|CPT Code Audit Guide

CPT Code Audit Guide

Use your hospital's CPT codes to cross-check your Medicare Summary Notice (MSN) and spot billing errors. Studies estimate 30–80% of hospital bills contain mistakes — this guide helps you find them.

30+

CPT codes in database

8

Billing error types

5

Appeal levels

Look Up a CPT Code

Enter a CPT code from your hospital bill or search by procedure name to see the Medicare-approved amount and common billing errors.

All 30 Medicare Surgery CPT Codes — Quick Reference

Click any row to see full details, common billing errors, and red flags for that code.

📍 Show region-adjusted amounts for your location

RVU-based codes are adjusted using 2026 CMS GPCI values for your locality. Amounts shown in blue.

CPTProcedureMedicare ApprovedYour 20%
27130Total Hip Arthroplasty (Total Hip Replacement)$1,259~$252
27446Partial Knee Replacement (Unicompartmental)$1,048~$210
27447Total Knee Arthroplasty (Total Knee Replacement)$1,156~$231
43235Upper GI Endoscopy (EGD) — Diagnostic Only$160~$32
43239Upper GI Endoscopy (EGD) with Biopsy$196~$39
45378Diagnostic Colonoscopy$220~$44
45380Colonoscopy with Biopsy$270~$54
45385Colonoscopy with Snare Polypectomy$310~$62
64483Transforaminal Epidural Steroid Injection — Lumbar/Sacral$129~$26
64490Paravertebral Facet Joint Injection — Cervical/Thoracic$115~$23
66982Complex Cataract Removal with IOL Implant$820~$164
66984Cataract Removal with IOL Implant (Standard Lens)$699~$140
71046Chest X-Ray, 2 Views$25~$5
73560X-Ray Knee, 1-2 Views$29~$6
73721MRI Lower Extremity (Knee/Hip) without Contrast$155~$31
73723MRI Lower Extremity (Knee/Hip) with and without Contrast$309~$62
85025Complete Blood Count (CBC) with Differential$12~$2
88305Surgical Pathology — Level IV (Tissue Biopsy Examination)$75~$15
93000Electrocardiogram (EKG) with Interpretation$16~$3
97012Mechanical Traction (Physical Therapy) — per 15 minutes$20~$4
97110Therapeutic Exercise (Physical Therapy) — per 15 minutes$34~$7
97530Therapeutic Activities (Physical Therapy) — per 15 minutes$35~$7
99213Office Visit — Established Patient, Low Complexity (Level 3)$58~$12
99214Office Visit — Established Patient, Moderate Complexity (Level 4)$85~$17
99215Office Visit — Established Patient, High Complexity (Level 5)$127~$25
G0121Colorectal Cancer Screening — Colonoscopy (Preventive)$220$0
01402Anesthesia for Total Knee Replacement (CPT 27447)
01214Anesthesia for Total Hip Replacement (CPT 27130)
00840Anesthesia for Intraperitoneal Procedures (Cataract)
00810Anesthesia for Lower Intestinal Endoscopy (Colonoscopy)

Blue amounts are locality-adjusted for BAKERSFIELD using 2026 CMS GPCI. * Based on 2026 CMS Physician Fee Schedule (CF = $33.4009). Actual amounts vary by location.

CPT codes and Medicare-approved amounts are based on 2026 CMS Physician Fee Schedule data (CF = $33.4009). National averages — actual amounts vary by location and provider. This guide is for educational purposes only and does not constitute legal or medical advice. For personalized help, contact your SHIP counselor at shiphelp.org.