Enter the CPT/HCPCS codes from your bill to get plain‑language explanations, typical cost ranges, and potential red flags to ask about. This tool runs fully in your browser.

Educational only — not medical, legal, or billing advice. For the U.S. only. No personal health information (PHI) is collected or stored.

By OrbDoc Editorial Medically reviewed by Billing Specialist Last updated: Nov 2, 2025

You should know

Americans spend billions each year due to preventable billing mistakes. Always request an itemized bill with codes, then review using the checklist below.

• Get a detailed, itemized bill (CPT/HCPCS with modifiers)
• Match services received to what’s billed
• Verify code levels are appropriate for the visit
• Check for duplicates / global vs split double bills
• Ask for clarification on anything unclear
• Request prompt‑pay discounts or charity/financial assistance

Understanding Your Options

✅ When You Have Leverage

• • Balance billing: Provider charged more than EOB amount (contract violation for in-network providers)
• • You’re uninsured: Self-pay rates are negotiable before or after service
• • Billing errors: Duplicate charges, wrong codes, services not rendered
• • Financial hardship: Apply for charity care (income-based, requires documentation)

❌ When You Don’t Have Leverage

• • Insurance processed claim: Provider legally bound by contracted rates
• • Charges match EOB: “Patient responsibility” is non-negotiable
• • High deductible plans: You owe 100% until deductible met
• • Legitimate charges: Services rendered correctly, coding is accurate

💡 Key Insight: Why Negotiation Fails After Insurance Processing

Once your insurance processes a claim at contracted rates, providers cannot arbitrarily discount your portion without violating their contract with the insurance company.

What actually works: Apply for financial assistance (charity care) through the hospital’s formal program. This is income-based, requires documentation (pay stubs, tax returns), and doesn’t violate insurance contracts. For providers, proper Medicare billing optimization and audit defense systems help avoid billing disputes.

⚠️ File a Balance Billing Complaint with Your State

If your provider refuses to adjust charges after you’ve contacted their billing department and your insurance company, your state’s Department of Insurance can enforce provider contracts and investigate balance billing violations.

State insurance regulators have authority to:

• Investigate provider billing practices
• Enforce insurance network contracts
• Order refunds for balance billing violations
• Impose penalties on non-compliant providers

Typical timeline: Initial review in 2-4 weeks, investigation in 4-8 weeks. State DOI involvement often resolves balance billing disputes faster than legal action.

Looking for bill upload? We’re working on adding photo/PDF upload to automatically extract codes. For now, enter codes manually or contact us for help reviewing your bill.

For Healthcare Providers

If you’re a provider managing billing complexity, OrbDoc helps you document accurately for proper coding, avoid denials, and optimize revenue.

Insight: When patients are confused by bills, it often indicates incomplete documentation. Better documentation → fewer patient questions → fewer denials.

Learn more about CPT codes

Browse our CPT code resources to better understand common procedures and billing terms.

How to analyze your medical bill in 3 steps

1. Add your CPT/HCPCS codes. These 5‑character codes appear on statements and explain what was billed.
2. Select your insurance type. Coverage patterns differ for Medicare, Medicaid, Commercial, and Uninsured patients.
3. Review plain‑language results. See explanations, typical cost ranges, and potential red flags to discuss.

Frequently asked questions

Do you store any personal data?

No. The analyzer runs fully in your browser and does not collect or store PHI.

Is this medical or legal advice?

No. This is an educational tool to help you ask better questions.

Where do the cost ranges come from?

Ranges are derived from public sources (e.g., Medicare fee schedule) and are estimates that vary by locality and plan.

What does CPT stand for?

CPT stands for Current Procedural Terminology. CPT codes are 5-digit numbers that identify medical services and procedures billed to insurance.

How do I know if my bill is correct?

Compare charges to typical cost ranges, check for duplicate codes, verify insurance coverage, and review your Explanation of Benefits (EOB). The analyzer flags common issues like unbundling and unusual cost combinations.

What should I do if my bill seems wrong?

Contact your provider’s billing department first. Ask about specific codes, request an itemized bill, and verify insurance processing. If issues persist, contact your insurance company or seek patient advocacy help.

Can I negotiate my medical bill?

Yes. Many providers offer payment plans, financial assistance, or discounts for uninsured or high-deductible patients. Ask early and be persistent. Some hospitals have charity care programs.

What’s the difference between CPT and HCPCS codes?

CPT codes are 5-digit numbers for medical services. HCPCS codes (Healthcare Common Procedure Coding System) include CPT codes plus additional codes for supplies, drugs, and services not in CPT (often start with letters).

Why does my insurance deny codes?

Common reasons include: missing documentation, services not medically necessary, bundling rules, prior authorization required, or coverage limitations. Ask your provider to resubmit with additional documentation.

What are medical billing modifiers?

Modifiers are 2-digit codes added to CPT codes to indicate special circumstances, like -25 (significant separate E/M service) or -59 (distinct procedural service). They affect how codes are processed and reimbursed.

How do I read an EOB (Explanation of Benefits)?

An EOB shows what your insurance covered, what you owe, and why. Compare it to your bill: the charges, allowed amounts, your share (deductible/coinsurance), and any denials or adjustments.

What is balance billing?

Balance billing occurs when a provider bills you for the difference between their charge and what insurance paid. For in-network providers, this is usually prohibited beyond your deductible/coinsurance.

How long do I have to pay a medical bill?

Timelines vary by state and provider. Typically 30-90 days. Medical bills generally don’t affect credit immediately, but collections can. Contact providers early to arrange payment plans if needed.

Common hospital bill line items explained

CT Scan + Radiology – Diagnostic

Facility technical charge vs. physician interpretation. You should not see a global code billed together with split professional/technical components for the same study.

EKG/ECG

Global (93000) vs. split billing (93005 technical, 93010 professional). Global and split together is typically a double bill.

Emergency Room

Facility level charge + separate professional fee for the clinician. Verify the level matches documentation.

Preventive Care Services

In‑network preventive services are often $0 cost‑share in outpatient settings. If you were billed, ask if recoding applies.

Pharmacy (Inpatient/ED)

Hospital/ED medication billing uses HCPCS (J‑codes) and differs from retail pharmacy. Confirm the medication was administered and billed correctly.