Each January, the code sets change. New CPT codes appear, older ones are retired, and diagnosis codes gain detail they did not have the year before. None of that arrives as an announcement at the front desk. It tends to show up months later, as a claim that pays a little less than expected or a care gap that stays open, and by then it looks like a billing problem when it really began with the list of codes the practice chooses from.
A simple, once-a-year look at that list is one of the kinder things a practice can do for itself. It takes about an afternoon, and it helps make sure your team can bill for the care it is giving.
The list shapes what can be billed
A superbill, whether it is a paper encounter form or the charge-capture pick list inside your electronic health record (EHR), is usually built once and rarely revisited. Most other things in a practice get a regular look, including the schedule, the fee schedule, and the formulary. The list of codes a provider can choose from is often inherited from whoever first set up the system, and because a provider can only choose what the list offers, it gently sets the ceiling on what the practice is able to bill and close.
That matters more than it might seem, because a claim is read more than once after it leaves your office. The plan’s payment system reads it to decide what to pay, and the plan’s quality program reads it to decide whether a measure was met. Under the Equality Care Incentive Program (ECIP), activities become payable when they are confirmed by claims or by the payer’s quality file [1]. A single missing line can affect all three, which is why a code that pays nothing on the fee schedule is sometimes one of the most valuable lines on the claim.
Three ways a superbill drifts over time
Drift is gradual, and no one is at fault for it. It tends to happen in three ways.
A service you provide, with nothing to select
In May 2024, the FDA expanded primary HPV testing to allow self-collection in a clinical setting, and practices began offering it. The code is CPT 87626 [2]. When a line like that never makes it onto the pick list, the visit is billed without it and the screening is not counted, however well the encounter went. Result codes can drift the same way. Our April piece on coding looks closely at what happens when a documented result never reaches the claim.
Codes that have been retired
CPT 99201 was eliminated by the CPT Editorial Panel effective January 1, 2021 [3]. The telephone visit codes 99441 through 99443 were deleted for 2025 and replaced by a new family of telemedicine codes [4]. Both can still be found on pick lists years later, simply because nothing in a normal day flags a code as retired. The claim comes back denied, and the denial is usually handled one at a time, which makes it hard to see that the list is where it started.
The general code where a specific one belongs
Our own kidney guidance suggests avoiding stage 3 unspecified (N18.30) when the eGFR is known [5], and ECIP’s concurrent review asks for conditions to be documented to the highest level of specificity [6]. The unspecified option is always the quickest one to select, especially at the end of a long day. When a general code sits at the top of a section, it can easily become a habit, and over time the practice’s documentation shows patients as less complex than they are.
How the afternoon can go
We would suggest bringing three people together, which are a provider, whoever looks after the charge-capture setup, and your Practice Performance Advisor (PPA). Your PPA will bring the current code list for the measures your market is scored on. That gives everyone a reliable reference to work from, and it saves your team from comparing the list against another document that may be a year behind.
It tends to go most smoothly one section at a time, moving through visit codes, services and procedures, result codes, diagnoses, and modifiers. For each line, the group can simply note whether something is missing, retired, or more general than it needs to be. The diagnosis section usually rewards the most time, because that is where general codes are easiest to overlook.
When you have finished, it helps to count what you found in each section. That count is a starting point most practices have never had. Taking the same look the following January, after the code sets have turned over again, will show whether the list is being kept current.
What it is worth
Across participating practices, we recorded $11.9 million in ECIP-eligible activities in 2024 [7], and every dollar of it arrived on a claim carrying codes that someone was able to select. We do not have a published figure for what an updated superbill is worth on its own, and we would rather not guess. The most honest measure is your own, which is your count before, your count after, and what you see in the following quarter’s claims and in the rejections queue in CareEmpower® [8].
A decision worth revisiting
A superbill can feel like plumbing, but it works more like a quiet policy, because it decides in advance which of your team’s work can be recorded. That seems well worth one afternoon a year.
January is a lovely time for it, when the code sets have just changed and a fresh look will do the most good. If you would like company for it, your PPA would be glad to sit down with you, and we are grateful for the care behind every one of those claims.
References
1. Equality Health. “2026 ECIP Reference Guide.” Payable activities: confirmed by claims, confirmed in the quality file, or marked for closure in CareEmpower following 180 days.
2. Equality Health. “Cervical Cancer Screening — Quality Guide (CCS).” February 2025, pp. 2–3. (FDA expanded use of primary HPV testing allowing self-collection in a clinical setting, May 2024; CPT 87626 for self-collection ordering.)
3. Centers for Medicare & Medicaid Services. “Fact Sheet — Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation and Management (E/M) Visits.” January 11, 2021, p. 1. (“The CPT Editorial Panel eliminated CPT code 99201.”) https://www.cms.gov/files/document/physician-fee-schedule-pfs-payment-officeoutpatient-evaluation-and-management-em-visits-fact-sheet.pdf
4. American Medical Association. “How the AMA meets the need for new telehealth CPT codes.” (Telephone-only codes 99441–99443 deleted and replaced by the 98000–98016 telemedicine family, effective January 1, 2025.) https://www.ama-assn.org/practice-management/cpt/how-ama-meets-need-new-telehealth-cpt-codes
5. Equality Health. “Chronic Kidney Disease Documentation and Coding — Quality Guide.” May 2024, p. 2. (“Avoid use of stage 3 unspecified (N18.30) when eGFR is known.”)
6. Equality Health. “2026 ECIP Reference Guide,” Appendix I, Concurrent Review Business Rules.
7. Equality Health. ECIP-eligible activities across participating practices, 2024.
8. Equality Health. “CareEmpower User Guide.” February 2026, p. 34.
