Medical bill glossary

On the statement

Total charges

The hospital’s full list price for everything on the bill. Insurance payments, adjustments and discounts are taken off it before the amount you owe.

Chargemaster price

The hospital’s own list price for each item and service. Hospitals must publish their standard charges online, so you can look them up.

Insurance adjustmentOn bills: ADJ

An amount taken off the charges because of the price your insurer and the provider agreed. You do not pay an adjusted amount.

Insurance payment

What your insurer paid the provider for this care. The EOB your insurer sends should show the same amount.

Pending insurance

Amounts the provider is still waiting for your insurer to pay or decide on. Until the insurer decides, this part is not yet your balance, so it is fair to ask before paying it.

Patient responsibility

The part of the bill the provider says is yours to pay after insurance. Compare it with the “you may owe” amount on your EOB.

Amount due

The amount the provider is asking you to pay now. It may include or leave out earlier payments, so compare it with the patient responsibility shown.

Patient payments

Money you have already paid on this account. Check that every payment you made appears here.

Previous balance

What the last statement said you owed, carried over to this one. It should match that statement minus what you have paid since.

Credit balance

A negative amount, or one marked CR, means the provider owes you money, for example after you or your insurer paid too much. You can ask for it to be refunded.

Self-pay discount

A reduction some hospitals give to patients paying without insurance. Policies differ, so ask the billing office what applies to you.

Prompt-pay discount

A discount some providers give if you pay the whole balance quickly. Check the deadline printed on the bill.

Statement date

The day this bill was printed. Deadlines are usually counted from it.

Due date

The date the provider asks to be paid by. If you are still asking questions about the bill, you can ask the billing office to put the account on hold until they answer.

Account numberOn bills: ACCT

The provider’s reference for this bill or this stay. Have it ready when you call or write.

Guarantor

The person responsible for paying the bill. For a child it is usually a parent, so it may not be the patient.

Date of serviceOn bills: DOS

The day the care was given. A date when you were not there is worth asking about.

Admission and discharge dates

The days a hospital stay started and ended. Room charges are usually counted per night, so the day you leave is often not charged.

Quantity (units)On bills: QTY

How many of an item, or how many blocks of time, were billed. Some services are billed in 15-minute units, so 4 units can mean one hour.

Unit priceOn bills: EA

The price of one unit. The line total should equal the quantity times this price. EA means each.

Miscellaneous

A catch-all heading. It is reasonable to ask what exactly it includes.

Late fee or finance charge

An extra charge for paying after the due date. Ask what it is based on, especially if you were still waiting for answers about the bill.

Insurance

DeductibleOn bills: DED

The amount you pay for covered care each plan year before your insurance starts sharing more of the cost.

CoinsuranceOn bills: COINS

Your percentage of the allowed cost after you have met your deductible, for example 20%.

Copay

A fixed amount you pay for a covered service, such as $30 for a visit.

Allowed amount

The most your insurer accepts as the price of a service. In-network providers agree not to bill you above it.

Out-of-pocket maximumOn bills: OOPM

The most you pay for covered in-network care in a plan year. Once you reach it, the plan pays the rest of covered in-network costs.

Explanation of Benefits (EOB)On bills: EOB

A statement from your insurer showing what was billed, what it allowed, what it paid and what you may owe. It is not a bill, but it is the best thing to compare your bill with.

Claim

The request a provider sends your insurer to be paid for your care. The claim number links the bill to your EOB.

Denied claim

Your insurer refused to pay all or part of a claim. The EOB gives a reason, and many denials can be appealed or fixed by the provider sending the claim again.

Not covered

A service your plan does not pay for. Check your plan documents, and ask the provider whether it was billed with the right code.

In-network

A provider with a contract with your insurer, which usually means lower agreed prices for you.

Out-of-networkOn bills: OON

A provider without a contract with your insurer. Costs are often higher, and the provider may bill you directly.

Balance billing

When a provider bills you for the difference between its price and what your insurer allowed. Federal and state rules forbid it in many situations, including most emergencies.

Prior authorization

Approval some plans require before certain care. If a claim was denied for missing approval, ask the provider whether getting it was their job: for in-network care it often is.

Coordination of benefitsOn bills: COB

How two insurance plans decide which one pays first. A claim can be held while the insurer asks whether you have other coverage.

Primary and secondary insurance

When you have two plans, the primary one pays first and the secondary one may cover some of what is left.

Reason codes (CO, PR, OA)On bills: CARC, RARC

Short codes on an EOB that explain each adjustment. CO means the provider writes the amount off under its contract with your plan. PR means the amount is your share. OA and PI are other adjustments.

CO-45

On an EOB, the part of the charge above what your plan allows. Under the contract it is written off, so an in-network provider should not bill you for it.

PR-1, PR-2, PR-3

Your share on an EOB: PR-1 is deductible, PR-2 is coinsurance and PR-3 is copay. These are the amounts the provider can bill you.

MedicareOn bills: MSN

The federal health insurance for people 65 and over and for some younger people with disabilities. Medicare mails a Medicare Summary Notice, its version of an EOB.

Medicaid

Health coverage from your state for people with low incomes (Medi-Cal in California). Providers who accept Medicaid generally cannot bill you more than the small amount the program allows.

Advance Beneficiary Notice (ABN)On bills: ABN

A form a Medicare provider asks you to sign when it thinks Medicare may not pay. If you were not given one, you may not have to pay for some services Medicare refuses.

Medical necessity

Insurers pay for care they judge needed for your condition. A “not medically necessary” denial can be appealed, often with a letter from your doctor.

Appeal

Asking your insurer to review a decision not to pay. Your EOB says how and by when; private plans usually allow 180 days.

Hospital departments and charges

Facility fee

A charge for using the hospital or clinic building, equipment and staff, billed separately from the doctor’s own fee.

Professional (physician) fee

The charge for the doctor’s or clinician’s own work. It usually comes on a separate bill from the hospital’s.

Room and board

The daily charge for a hospital bed, meals and basic nursing. It is usually counted per night, so check the number of days against your stay.

Intensive care (ICU, CCU) and step-downOn bills: ICU, CCU, MICU, SICU

Daily room rates for closer monitoring. They cost more than a regular room, so check that the days match the time you spent in that unit.

Observation

Hospital care in a bed while doctors decide whether to admit you. It is billed by the hour and counts as outpatient care, which changes what insurance and Medicare pay.

Emergency room

Emergency visits usually bring two charges: the hospital’s facility charge, with a level from 1 to 5, and a separate bill from the emergency doctor.

Trauma activation

A fee for calling the trauma team to meet you when you arrive. It is often large, so ask whether the team was activated and why.

Urgent care

A walk-in clinic for problems that are not emergencies. If it belongs to a hospital, it may add a facility fee like a hospital department.

Operating room (OR)

The charge for the operating room, its staff and basic equipment, usually by time. The surgeon and the anesthesia team bill separately.

AnesthesiaOn bills: CRNA

Medicines and care that keep you asleep or numb during a procedure, usually billed by time. The hospital and the anesthesia provider may each send a bill.

Recovery roomOn bills: PACU

The area where you are watched as you wake up after a procedure, usually billed by time.

PharmacyOn bills: RX

Medicines given during your care. A summary bill shows one total; the itemized bill lists each drug, dose and quantity.

Drugs requiring detailed coding

Drugs that must be billed with their own code, usually medicines given by injection or through a vein. The itemized bill shows each one.

General classification

Wording copied from the standard department names on hospital claim forms. It means the charge is grouped under the department in general, not under a narrower sub-type.

Medical and surgical supplies

Items used during your care, such as dressings, gloves, tubing and kits. If the bill only says “supplies”, ask what each one was.

Implants

Devices left in your body, such as screws, plates, stents or lenses. They are often among the largest supply charges, and the itemized bill should name each one.

Laboratory (lab)

Tests on blood, urine or tissue. Chemistry, hematology (blood cells), immunology, microbiology (infections) and pathology (tissue) are lab departments.

Blood bank

Charges for preparing, storing and giving blood or blood products.

Radiology (imaging)

Imaging such as X-rays. The hospital bills for taking the images; a radiologist may bill separately for reading them.

CT scan (CAT scan)On bills: CT

A detailed X-ray scan taken in slices. “With contrast” means a dye was used; “with and without” means two sets of images.

MRIOn bills: MRI, MRA

A scan made with magnets instead of X-rays. It is usually one of the most expensive imaging tests.

Ultrasound and echocardiogram

Imaging made with sound waves. An echocardiogram, or echo, is an ultrasound of the heart.

Cardiology and telemetry

Heart tests and heart monitoring. Telemetry means continuous heart monitoring, often charged per day on top of the room.

Respiratory therapyOn bills: NEB, O2

Breathing treatments, oxygen, and lung tests or support. Charges are often per treatment or per day, so compare the number with your stay.

Physical, occupational and speech therapyOn bills: SLP

Therapy to help you move, manage daily tasks, swallow or speak. It is often billed in 15-minute units, so compare the units with the time spent.

Audiology

Hearing tests and hearing care.

Other diagnostic services

A heading for tests that do not fit another department. Ask which tests it includes.

Consultation

A visit from a specialist your doctor asked to see you. The specialist usually bills separately from the hospital.

Ambulance (ALS, BLS)On bills: ALS, BLS

ALS (advanced life support) and BLS (basic life support) are ambulance levels, billed as a base rate plus mileage. Federal law protects you from surprise bills for air ambulances, but not for ground ambulances, although some states do.

Durable medical equipment (DME)On bills: DME

Equipment you take home, such as crutches, a walker or a brace. Check that you received it, and compare the price with what a store charges.

Outpatient

Care without a formal admission to the hospital. Observation stays count as outpatient too.

Inpatient

Care after a formal admission to the hospital. Being in a hospital bed does not by itself mean you were admitted, so ask whether it was observation.

Labor and delivery, nursery and NICUOn bills: NICU

Charges for childbirth and newborn care. NICU is intensive care for newborns, and phototherapy is light treatment for newborn jaundice. The baby usually gets a separate bill.

Triage

The first check by a nurse in the emergency room to decide how urgent your case is. It is usually part of the emergency visit itself.

Medication administration

The charge for giving you a drug, separate from the price of the drug itself.

Tests, treatments and supplies

Venipuncture (blood draw)

The fee for drawing blood. More than one on the same day can be correct when blood was taken at different times.

CBC (complete blood count)On bills: CBC

A common blood test that counts red cells, white cells and platelets. “With diff” adds the types of white cells.

BMP and CMP (metabolic panels)On bills: BMP, CMP

Blood chemistry panels that check kidneys, sugar and salts. The comprehensive one (CMP) also checks the liver and already includes everything in the basic one (BMP), so both on the same day is worth asking about.

Urinalysis (UA)On bills: UA

A urine test.

PT/INR and PTT (clotting tests)On bills: PTT, APTT, INR

Blood tests that measure how fast blood clots, often done before surgery or for people taking blood thinners.

Troponin

A blood test for heart muscle damage. In the emergency room it is often repeated a few hours apart, so two on the same day can be correct.

Lipid panel

A blood test for cholesterol and other fats.

Hemoglobin A1cOn bills: A1C, HBA1C

A blood test of your average blood sugar over the past two to three months.

TSH (thyroid test)On bills: TSH

A blood test of how well your thyroid works.

Culture

A test that grows a sample to look for an infection. Blood cultures are usually taken in pairs, so two lines can be expected.

Rapid tests (strep, flu, COVID)

Quick swab tests for common infections.

hCG (pregnancy test)On bills: HCG

A pregnancy test on blood or urine. Many emergency rooms do one before X-rays or some medicines.

EKG or ECG (electrocardiogram)On bills: EKG, ECG

A quick test of the heart’s electrical activity. There may be one charge for doing it and another for reading it.

Contrast

A dye given to make a scan clearer. It can appear as its own drug or supply line. W/O means without.

IV (intravenous) fluids and infusionsOn bills: D5W

Fluids or medicine given through a vein. The first hour and each extra hour are often separate lines, and each bag of fluid can be its own line.

InjectionOn bills: INJ

A medicine given with a needle. There is usually one line for the drug and another for giving it.

Vaccine (immunization)

A vaccine. Under the Affordable Care Act, most plans cover recommended vaccines from in-network providers at no cost to you.

Dose units (mg, mcg, ml)On bills: MG, MCG, ML

Amounts of a medicine: milligram, microgram and milliliter. Pharmacy lines often show a price per unit of dose.

Tablet or capsule (TAB, CAP)On bills: TAB, CAP

One pill. Pharmacy lines on itemized bills often show the price of each pill, which can be well above a drugstore price.

Kit or tray

A pre-packed bundle of supplies for one procedure, such as an IV start kit. Ask whether items inside the kit were also billed one by one.

STAT

Means urgent. Some providers charge more for urgent tests.

Codes and forms

CPT code

A five-digit code for a medical service or procedure, such as a visit, a test or a surgery. The code set belongs to the American Medical Association, so we name only its families, in our own words.

HCPCS code

A letter and four digits, used for drugs, supplies, equipment and ambulance rides. Medicare publishes the names for free, and MedBillCheckup shows them next to the line.

ICD-10 diagnosis code

A code describing the diagnosis or reason for the visit. It explains why care was given, not what it cost.

Revenue code

A four-digit code hospitals use to group charges by department, such as pharmacy or emergency room.

NDC (National Drug Code)On bills: NDC

A 10- or 11-digit number that identifies a drug product and its package. It matches a pharmacy line to the exact medicine.

Modifier

Two characters added to a code for more detail. Common ones: 25 is a separate visit on the same day as a procedure, 59 or XS a distinct service, 76 or 77 a repeat of the same procedure, 26 the doctor’s reading only, TC the equipment part only, LT and RT left and right, 50 both sides.

Visit level (E/M)

Visit codes come in levels, usually 1 to 5. A higher level means more complex medical decisions and a higher price. If the level seems high for your visit, ask what it was based on.

DRG (diagnosis related group)On bills: DRG

A group a hospital stay is put in, mostly by diagnosis. Medicare and many insurers pay a set amount per group, whatever the itemized charges add up to.

UB-04

The standard claim form hospitals send to insurers. It lists revenue codes, procedure codes and charges, and you can ask the hospital for a copy.

CMS-1500

The standard claim form doctors and clinics send to insurers.

NPIOn bills: NPI

A ten-digit number that identifies a healthcare provider in the United States.

Place of service

Where the care was given, such as a doctor’s office, a hospital outpatient department or an emergency room. It can change the price: hospital-based clinics often add a facility fee.

Your rights and where to get help

Itemized statement

A detailed list of every charge on your bill, with codes and dates. You can ask the billing office for one, free.

Good Faith EstimateOn bills: GFE

A written estimate of expected charges that providers must give uninsured or self-pay patients before scheduled care.

No Surprises Act

A federal law, in force since 2022, that protects you from most surprise out-of-network bills for emergency care and for out-of-network doctors at in-network hospitals. Uninsured patients can also dispute a bill $400 or more above their Good Faith Estimate.

Self-pay

Paying without insurance, or choosing not to use it. Self-pay patients have the right to a Good Faith Estimate before scheduled care.

Financial assistance (charity care)On bills: FAP

Non-profit hospitals must have a written policy that lowers or cancels bills for eligible patients, often based on income. You can usually apply even after you receive the bill.

Payment plan

Paying the bill in monthly parts. Ask whether the plan is interest-free before agreeing to a medical credit card.

Collections

When a bill is passed to a debt collector. Within 30 days of a collector’s first notice, you can ask it in writing to prove the debt.

Price transparency

Hospitals must publish their prices online, including the rates agreed with each insurer. You can use them to compare what you were charged.

Procedure code families (CPT)

Five-digit procedure codes come in families. The exact wording of each code belongs to the American Medical Association, so here is only the kind of service each range stands for, in our own words. Your provider can tell you what a single code on your bill means.