CPT Code
Current Procedural Terminology codes used by healthcare providers to identify specific medical services for billing. Each joint injection, office visit, or therapy session has a specific CPT code.
Extended Definition
CPT codes are five-digit numbers that describe medical, surgical, and diagnostic services. Created and maintained by the American Medical Association, they’re the standard language for billing and tracking healthcare services.
Common CPT Codes for Joint Pain
Office Visits:
- 99213: Established patient, moderate complexity
- 99214: Established patient, moderate-high complexity
- 99215: Established patient, high complexity
Joint Injections:
- 20610: Large joint injection (knee, hip, shoulder)
- 20611: Large joint injection with ultrasound guidance
- 76942: Ultrasound guidance for injection
HA Injection Drugs (J-Codes):
- J7321: Hyalgan
- J7323: Euflexxa
- J7325: Synvisc/Synvisc-One
- J7326: Gel-One
- J7327: Monovisc
Physical Therapy:
- 97110: Therapeutic exercises
- 97140: Manual therapy
- 97530: Therapeutic activities
How CPT Codes Affect You
On your EOB:
- Shows what services were billed
- Determines what insurance pays
- Helps you verify correct billing
Potential issues:
- Wrong code = wrong payment
- Upcoding (billing higher code than appropriate)
- Unbundling (billing separately for combined services)
Checking Your Bills
- Request itemized bill with CPT codes
- Compare to services you received
- Verify codes match your EOB
- Question unfamiliar or duplicate codes
Resources
- Look up CPT codes on CMS.gov
- Ask billing department to explain codes
- Compare to Medicare fee schedules
Related Terms
More Insurance Terms
View allAppeal
A formal request to have your insurance company reconsider a denied claim or coverage decision. You have the right to appeal most insurance denials, including Medicare decisions.
Coinsurance
Your share of the costs of a covered service, calculated as a percentage. With Medicare Part B, you pay 20% coinsurance after meeting your deductible.
Covered Service
A healthcare service that your insurance plan includes in your benefits and will help pay for, assuming you meet all requirements like deductibles and prior authorization.
Deductible
The amount you must pay out-of-pocket for healthcare services before your insurance starts paying. Medicare Part B has an annual deductible of $240 (2024).
DME (Durable Medical Equipment)
Medical equipment prescribed for home use that can withstand repeated use, serves a medical purpose, and is appropriate for home settings. Includes knee braces, walkers, TENS units, and other devices for joint pain.