How to Read a Medical Bill: CPT Codes and Charges Explained
Learn how to read your medical bill, understand CPT and HCPCS codes, and spot billing errors. Our guide breaks down hospital bills line by line.
Understanding Your Medical Bill
Medical bills can be confusing with their cryptic codes, multiple charges, and complex calculations. But understanding your bill is essential—studies show 30-80% of medical bills contain errors. This guide helps you decode every section of your medical bill so you can verify charges and catch mistakes before you pay.
Types of Medical Bills You May Receive
After a hospital visit, you may receive multiple bills from different providers. Understanding who is billing you helps you track what you owe and catch duplicate charges.
- Hospital/Facility bill: Room, supplies, facility fees, nursing care
- Physician bill: Doctors who treated you (may be separate from hospital)
- Anesthesiologist bill: Often billed separately from surgeon
- Radiologist bill: For reading X-rays, CT scans, MRIs
- Pathologist bill: For lab work and test interpretation
- Emergency room physician bill: ER doctors are often independent
- Ambulance bill: Emergency transport services
Key Sections of a Medical Bill
Every medical bill contains similar information, though formats vary. Here are the key sections to review:
- Patient information: Your name, address, date of birth, account number
- Service dates: When you received care
- Provider information: Who provided the service
- Itemized charges: Individual services with codes and prices
- Insurance payments: What your insurance paid
- Adjustments: Discounts from network pricing
- Patient responsibility: What you owe (deductible, copay, coinsurance)
- Payment due date and instructions
Understanding CPT and HCPCS Codes
Medical bills use standardized codes to identify services. CPT (Current Procedural Terminology) codes are 5-digit codes for medical procedures and services. HCPCS (Healthcare Common Procedure Coding System) codes cover supplies, equipment, and services not in CPT. Understanding code categories helps you verify that charges match the care you received.
- 99201-99499: Evaluation and management (office visits, hospital care)
- 00100-01999: Anesthesia services
- 10000-69999: Surgical procedures
- 70000-79999: Radiology (X-rays, CT, MRI, ultrasound)
- 80000-89999: Pathology and laboratory
- 90000-99199: Medicine (injections, infusions, therapies)
- A0000-V9999: HCPCS codes for supplies and equipment
Common Medical Billing Codes You'll See
These are some of the most frequently billed codes that appear on medical bills:
- 99213: Office visit, established patient, moderate complexity
- 99214: Office visit, established patient, moderate-high complexity
- 99283: ER visit, moderate severity
- 99284: ER visit, high severity
- 99285: ER visit, highest severity (life-threatening)
- 36415: Venipuncture (blood draw)
- 85025: Complete blood count (CBC)
- 80053: Comprehensive metabolic panel
- 71046: Chest X-ray, 2 views
- 74177: CT scan of abdomen and pelvis with contrast
Red Flags: Common Medical Billing Errors
Watch for these common billing mistakes that could be costing you money:
- Duplicate charges: Same service billed multiple times
- Unbundling: Separating charges that should be billed together
- Upcoding: Using a code for a more expensive service than provided
- Incorrect quantities: Wrong number of units for medications or supplies
- Wrong patient information: Errors in name, DOB, or insurance
- Services not received: Charges for procedures you didn't get
- Operating room time errors: Incorrect surgery duration
- Balance billing: Being billed more than allowed for in-network care
How to Review Your Medical Bill for Errors
Request an itemized bill
Call the billing department and request a fully itemized statement showing every charge with CPT/HCPCS codes, descriptions, quantities, and prices. You have a legal right to this.
Compare to your EOB
Match the itemized bill against your Explanation of Benefits from insurance. The patient responsibility on your EOB should match what the provider is billing you.
Verify dates and services
Check that all service dates match when you actually received care. Verify each procedure listed is something you remember receiving.
Look up unfamiliar codes
Search CPT codes online to understand what each charge represents. Verify the code descriptions match the care you received.
Dispute errors in writing
If you find errors, document them in writing to the billing department. Include your account number, specific charges in question, and why you believe they're incorrect.
Frequently Asked Questions
What are CPT codes on a medical bill?
CPT (Current Procedural Terminology) codes are standardized 5-digit codes that identify medical services and procedures. They're used for billing insurance and help ensure consistent pricing across healthcare providers.
How do I get an itemized medical bill?
Call the billing department and request an itemized statement. You have a legal right to receive one. Ask for all CPT/HCPCS codes, descriptions, quantities, and prices for every service.
Why did I get multiple bills for one hospital visit?
Hospitals, physicians, anesthesiologists, radiologists, and other providers often bill separately. Each may have different contracts with your insurance, resulting in multiple bills for a single visit.
What is the difference between a bill and an EOB?
An EOB (Explanation of Benefits) is an informational statement from your insurance showing how a claim was processed. A bill is a payment request from your provider. Always compare them—your bill should match your EOB's patient responsibility amount.
How do I know if my medical bill has errors?
Request an itemized bill and compare it to your EOB and your memory of services received. Look for duplicate charges, services you don't recognize, incorrect dates, and amounts that don't match your EOB.
What should I do if I find an error on my medical bill?
Contact the billing department in writing, specifying the error and providing documentation. Keep copies of all correspondence. If unresolved, contact your insurance company or file a complaint with your state health department.
Need Help Understanding Your Medical Bill?
Upload your medical bill and EOB, and our AI will analyze the charges, verify codes, and identify potential errors or overcharges.
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