Medical billing and coding tools
Code lookups and form decoders for the day-to-day of medical billing and coding.
More about this page
ICD-10-CM, HCPCS Level II, CPT structural rows, NDC, CARC and RARC, MS-DRG, APC, NUBC revenue and TOB, CMS-1500 and UB-04 field-by-field references.
39 tools in this hub, all free, all in your browser.
Billing & Coding
- Time-Based E/M Code Selector (2021) Map total provider time on the date of an office or outpatient encounter to the corresponding 2021 AMA CPT…
- MDM-Based E/M Code Selector (2021) E&M level by medical decision making.
- NDC 10 ↔ 11 Digit Converter Translate a National Drug Code between its FDA-assigned 10-digit segmentation…
Billing & Reimbursement
- MPFS Allowed Amount (RVU x GPCI x CF) Medicare PFS payment from RVUs.
- Multiple-Procedure Payment Reduction (MPPR) Applies the multiple-procedure payment reduction to a set of surgical or endoscopic lines.
- Bilateral (Modifier 50) Payment by Indicator Bilateral-surgery payment by the MPFS bilateral indicator (0/1/2/3).
- Assistant / Co- / Team-Surgeon Payment Co-surgeon / assistant / team payment.
- Medicare 2% Sequestration Adjustment Medicare sequestration.
- NCCI Edit & Modifier-Bypass Checker NCCI Procedure-to-Procedure edit check.
- MUE Units Adjudication (MAI 1/2/3) Medically Unlikely Edit check.
- Modifier 59 vs XE/XS/XP/XU Selector Picks the right distinct-service modifier.
- Global Surgery Period & Required Modifier Surgical global-period check.
- Pricing vs Informational Modifier Order Orders CPT/HCPCS modifiers on the claim line.
- E/M MDM Level by Setting (2023, all places of service) 2023 E&M level by medical decision making.
- Critical Care Time (99291 + 99292 Units) Critical-care time coding.
- Split / Shared Visit & FS Modifier Split/shared visit attribution.
- Prolonged Services (99417 / G2212 Units) Prolonged-services coding.
- Therapy Units (8-Minute Rule vs Rule of Eights) Timed-therapy billable units from cumulative minutes under the Medicare 8-minute rule or the AMA/SPM substantial-portion rule.
- Anesthesia Units (Base + Time + Modifying x CF) Anesthesia payment: (base + time + modifying) units x conversion factor, then the medical-direction…
- HCPCS Drug Billing Units (Dose -> Units) Convert an administered dose to HCPCS/J-code billing units by the code descriptor unit size, with the…
- Drug Wastage (JW / JZ Units, Single-Dose Vial) Single-dose-vial wastage.
- Infusion Hierarchy (Initial Code Picker, 96360-96379) Assign the CPT infusion/injection hierarchy (one initial, then sequential/concurrent/push) across a set of…
- NPI Luhn Check-Digit Validator / Generator NPI Luhn check-digit validation (10 digits) or generation from a 9-digit base, per the CMS/ISO 80840 prefix rule.
- Medicare Beneficiary Identifier (MBI) Format Validator Medicare Beneficiary Identifier (MBI) format validation: the 11-position CMS grammar and excluded-letter rules.
- ICD-10-CM Structural & Specificity Checker ICD-10-CM structural and specificity check: category/subcategory grammar and whether a 7th character is required.
- 835 / EOB Remittance Balancing 835 / EOB remittance balancing: billed minus paid minus the CO/PR/OA/PI adjustments.
- IPPS DRG Payment Estimate IPPS DRG payment estimate: relative weight x the wage-index-adjusted operating+capital base, with the per-diem transfer reduction.
- OPPS APC Payment Estimate OPPS APC payment estimate: relative weight x conversion factor, wage adjusted.
Insurance & Patient Literacy
- Medicare Appeal-Level Deadline Calculator Medicare claim-appeal deadline.
- Claim Timely-Filing Deadline Timely-filing deadline: the payer window (Medicare 365 days, or a custom limit) from the date of service and the deadline date.
- Prior-Authorization Decision-Deadline Clock Prior-authorization decision deadline under CMS-0057-F.
- 60-Day Overpayment Report-and-Return Clock Medicare 60-day overpayment report-and-return deadline from the identification date (42 CFR 401.305).
- Medicare Patient Cost-Share (Part A / B / SNF) Medicare patient cost-share.
- Coordination of Benefits & Medicare Secondary Payer Coordination of benefits.
- Contractual Write-Off vs Patient Balance Allowed-amount split: contractual write-off, patient responsibility (deductible + coinsurance + copay), and…
- No Surprises Act Cost-Share (QPA-Based) No Surprises Act cost-share.