Urgent Care CPT Codes in 2025: Your Ultimate Guide

Urgent care facilities offer immediate medical attention without the need for an appointment. In fact, according to the CDC, around 26% of adults and 8% of kids visited urgent care centers or retail health clinics in 2021. With such a rising demand, staying updated with urgent care CPT codes can get tricky. 

This guide will walk you through everything you need to know about CPT codes for urgent care, the challenges of urgent care billing, and best practices to follow.

Table of Contents

1. What are Urgent Care CPT Codes?
2. Challenges of Urgent Care Coding and Billing
3. The Most Common CPT Codes for Urgent Care
4. Exclusive ‘S’ Codes in Urgent Care Billing
5. Changes to Urgent Care CPT Codes in 2025
6. Best Practices for Using Urgent Care CPT Codes

What are Urgent Care CPT Codes?

To ensure proper reimbursement for services, urgent care centers need to accurately report their procedures using Current Procedural Terminology (CPT) codes. 

These urgent care CPT codes are standardized five-digit codes that cover a variety of services such as evaluation and management (E/M) visits, minor surgical procedures, diagnostic tests, and therapeutic services. 

They help explain to insurance companies what kind of urgent care was provided, so your clinic can get reimbursed properly.

Using the correct urgent care procedure codes is important because mistakes can lead to claim denials, delayed payments, or lost revenue. It also helps your facility ensure you get paid accurately and on time for the services you deliver.

Challenges of Urgent Care Coding and Billing

Some common issues faced by urgent care centers in coding and billing are:

• Urgent Care Coding Guidelines: The guidelines for urgent care coding are quite similar to those for primary care coding. Providers need to use the right code that matches the service given and follow the insurance company's requirements.
• Time Constraints: In urgent care, there often isn't time to get insurance pre-authorization or check coverage before treating a patient.
• Medicare Limitations: While Medicare covers 80% of urgent care expenses, this is generally less than what private insurance pays for urgent care services.
• Different Rules for Different Insurers: Insurance companies don’t always follow the same rules. One might accept a code that another rejects. This can make urgent care billing tricky and collecting payments harder.

Knowing these challenges and how to handle them helps urgent care centers improve coding and keep payments flowing smoothly.

The Most Common CPT Codes for Urgent Care

This urgent care CPT code list can help you understand which code to use for a specific service, ensuring accurate urgent care billing:

Evaluation and Management (E/M) Codes

These codes cover patient visits for evaluation and management of a condition. The most commonly used E/M codes of CPT for urgent care visit are:

• 99202-99205: New Patient Office or other outpatient services
• 99212-99215: Established Patient Office or other outpatient services

Urgent Care Procedure Codes

Urgent care centers often perform procedures like wound repair, suturing, or fracture care. Common CPT codes for these procedures include:

• 12001-12018: Simple repair of superficial wounds
• 29515: Application of short leg splint
• 29200: Strapping of thorax

Diagnostic Testing Codes

When performing lab tests, X-rays, or other diagnostic procedures, you’ll need to use the appropriate CPT codes, such as:

• 71045: Chest X-ray, single view
• 80061: Lipid panel
• 87804: Rapid strep test

Injection and Infusion Codes

If your urgent care offers injection or infusion services, common CPT codes include:

• 96372: Therapeutic injection (e.g., antibiotics, steroids)
• 96374: Therapeutic, prophylactic, or diagnostic injection (IV push)

Exclusive ‘S’ Codes in Urgent Care Billing

Along with traditional CPT codes, urgent care centers often use ‘S’ codes. These codes are used to identify specific services in urgent care settings, and are part of the Healthcare Common Procedure Coding System (HCPCS).

The most recognized HCPCS ‘S’ codes for urgent care billing are:

S9083: Global Fee for Urgent Care Centers

This code is used to represent a flat-rate billing structure for urgent care services. Some payers accept the S9083 CPT code, which covers all services provided during a single urgent care visit, regardless of the number of procedures or tests performed. However, not all insurance companies recognize 'S' codes, so it’s crucial to verify with each payer before using them.

S9088: Services Rendered in an Urgent Care Center

This code is used to indicate that services were provided in an urgent care setting, allowing the insurer to process the claim correctly. It’s an additional code that helps differentiate urgent care services from those performed in other settings like emergency rooms or primary care.

These ‘S’ urgent care codes:

• Can be billed for every urgent care center visit (except for Medicare) with an E/M code.
• Are used by some payers to bundle all services rendered in an urgent care visit into a single, one-size-fits-all global code for reimbursement.

Changes to Urgent Care CPT Codes in 2025

The American Medical Association (AMA) updates CPT codes every year, and 2025 is no exception. For 2025, CPT has been updated to include 270 new codes, with 38 codes being revised and 112 codes being deleted.

Some of the key changes to urgent care CPT codes for 2025 include:

• Remote therapeutic monitoring (RTM) codes have been revised, now covering digital therapies and device supplies for data transmissions or data access.
• New category III codes classify AI medical services, with 7 new codes added for data analysis in ECGs and medical chest imaging (0877T-0880T).
• Updates in the general surgery section reflect new techniques for tumor removal in the abdomen (49186-49190) and for skin grafts (15011-15018).

Best Practices for Using Urgent Care CPT Codes

Here are some tried-and-true CPT code tips for your urgent care center:

• Document Patient Details: Always record the patient's primary complaint, medical history, physical exam findings, diagnostic tests, results, treatment plan, and the patient’s response.
• Stay Educated on Code Changes: Urgent care coding requirements evolve annually, and new codes may affect reimbursement. Regularly reviewing CPT code updates avoids claims rejections and denials.
• Conduct Regular Coding Audits: Auditing your coding practices helps identify errors and areas for improvement. By catching mistakes early, you can avoid costly denials and maintain a smooth revenue cycle.
• Train Staff Regularly: Ensure your urgent care coding and billing team stays informed of the latest CPT coding rules. Ongoing training helps them understand complex cases and new code requirements.
• Use Appropriate Modifiers: CPT modifiers can clarify services performed and prevent claim denials. For example, using an urgent care modifier like 25 can indicate a significant, separately identifiable E/M service by the same physician on the same day of a procedure.

Lastly, partnering with an experienced medical coding service like 314e can make all the difference. 314e's urgent care coding services are specifically designed to support urgent care facilities, helping you maximize revenue by providing accurate and up-to-date coding solutions. 

With expertise in urgent care CPT codes, 314e can help streamline your processes, reduce claim denials, and ensure compliance with the latest urgent care coding guidelines. Schedule a meeting with our coding expert today to see how we can help your urgent care center thrive.