Limited Education Center
CPT Concepts for Medical Billing and Reimbursement
Learn the workflow concepts that connect professional and outpatient services to diagnoses, modifiers, NCCI edits, documentation, payer policy, and adjudication.
This is not a CPT codebook. CPT content and complete descriptors are copyrighted by the American Medical Association. Use a current licensed source for code selection, official descriptors, parenthetical instructions, and annual updates.
CPT vs. HCPCS
CPT is commonly called HCPCS Level I. HCPCS Level II is the separate alphanumeric system frequently used for equipment, supplies, drugs, and other items.
Open lessonProfessional and technical components
Learn why modifier 26 and TC describe different portions of certain eligible services and why not every code can be split.
Open lessonRepeat services
Distinguish modifiers 76, 77, and 91 from duplicate billing and from repeat work caused by an error or inadequate specimen.
Open lessonNCCI procedure-to-procedure edits
Research code pairs, modifier indicators, edit rationale, and documentation before reporting a distinct-service modifier.
Open lessonWhat this center covers
- Code-system boundaries and claim roles
- Modifier reasoning and documentation
- NCCI PTP and MUE research workflows
- Medical necessity, coverage, and denial prevention