprehensive visit, high complexity

Urgent Care CPT Codes Explained (2025): From E/M to Procedures

There is no single CPT code for “urgent care”; rather, billing uses a combination of Evaluation and Management (E/M) codes like 99202-99205 (new patients) and 99212-99215 (established patients) to describe the complexity of the visit, along with S-codes like S9088 (“Services rendered at an urgent care facility”) or S9083 (“Global fee for urgent care”). The specific E/M code chosen depends on the patient’s status and the documentation of the visit, while S-codes are used to indicate the service was performed in an urgent care setting.

Common E/M Codes:

These codes are the most frequently used in urgent care and are categorized by whether the patient is new or established, as well as the complexity of their visit.

New patients (not seen in the last three years):

99202: Straightforward visit (15–29 minutes).

99203: Low-complexity visit (30–44 minutes).

99204: Moderate-complexity visit (45–59 minutes).

99205: High-complexity visit (60–74 minutes).

Established patients (seen in the last three years):

99212: Straightforward visit (10–19 minutes).

99213: Low-complexity visit (20–29 minutes).

99214: Moderate-complexity visit (30–39 minutes).

99215: High-complexity visit (40–54 minutes).

Urgent Care Specific Codes (S-codes):

These are specific codes that identify services provided in an urgent care setting and are recognized by commercial payers, though generally not by Medicare.

S9088: Used in addition to an E/M code to indicate that services were rendered in an urgent care center, helping to account for the higher cost of immediate care.

S9083: A global fee code used by some payers for a single, flat-rate fee that bundles all services during an urgent care visit.

How to Use Them Together:

to Use Them Together:

Determine the appropriate E/M code based on the patient’s history (new or established) and the complexity of their condition.

Add the S-code (such as S9088) to the claim to inform the payer that the service was delivered in an urgent care setting, according to the payer’s rules.

2025 Urgent Care CPT Codes Billing Guidelines

1. CPT code 99212

CPT code 99212 is for an office or outpatient visit with an established patient for a problem that is typically straightforward and self-limited or minor. In an urgent care setting, this code is used for patients who have previously been seen by a provider in the same practice within the last three years.

For urgent care billing, a provider can use either the total time spent or the complexity of the medical decision-making (MDM) to select the appropriate CPT code.

Requirements for CPT 99212

To be billed as 99212, the urgent care visit must meet one of the following criteria:

Total time: The visit involves 10 to 19 minutes of total time spent by the provider on the date of the encounter. This includes all related tasks, such as reviewing records, performing the exam, and documenting.
Medical decision-making (MDM):
The MDM for the visit is of straightforward complexity. This involves a limited number of problems that require minimal data review and carry a low risk of complications.
Modifiers: -25 if a minor procedure is also done

Examples of 99212 in an urgent care setting

A visit coded as 99212 in urgent care would typically involve a patient with a minor, self-limited issue. Examples include:

A patient with a mild upper respiratory infection is advised to use over-the-counter medication.
A follow-up visit for a stable, controlled chronic condition, such as hypertension, where the provider briefly checks blood pressure and confirms the medication plan.
A patient returning to discuss stable results from a test that was previously ordered.
An established patient with a simple issue like a sprained ankle, where the provider performs a focused exam and provides straightforward recommendations for care.

Note on nurse-only visits: In some cases, and depending on insurance guidelines, a visit managed by a nurse under the supervision of a physician can be billed as 99212. However, this is for “incident-to” billing and requires checking with the patient’s specific insurance policy

2. CPT code 99213

CPT code 99213 is for an office or other outpatient visit for the evaluation and management of an established patient. An established patient has been seen by a physician or another qualified healthcare professional within the same practice and specialty within the last three years.

This code represents a low level of medical decision-making (MDM) and a moderate-length visit.

Key criteria for CPT code 99213

To bill using CPT code 99213, a visit must meet one of the following requirements:

Total Time: The total time spent by the provider on the date of the encounter is 20 to 29 minutes. This includes time for preparing, examining the patient, documenting the visit, and coordinating care.
Medical Decision-Making (MDM): The MDM for the visit is of low complexity. This is appropriate for conditions that are stable or minor, such as a follow-up for a well-controlled chronic illness or an acute, uncomplicated injury.
Modifiers & Pairings: -25 as needed

Common scenarios for CPT code 99213

Routine follow-up: A patient with a stable, well-controlled chronic condition, like hypertension or diabetes, comes in for a check-up.
Minor illness: A patient is seen for an uncomplicated issue, such as a common cold or a simple rash.
Prescription renewal: A provider reviews a patient’s medication for a stable condition and issues a refill.
Initial evaluation of a new symptom: A patient comes in to discuss a new symptom that does not require extensive testing or complex decision-making.

Documentation requirements

Accurate and thorough documentation is essential for supporting the use of CPT code 99213 and ensuring proper reimbursement. It should reflect the chosen method of coding (either time or MDM) and include:

The reason for the visit (chief complaint)
Relevant medical history
Physical examination findings
The provider’s assessment and treatment plan
The total time spent during the encounter, if billing is based on time

3. CPT code 99214

CPT code 99214 is used for an office or other outpatient visit to evaluate and manage an established patient. It signifies a visit of moderate complexity, which can be determined by the level of medical decision-making (MDM) or the total time spent on the date of the encounter.

Requirements for 99214

To bill using CPT code 99214, the provider must document that the visit meets one of the following criteria:

Total Time: The provider spends 30 to 39 minutes on the date of the encounter. This includes both face-to-face and non-face-to-face time, encompassing activities such as reviewing tests, documenting in the electronic health record (EHR), counseling patients, and coordinating care.
Modifiers & Pairings:-25 if also doing a minor procedure
Medical Decision-Making (MDM): The MDM is of moderate complexity, which is a higher level than the low complexity required for a 99213 visit. This is assessed by considering three key elements:
- Number and complexity of problems: The provider addresses multiple stable chronic conditions or a single chronic condition that is worsening.
- Amount and complexity of data: The provider reviews a moderate amount of data, which may include reviewing test results, medical records, or imaging studies.
- Risk of complications: There is a moderate risk of complications from the patient’s condition or management.

Examples for CPT 99214

Scenarios that often qualify for CPT 99214 include:

A patient with uncontrolled diabetes and high blood pressure who requires medication adjustments and lab work to be reviewed.
A patient with chronic asthma who reports increased wheezing and needs a new treatment plan and referral to a pulmonologist.
Managing multiple chronic conditions where the patient is at a moderate risk of complications.
A mental health patient needing a medication adjustment for a stable but inadequately controlled mental health issue.

4. CPT code 99215

CPT code 99215 is for the highest-level evaluation and management (E/M) service for an established patient in an office or outpatient setting. The code can be selected based on either the total time spent or the complexity of the medical decision-making (MDM).

Requirements for CPT 99215

To bill using CPT code 99215, the visit must meet either of the following criteria:

Medical Decision-Making (MDM): A high level of MDM is required. This is met by satisfying at least two of the three MDM elements: number and complexity of problems, amount and complexity of data reviewed, and risk of complications. High MDM involves managing complex, severe conditions, reviewing extensive data, or dealing with a high risk of morbidity or mortality.
Modifiers & Pairings:-25 if appropriate
Total Time: The total time spent by the provider on the date of the encounter must be 40 to 54 minutes. This includes both face-to-face and non-face-to-face activities related to the patient’s care on that day.

Typical use cases

CPT code 99215 is used for complex visits, such as managing multiple uncontrolled chronic conditions, severe exacerbations of illness (e.g., unstable angina), or when a worsening condition requires extensive care planning.

Important note:

Due to its high reimbursement, CPT 99215 claims are frequently audited, making detailed documentation crucial to support the high complexity or time spent and avoid denials.

5. CPT code 99202

CPT code 99202 is used for an office or other outpatient visit to evaluate and manage a new patient. It is considered a straightforward or low-level visit, and the appropriate billing level can be determined by either the total time spent or the complexity of medical decision-making.

Key requirements

To use CPT code 99202, the following must be met:

Patient status: The patient is new to the practice. This means they have not received any professional services from the billing physician or another physician in the same specialty and group practice within the previous three years.
Medical decision-making (MDM): The MDM for the visit must be of straightforward complexity. This involves:
1. Addressing a minimal number of problems, typically one self-limited or minor issue.
2. Reviewing minimal or no data.
3. Involving a low risk of complications from management decisions.
Time: When using time for code selection, the total time spent by the provider on the date of the encounter must be 15 to 29 minutes. This includes both face-to-face and non-face-to-face activities related to the patient’s care.
Documentation: The medical record must include a medically appropriate history and/or examination.
Modifiers: Use -25 on E/M if a minor procedure is also done and E/M is significant/separate

Examples of 99202 visits:

A new patient with a simple issue like a common cold, sore throat, or a minor skin rash.
An initial consultation for a well-controlled, chronic condition.
An initial visit to an urgent care clinic for a minor ailment.

6. CPT code 99203

CPT code 99203 is used for an office or other outpatient visit for the evaluation and management (E/M) of a new patient that requires a low level of medical decision-making. The appropriate billing level can be determined either by the complexity of the medical decision-making (MDM) or the total time spent by the provider.

Requirements for 99203

To bill for a 99203 visit, the encounter must meet specific criteria related to either time spent or the complexity of medical decision-making.

Time: The provider must spend a total of 30 to 44 minutes on the date of the encounter. This includes both face-to-face and non-face-to-face activities related to the patient’s care.
Medical Decision-Making (MDM): The MDM for the visit must be of low complexity. Low complexity MDM typically involves addressing one or more stable chronic illnesses or an acute, uncomplicated illness, reviewing a limited amount of data, and managing a condition with a low risk of complications.
Modifiers: -25 when applicable

Key details

New patient: The patient must be new to the billing physician or group practice.
Documentation: Documentation should clearly support the chosen coding method (time or MDM complexity).
Common mistake: Using 99203 for an established patient instead of the appropriate established patient code series (9921x) is a common billing error.

7. CPT code 99204

CPT code 99204 is used for an office or other outpatient visit for the evaluation and management (E/M) of a new patient that requires a moderate level of medical decision-making. The provider can choose this code based on either the complexity of the medical decision-making (MDM) or the total time spent during the encounter.

Requirements for 99204

To be billed as 99204, the visit must satisfy one of the following criteria:

Medical Decision-Making (MDM): The visit must involve a moderate level of MDM. This is suitable for new patients presenting with conditions that require thorough evaluation, such as managing a new problem with a moderate risk of complications, reviewing a moderate amount of complex data, or considering multiple management options.
Modifiers: -25 if minor procedure, same day, and E/M significant
Total Time: The provider spends a total of 45 to 59 minutes on the date of the encounter. This includes both face-to-face and non-face-to-face time related to the patient’s care, such as:
- Reviewing records and test results
- Performing the patient history and examination
- Counseling the patient
- Coordinating care
- Documenting the encounter

Comparison with other new patient codes

99202 (Straightforward Complexity): This code is for less complex new patient visits, requiring 15–29 minutes of total time or straightforward MDM.
99203 (Low Complexity): This is for a new patient visit involving low MDM, typically lasting 30–44 minutes.
99205 (High Complexity): This code is for the most complex new patient visits, with high MDM and lasting at least 60 minutes.

8. CPT code 99205

CPT code 99205 is the highest-level evaluation and management (E/M) service for a new patient in an office or outpatient setting. It is reserved for highly complex cases that require extensive time and detailed medical decision-making.

Requirements for 99205

To justify billing with CPT code 99205, the visit must meet specific criteria based on either the total time spent or the level of medical decision-making (MDM).

Medical decision-making (MDM): High Complexity This is the highest level of MDM and involves managing complex, severe conditions with significant risk.

Number and complexity of problems: The provider addresses one or more chronic illnesses with severe exacerbation or a new problem with a high risk of morbidity or mortality.
Amount and complexity of data: An extensive amount of complex data must be reviewed and analyzed. This could include multiple test results, medical records, and communication with other healthcare professionals.
Risk of complications: The patient management decisions involve a high risk of complications, morbidity, and/or mortality.
Modifiers: -25 if appropriate

Total time: 60–74 minutes

If using time for code selection, the provider must spend between 60 and 74 minutes of total time on the date of the encounter. This time includes both face-to-face and non-face-to-face activities, such as:

Reviewing test results.
Documenting the visit in the medical record.
Counseling and educating the patient or family.
Coordinating care with other healthcare professionals.

Examples of 99205 visits

A new patient with uncontrolled diabetes and severe, progressive complications.
A new patient presenting with severe chest pain may indicate a myocardial infarction.
An initial psychiatric evaluation for a new patient with major depression and suicidal ideation is required, requiring complex risk assessment and management planning.
A new patient with a severely progressing chronic illness, such as advanced rheumatoid arthritis.

Documentation is critical

Due to its high level of reimbursement, CPT code 99205 is often audited by payers. Therefore, providers must ensure their documentation clearly and extensively supports the high complexity of the medical decision-making or the total time spent during the visit.

Urgent care procedure codes

These codes are used for treatments such as wound care or injury management.

10060–10061: Incision and drainage of an abscess.

12001–12007: Simple repair of superficial wounds and lacerations.

29515: Application of a short leg splint.

96372: Therapeutic injection (e.g., antibiotics, steroids).

Diagnostic testing codes

Urgent care centers often use codes for common tests like:

chest X-rays (71045)
rapid strep (87804, 87880)
COVID-19 (87635)
influenza (87804)
lipid panels (80061) to quickly assess patients’ lipid levels.

Common procedure and diagnostic codes:

Urgent care visits frequently involve procedures and tests, which are billed separately from the E/M visit code.

Incision & Drainage (10060/10061)

10060 = simple/single; 10061 = complicated/multiple (e.g., numerous incisions, packing/drain).

Laceration Repair (12001–13160)

Simple (12001–12021), Intermediate (12031–12057), Complex (13100–13160). Choose by site + length + complexity (layers, undermining, etc.).

Foreign Body Removal – Skin/Subcutaneous (10120/10121)

10120 for simple subcutaneous FB removal via incision; 10121 for complicated (e.g., extended exploration, infection).

Nail Trephination (11740)

Evacuation of subungual hematoma via trephination; if the entire nail is removed, codes such as 11730 may apply (per scenario).

Splint Application (29125–29126 and related)

Short-arm static (29125) or dynamic (29126) splints are separately billable when not part of restorative fracture care; don’t double-count removal/repair by the same group.

Point-of-Care Tests (CLIA-Waived)

Flu A/B antigen: 87804 (often QW if waived).
COVID-19 antigen (visual read): 87811.
COVID-19 NAAT (PCR): 87635 (often sent-out lab).
Urinalysis: 81002 (manual, no microscopy) vs 81003 (automated, no microscopy).

Vaccines & Administration

90471 for the first injected vaccine; +90472 for each additional the same day. Pediatric counseling often uses 90460/90461.

Urgent care E/M CPT levels: how many and which codes?

There are five levels of CPT codes for both new and established patients in the Evaluation and Management (E/M) section that are commonly used for urgent care services.

These levels correspond to the complexity of the visit, primarily determined by Medical Decision Making (MDM) or Total Time spent on the encounter.

Here are the specific CPT codes, broken down by patient type:

For New Patients (codes typically starting with 9920x)

99202: Level 2, Straightforward MDM (or 15-29 minutes)
99203: Level 3, Low MDM (or 30-44 minutes)
99204: Level 4, Moderate MDM (or 45-59 minutes)
99205: Level 5, High MDM (or 60-74 minutes)

Note: 99201 was deleted in 2023.

For Established Patients (codes typically starting with 9921x)

99212: Level 2, Straightforward MDM (or 10-19 minutes)
99213: Level 3, Low MDM (or 20-29 minutes)
99214: Level 4, Moderate MDM (or 30-39 minutes)
99215: Level 5, High MDM (or 40-54 minutes)

Note: 99211 is still used for straightforward visits that may not require the physical presence of a physician or other qualified healthcare professional, though it is less common in urgent care settings where a face-to-face evaluation by a QHP is usually performed.

In summary, there are a total of 8 commonly used distinct E/M CPT codes (4 for new patients, 4 for established patients) that span the levels of care provided in an urgent care setting.

FAQs

What are CPT codes 99213 and 99214?

CPT codes 99213 and 99214 are Office or Other Outpatient Services codes for established patient visits, with 99213 representing a low-complexity visit and 99214 representing a moderate-complexity visit. The main difference lies in the medical decision-making, history, physical examination, and time involved in the patient encounter, with 99214 requiring more in-depth assessment and documentation of complex issues, multiple conditions, or significant risks.

What is CPT code 99214?

CPT 99214 is used for an office or outpatient visit by an established patient requiring moderate complexity medical decision making. Typically, the service lasts about 30-39 minutes of face-to-face time. This includes detailed history and exam components. The time counted can include not only the face-to-face encounter but also non-face-to-face activities such as reviewing tests, documenting, and coordinating care. This code is often used for managing chronic diseases like diabetes or hypertension that require medication adjustments or lab reviews. Proper documentation of moderate medical decision-making complexity or time on the date of service is essential to justify this code, making it one of the keys to accurate billing and reimbursement success in outpatient care.

What differentiates CPT code 99214 from 99213?

While both codes represent established patient visits, 99214 requires a higher level of medical decision making and longer time spent (30-39 minutes vs. 20-29 minutes for 99213). The medical decision-making in 99214 involves managing multiple or worsening chronic conditions, reviewing multiple data points like labs or imaging, or handling medications with a moderate risk of complications. 99213, in contrast, is used for visits with lower complexity and typically stable chronic or minor acute issues.

What is CPT code 99212, and when is it used in urgent care?

CPT 99212 is used for established patient office visits with an expanded problem-focused history and exam for minor or self-limited issues. These encounters usually last about 10-19 minutes and are suitable for urgent care when the problem is straightforward and does not require complex decision-making or diagnostics.

What is the difference between CPT 99204 and 99205?

Both are new patient visit codes for office or outpatient services. 99204 entails a detailed history, detailed exam, and moderate complexity medical decision making. In contrast, 99205 is used when the visit requires a comprehensive history and examination, along with high-complexity decision-making, usually taking more time. These differences reflect the intensity and duration of evaluation needed for new patients.

When should modifier 25 be applied?

Modifier 25 is used when a significant, separately identifiable evaluation and management (E/M) service is performed on the same day as another procedure or service by the same provider. It indicates that the E/M service exceeded the usual care associated with the procedure, such as a separate patient complaint requiring evaluation beyond routine pre- or post-operative care.

When should modifier 93 be used?

Modifier 93 is appended to services delivered via synchronous audio-only telehealth, such as telephone visits where video is unavailable or impractical. This modifier distinguishes audio-only encounters from video-based telehealth (which uses modifier 95) for accurate billing and compliance with payer telemedicine policies.