Procedures
Procedures by plain-English name
The code a claim carries, starting from what the service is actually called. Each page names the code, shows what Medicare pays for it nationally, and points at the neighboring codes it gets confused with.
Amounts reflect the Q3 2026 Physician Fee Schedule release.
- A1C test 83036 A blood test reflecting average blood sugar over roughly the preceding three months, used to diagnose diabetes... Statutory exclusion — no national amount
- Allergy testing 95004 Skin prick testing to identify specific triggers behind allergic rhinitis, asthma, eczema, or suspected food a... Office $3.67 Facility $3.67
- Annual physical 99397 A comprehensive preventive exam for a patient who has been seen before, billed by the patient's age band — 993... Non-covered — no national amount
- Annual Wellness Visit G0439 Medicare's yearly prevention-planning visit. G0439 is the subsequent-year visit; G0438 is the first one a bene... Office $137.61 Facility $137.61
- Blood draw 36415 The needle stick itself, reported whenever blood is collected for laboratory testing — separately from whateve... Statutory exclusion — no national amount
- Bone density scan 77080 A DEXA scan of the hip and spine, used to screen for or monitor osteoporosis — typically repeated every one to... Office $39.41 Facility $39.41
- Cardiac stress test 93015 An exercise stress test with continuous monitoring, supervision, interpretation, and report — the standard tre... Office $73.48 Facility $73.48
- Cataract surgery 66984 Removal of a clouded natural lens and insertion of an artificial lens implant, done in one sitting. Office $462.60 Facility $462.60
- Chest x-ray 71045 An x-ray of the chest, ordered for cough, breathlessness, or chest pain. 71045 is a single view; 71046 is the... Office $25.38 Facility $25.38
- Chiropractic adjustment 98940 Spinal manipulation covering one to two regions of the spine, for joint dysfunction causing neck or back pain. Office $26.72 Facility $18.37
- Cholesterol test 80061 A lipid panel — the standard cholesterol test, bundling total cholesterol, HDL, and triglycerides, from which... Statutory exclusion — no national amount
- Colonoscopy 45378 An examination of the colon with a flexible scope. 45378 is the diagnostic version, used to investigate sympto... Office $378.10 Facility $164.67
- Complete blood count (CBC) 85025 A broad blood screen for anemia, infection, and bleeding problems. 85025 includes the white-cell differential;... Statutory exclusion — no national amount
- Cortisone shot J3301 The steroid medication itself — triamcinolone acetonide, billed per 10 mg given. Excluded — no national amount
- COVID test 87635 A PCR test for SARS-CoV-2, used to confirm or rule out COVID-19 in someone with symptoms or a known exposure. Statutory exclusion — no national amount
- CT scan of the abdomen 74177 A CT of the abdomen and pelvis with contrast — the usual study for an abdominal-pain work-up, suspected infect... Office $300.27 Facility $300.27
- Diabetes screening 82947 A quantitative blood glucose measurement, used for routine screening and for managing known diabetes. Statutory exclusion — no national amount
- Drug test 80305 A presumptive point-of-care drug screen read visually — the dip-card style test used most often in pain manage... Statutory exclusion — no national amount
- Echocardiogram 93306 An ultrasound of the heart with Doppler flow study, ordered to evaluate suspected heart failure, valve disease... Office $196.73 Facility $196.73
- EKG 93000 A recording of the heart's electrical activity. 93000 is the complete service — the tracing plus a physician's... Office $15.36 Facility $15.36
- Established patient office visit 99213 A routine visit with a clinician you have seen before. Level 3 (99213) is the most common office visit billed... Office $95.19 Facility $57.45
- Eye exam 92004 A comprehensive eye evaluation for a new patient, covering the full examination rather than a single focused p... Office $149.64 Facility $77.82
- Flu shot 90686 The quadrivalent, preservative-free influenza vaccine — one of several flu-vaccine formulations, each with its... Statutory exclusion — no national amount
- Gallbladder removal 47562 Laparoscopic removal of the gallbladder, done for symptomatic gallstones or gallbladder inflammation. Office $631.95 Facility $631.95
- Hearing test 92557 Comprehensive audiometry — the full hearing evaluation ordered when hearing loss is suspected. Office $35.74 Facility $25.72
- Heart monitor 93225 The recording portion of a Holter monitor — a wearable device that captures the heart rhythm continuously, typ... Office $18.04 Facility $18.04
- Hernia repair 49650 Laparoscopic repair of a first-time groin (inguinal) hernia causing a bulge, discomfort, or a risk of tissue b... Office $424.19 Facility $424.19
- Hip replacement 27130 Total hip arthroplasty, done for advanced hip arthritis or a failed hip that has not responded to non-surgical... Office $1,162.02 Facility $1,162.02
- Joint injection 20610 Injection into or aspiration of a major joint such as the knee, shoulder, or hip. 20605 covers intermediate jo... Office $68.81 Facility $39.75
- Knee replacement 27447 Total knee arthroplasty — resurfacing both sides of the knee joint, done for advanced arthritis that has not r... Office $1,159.35 Facility $1,159.35
- Mammogram 77067 A screening breast x-ray of both sides, done on a routine schedule for patients without symptoms. Office $126.26 Facility $126.26
- Mole removal 11400 Excision of a small benign skin growth on the trunk or a limb, taken off in full rather than sampled. Office $127.93 Facility $76.49
- MRI of the knee 73721 An MRI of a lower-limb joint without contrast — the standard knee study, ordered for persistent pain, locking,... Office $204.41 Facility $204.41
- New patient office visit 99203 A first office visit with a clinician who has not seen you in the last three years. Level 3 (99203) is the usu... Office $117.57 Facility $71.48
- Pelvic ultrasound 76856 An ultrasound of the pelvic organs outside of pregnancy, used to work up abnormal bleeding, pelvic pain, fibro... Office $105.21 Facility $105.21
- Physical therapy evaluation 97161 The initial assessment at a first physical therapy visit. 97161 is the low-complexity evaluation; 97162 applie... Office $97.86 Facility $97.86
- Prostate biopsy 55700 Needle sampling of the prostate to evaluate for cancer, usually prompted by an elevated PSA result or an abnor...
- PSA test 84153 A blood test measuring total prostate-specific antigen, used to screen for prostate cancer and to follow patie... Statutory exclusion — no national amount
- Psychiatric evaluation 90791 The initial diagnostic assessment at the start of mental-health care, reported typically once per episode of t... Office $173.35 Facility $137.28
- Psychotherapy session 90834 An individual psychotherapy session. 90834 covers a session of about 45 minutes — the standard length — while... Office $113.90 Facility $91.85
- Screening colonoscopy G0121 A colonoscopy done for screening rather than to investigate symptoms. G0121 covers a patient at average risk;... Office $378.43 Facility $165.00
- Skin biopsy 11102 A tangential (shave) sampling of a suspicious or changing skin lesion, sent for pathologic diagnosis. Office $95.53 Facility $30.06
- Sleep study 95810 An attended overnight sleep study in a laboratory, used to diagnose sleep apnea and other sleep disorders when... Office $673.70 Facility $673.70
- Stitches 12001 Simple repair of a small superficial wound — the straightforward stitching of a cut that does not involve deep... Office $113.90 Facility $44.09
- Strep test 87880 A throat swab for group A strep. 87880 is the rapid antigen test read in the office; 87651 is the more sensiti... Statutory exclusion — no national amount
- Thyroid test 84443 A thyroid-stimulating hormone (TSH) blood test — the first-line screen for an underactive or overactive thyroi... Statutory exclusion — no national amount
- Tonsillectomy 42820 Removal of the tonsils together with the adenoids in a patient under 12, done for recurrent throat infections... Office $260.86 Facility $260.86
- Upper endoscopy 43239 An examination of the esophagus, stomach, and upper small bowel with a flexible scope, with one or more biopsi... Office $418.85 Facility $123.58
- Urinalysis 81001 A urine test used to evaluate urinary symptoms, suspected infection, or as part of a wider work-up. 81001 incl... Statutory exclusion — no national amount
- Vaccine administration 90471 The act of administering a vaccine, reported once for the first injection at a visit and billed alongside the... Office $22.04 Facility $22.04
- Wart removal 17110 Destruction of up to 14 benign lesions such as warts in a single session, typically by freezing. Office $111.22 Facility $62.46
- Welcome to Medicare visit G0402 A one-time preventive visit available during a beneficiary's first 12 months of Medicare Part B enrollment. Office $174.69 Facility $114.23
General information about how Medicare prices a service, not coding advice for a specific claim. The correct code always depends on what was actually documented and performed.