Tips for Reading Medical Bills

When reviewing a medical bill make sure you ask for "an itemized bill" that shows all of the codes and fees for each code. Some organizations may bundle services together under a propritary (custom) code.

Not all "codes" on a bill are nationally recognized billing codes. Some may be private codes or codes that are specific to the hospital or medical group.

Nationally (USA/Medicare) recognized billing codes are from these code sets:

• CPT^® - Current Procedural Termonology - copyright the American Medical Association (AMA)
• HCPCS - Healthcare Common Procedure Coding System - produced by the Centers for Medicare and Medicaid Services (CMS)
• CDT - Current Dental Terminology - maintained by the American Dental Association (ADA) - also listed as "D####" codes in the HCPCS code set
• ICD-10-CM - International Classification of Diseases, 10th Revision, Clinical Modification - updated annually by the National Center for Health Statistics
• NDC – National Drug Codes - maintained by the U.S. Food & Drug Administration (FDA)

If you enter a code into our tool that is not in one of these code sets a note will appear indicating that it is an unknown code. This means the code could be a propritary or private code used by the billing organization.

Note: ICD-10-CM codes are for diagnosis and do not have fees associated with them. Also NDC fees or costs for drugs will not be listed.

An EOB or Explanation of Benefits document is not a bill. It's a description of what is covered by your insurance policy.