Glossary of Medical Billing Terms
Demystifying the complex language of healthcare billing. Understand your rights and the codes that determine your costs.
CPT Code (Current Procedural Terminology)#link
A set of five-digit codes used to describe medical, surgical, and diagnostic services and procedures. Insurance companies use these codes to determine how much to pay a provider. Errors in CPT coding are one of the most common causes of medical bill overcharges.
Upcoding#link
A type of billing fraud or error where a provider submits a CPT code for a more expensive service than the one actually performed. For example, billing for a complex emergency room visit when the treatment provided was simple.
Unbundling (Fragmented Billing)#link
The practice of billing multiple CPT codes for parts of a procedure that should be billed under a single, all-inclusive 'bundled' code. This often results in significantly higher total charges for the same treatment.
Balance Billing (Surprise Billing)#link
When an out-of-network provider bills a patient for the difference between the provider's charge and the allowed amount paid by the insurance company. The No Surprises Act now protects patients from many forms of balance billing.
HCPCS Code#link
Healthcare Common Procedure Coding System. These codes are used primarily for billing Medicare and Medicaid for products, items, and services not included in the CPT codes, such as durable medical equipment (DME), prosthetics, and ambulance services.
EOB (Explanation of Benefits)#link
A statement sent by a health insurance company to a patient explaining what medical treatments and/or services were paid for on their behalf. An EOB is not a bill, but it is essential for verifying the accuracy of the bill you receive from the provider.
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