Your 2025 Guide to Urgent Care Billing and Coding

Understanding the commonly billable procedures in urgent care is critical for compliance, accurate reimbursement, and preventing denials in 2025. Providers must apply the correct modifier 25 when a significant and separately identifiable E/M service is performed on the same day as a procedure, such as laceration repair plus evaluation. Proper use of Place of Service (POS) codes is essential—POS 20 for urgent care facilities, POS 11 for office (based on payer contracts), and POS 10/02 for telehealth. With Medicare telehealth flexibilities extended through September 30, 2025, urgent care providers can bill for patient-at-home visits, but must follow payer-specific modifier 95 requirements. Documentation remains key—link medical necessity, tests, and diagnoses, while ensuring ICD-10-CM FY2025 updates are implemented. Avoid common denials tied to modifier misuse, outdated codes, or incorrect POS entries. Stay compliant with CMS, NCCI, and payer-specific billing rules to maximize reimbursement.