What Is CPT Code 99396? CPT code 99396 is a preventive medicine evaluation and management (E/M) code used for routine physical exams in established patients aged 40 to 64 years. It is part of the CPT coding system maintained by the American Medical Association (AMA). In simple terms, CPT 99396 is used when a doctor […]
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What Are OT Evaluation CPT Codes (97165, 97166, 97167) and How Do They Work? Occupational therapy (OT) evaluation CPT codes—97165, 97166, and 97167—are used to classify the complexity of an OT evaluation for billing and documentation purposes. These codes help insurers determine reimbursement based on the level of clinical decision-making and patient needs. If you’re
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What Are CPT Codes G0151, G0152, and G0157 in Home Health Physical Therapy? If you’re trying to understand codes like G0151, G0152, or G0157, you’re looking at how physical and occupational therapy services are billed in home health care. These are not traditional CPT codes—they are HCPCS Level II codes used mainly by Medicare to
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What Is the Difference Between Copay vs Deductible vs Coinsurance? Understanding copay, deductible, and coinsurance is essential because these three terms determine how much you actually pay for healthcare—even if you have insurance. In simple terms: Copay = fixed amount you pay per visit Deductible = the amount you pay before insurance starts sharing costs
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What Is Timely Filing in Medical Billing? Timely filing in medical billing refers to the maximum time limit a healthcare provider has to submit a medical claim to an insurance company for reimbursement. If a claim is not submitted within this deadline, the insurer may deny payment completely, regardless of whether the service was valid
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How Do You Write a Medical Billing Appeal Letter (Template + Example)? If your health insurance claim was denied or you received an unexpected medical bill, you can challenge it by writing a medical billing appeal letter. This letter is your formal request asking the insurer or provider to review and reconsider the decision. A
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What Are the Top Denial Reasons and How Can You Fix Them? Denials happen when a claim, application, or request is reviewed and not approved due to missing, incorrect, or non-compliant information. Whether it’s a health insurance claim, loan application, or reimbursement request, denials are common—but most are fixable. Understanding why denials happen is the
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What Is the Difference Between Denials and Rejections? The difference between a denial and a rejection comes down to when and why a request is refused. A rejection happens early due to errors or missing information, while a denial happens after review because the request does not meet the criteria. This distinction matters more than
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What Is Medical Necessity in Billing? Medical necessity in billing refers to whether a healthcare service or procedure is appropriate, reasonable, and essential for diagnosing or treating a patient’s condition based on accepted medical standards. In simple terms, insurance companies only pay for services they consider medically necessary—not just helpful or requested. Understanding this concept
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What Are the Top 25 CPT Modifiers With Simple Examples? If you’ve ever looked at a medical bill or insurance claim, you’ve probably seen small two-digit codes added to procedures—these are CPT modifiers. They might look simple, but they play a huge role in how healthcare providers get paid. In this guide, you’ll learn the
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