Incorrect codes used for a TB test

Almost a year ago, I went and got a TB test done at an urgent care. I had gone before elsewhere and paid $40 so I expected the same here. This urgent care asked me if I had health insurance to which I said yes (should’ve said no) and they ran my insurance and I didn’t pay anything. A month or so later, I receive a bill for $322… for A TB TEST!! I thought this was an outrageous amount and immediately called the urgent care and my insurance. Urgent care blamed my insurance and insurance blamed the urgent care. No one was taking responsibility for this ridiculous bill. I did more digging on my end to see what I was billed for. The codes they used for my appointment were 9921525 and 9920525 which is for new patient office visits that involve a high level of medical decision making, comprehensive history and exam, and a typical encounter of 60-74 minutes. I was FLOORED because obviously a TB test entails none of this. So I sent an email to the urgent care pointing out the incorrect codes. They responded to my email telling me they reviewed my claim and resubmitted to my insurance. They told me there was nothing else I needed to do. So I left it alone… until I received another bill a month later for $322 from the urgent care. I then decided to submit two claims to my insurance on two separate occasions and sent out three more emails to the urgent care regarding the claims. NO ONE has since responded but of course, I keep receiving the same bill every month. Today I decided to check on my claims through my insurance account and of course there was no update. As I stated before, it’s been almost a year since this appointment so I looked up how long before I get sent to collections. That’s when I saw that you don’t get sent to collections for medical bills under $500. At this point, I’m ready to say F it and never reach out to either of them again. I have since changed insurance (I turned 26 and left my parent’s) and will likely never return to that urgent care. What’s the worst that can happen??

Incorrect codes used for a TB test
byu/Forsaken-Cold1311 inInsurance

Posted by Forsaken-Cold1311

Dijon2017 on February 9, 2026 7:35 am

If you have an affordable ACA compliant health insurance plan, that’s great! However, understanding and being able to navigate healthcare in the US system can indeed be complex and complicated.

In an attempt to decrease confusion, you want to understand your insurance policy coverages and also the fact that the costs to a pay for an outpatient (office or UC) and/or non-emergency visit likely includes whether it was in-network or out-of-network, established (99215) or new patient (99205), screening or diagnostic, the type of test, who (physician vs nurse) was involved with your care, who placed/read or drew your blood, in addition to the actual “TB TEST”.

Billing can reflect the actual time spent face-to-face with a patient during the encounter as well as pre and post-visit time and/or the medical complexity or medical decision-making involved (that doesn’t necessarily have to reflect the actual time spent with the patient) in the care of that patient.

In general, a new patient visit is generally more expensive than an established care visit (for the majority of patients who seek care in an outpatient setting for the same issue/care). In my state, getting the skin PPD test also includes the reading of the test…so there shouldn’t be an additional service fee if they were both done at the same facility.

Again, for future reference, when you go to an UC or an office visit for a new/first visit, it’s usually a higher cost than for an established care or nurse visit. Moreover, you’re less likely to be able to have a “nurse visit” if you are a new patient to that particular facility.

If you should ever require a TB or other testing for a job/other screening, you should seek out the occupational health facilities affiliated with the potential employer or your local department of health to see if they might offer the services for free/low-cost.

In short, this situation you experienced is not unique to a specific insurance carrier and doesn’t necessarily mean it can/will be avoided by changing your health insurance carrier (or policy) or avoiding that particular urgent care. It’s much more complicated than that. And, because that it the case, in an attempt to decrease the chance that you receive medical bills that you don’t understand/agree with, you should be diligent in learning/reading your insurance policy (including coverages, exclusions, appeals, etc.) that should be accessible/provided by your health insurance policy/carrier, not relying on your doing your own “digging”/research (via a search engine, web browser or chat GPT/LLM). When you have a better understanding of your health insurance policy, you’ll likely be better able to more effectively communicate with doctors’ offices, other medical facilities (e.g. UC, ASCs, hospitals, radiological facilities, etc.) and health insurance companies.

2 Comments

adjusterjack on February 9, 2026 5:11 am

You might get sued for the debt. That’s allowed.
Dijon2017 on February 9, 2026 7:35 am

If you have an affordable ACA compliant health insurance plan, that’s great! However, understanding and being able to navigate healthcare in the US system can indeed be complex and complicated.

In an attempt to decrease confusion, you want to understand your insurance policy coverages and also the fact that the costs to a pay for an outpatient (office or UC) and/or non-emergency visit likely includes whether it was in-network or out-of-network, established (99215) or new patient (99205), screening or diagnostic, the type of test, who (physician vs nurse) was involved with your care, who placed/read or drew your blood, in addition to the actual “TB TEST”.

Billing can reflect the actual time spent face-to-face with a patient during the encounter as well as pre and post-visit time and/or the medical complexity or medical decision-making involved (that doesn’t necessarily have to reflect the actual time spent with the patient) in the care of that patient.

In general, a new patient visit is generally more expensive than an established care visit (for the majority of patients who seek care in an outpatient setting for the same issue/care). In my state, getting the skin PPD test also includes the reading of the test…so there shouldn’t be an additional service fee if they were both done at the same facility.

Again, for future reference, when you go to an UC or an office visit for a new/first visit, it’s usually a higher cost than for an established care or nurse visit. Moreover, you’re less likely to be able to have a “nurse visit” if you are a new patient to that particular facility.

If you should ever require a TB or other testing for a job/other screening, you should seek out the occupational health facilities affiliated with the potential employer or your local department of health to see if they might offer the services for free/low-cost.

In short, this situation you experienced is not unique to a specific insurance carrier and doesn’t necessarily mean it can/will be avoided by changing your health insurance carrier (or policy) or avoiding that particular urgent care. It’s much more complicated than that. And, because that it the case, in an attempt to decrease the chance that you receive medical bills that you don’t understand/agree with, you should be diligent in learning/reading your insurance policy (including coverages, exclusions, appeals, etc.) that should be accessible/provided by your health insurance policy/carrier, not relying on your doing your own “digging”/research (via a search engine, web browser or chat GPT/LLM). When you have a better understanding of your health insurance policy, you’ll likely be better able to more effectively communicate with doctors’ offices, other medical facilities (e.g. UC, ASCs, hospitals, radiological facilities, etc.) and health insurance companies.

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