Our Data: Methodology, Sources, and Update Cadence
Every CPT code, ICD-10 code, NCCI bundling rule, denial code, and industry statistic on this site traces to a primary source. This page documents where the data comes from, how often we update it, and how AAPC-certified specialists review the curated content.
Why this page exists
Medical billing is a YMYL (Your Money or Your Life) topic — practices make real financial decisions based on the codes, denial-code strategies, and industry benchmarks they read online. Wrong information in this domain compounds: bad CPT data drives miscoded claims, wrong NCCI rules drive CO-97 denials, and outdated industry statistics misinform business decisions.
This page documents how we source the data on this site, how often we refresh each dataset, the editorial review process, and the correction policy. If you cite anything from gomedicalbilling.com — whether you are a practice manager building internal training, a journalist sourcing statistics, or a billing partner referencing our denial code library — you should know how the underlying data is maintained.
For the people behind the editorial review, see our medical coding team page.
Primary data sources
CMS Medicare Physician Fee Schedule (PFS)
Annual + quarterlyRVU values, conversion factor, payment rates, status indicators, and global periods are sourced from the current CMS PFS Final Rule. Updated annually with each calendar year rule release plus quarterly modifier updates as published by CMS.
Visit sourceNational Correct Coding Initiative (NCCI) Edits
Quarterly (Apr/Jul/Oct/Jan)Procedure-to-Procedure (PTP) bundling edits and Medically Unlikely Edits (MUE) are sourced directly from the CMS NCCI quarterly file. Refreshed each quarter on CMS's official publication date — typically within 5 business days of release.
Visit sourceAmerican Medical Association (AMA) CPT Code Set
Annual (January)CPT codes and short descriptors are sourced from the AMA CPT code set. Long descriptors are AMA-copyrighted and not redistributed; we link to the AMA CPT manual for full definitions where deeper guidance is needed.
Visit sourceX12 Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC)
3x per yearCARC and RARC code descriptions are sourced from X12 N standards — the same codes used by every U.S. payer in electronic remittance advice. Updated 3x per year per X12 publication schedule.
Visit sourceICD-10-CM (Public Domain via CDC and CMS)
Annual (October 1)ICD-10-CM diagnosis code descriptions are public domain via the CDC and CMS. The annual code set update takes effect October 1 each year. We apply the new codes within 14 days of the official effective date.
Visit sourceHCPCS Level II
QuarterlyHCPCS Level II codes (J-codes for drugs, E-codes for DME, K-codes for supplies, etc.) are sourced from the CMS HCPCS quarterly update file.
Visit sourceCMS Geographic Practice Cost Index (GPCI)
AnnualLocality-specific fee calculations use the CMS GPCI file to adjust national RVU-based payments to specific geographic localities. Updated with each annual MPFS rule release.
Visit sourceMGMA Benchmarks and Industry Reports
As publishedIndustry benchmarks for denial rates, days in A/R, claim rework costs, and revenue cycle KPIs are referenced from MGMA published reports. Where applicable, we cite the specific MGMA Stat or annual benchmark report.
Visit sourceOIG Work Plan and CMS CERT Reports
As publishedAudit risk patterns, fraud-and-abuse focus areas, and compliance considerations are referenced from the HHS Office of Inspector General Work Plan and the CMS Comprehensive Error Rate Testing program reports.
Visit sourceChange Healthcare Revenue Cycle Denials Index
As publishedIndustry-wide denial volume and financial-impact data ($262B initially denied claims, etc.) is sourced from Change Healthcare's published Revenue Cycle Denials Index analysis.
Visit sourceOur editorial process
Source Verification
Every data point published on this site traces to a primary source listed above. We do not aggregate from secondary sources, scrape competitor sites, or use AI-generated statistics. Every number is sourced to a CMS, AMA, MGMA, or other primary publication with a public URL.
AAPC-Certified Review
Curated content — extended glossary entries, denial code appeal strategies, specialty billing guides, hub authority pages, and cornerstone blog articles — is reviewed by AAPC-certified medical billing and coding specialists before publication and on each scheduled refresh.
Scheduled Updates
Different data sources have different update cadences. NCCI edits: quarterly within 5 business days of CMS release. ICD-10-CM: annually within 14 days of October 1. CPT: annually within 14 days of January 1. Industry stat pages: refreshed when new primary research is published.
Indexability Gate
Programmatic pages (CPT codes, ICD-10 codes, glossary terms, denial scenarios) pass through an indexability classifier that emits noindex,follow on any page whose template cannot render meaningfully — anesthesia codes without ASA data, deleted codes, status-I/M/N/X codes, zero-data stubs. The gate prevents broken templates from contaminating Google's domain quality assessment.
Correction Policy
We welcome corrections. If you find an error — outdated payment data, incorrect CARC code description, missing modifier, mismatched specialty mapping — email sales@gomedicalbilling.com with the specific page URL and the source for the correct value. Verified corrections are applied within 5 business days and noted in the page's last-updated timestamp.
Editorial Independence
Our published industry data does not promote payer or vendor relationships. We have no commercial relationships with Change Healthcare, MGMA, the AMA, AAPC, or AHIMA. Where we cite competitor billing platforms or RCM services for comparison, the comparisons are factual and based on publicly available pricing and feature documentation.
The data spine behind this site
Every code page on this site (CPT, ICD-10, HCPCS, denial codes, modifiers) is generated from a structured database that consolidates the primary sources above into a single queryable layer. This includes:
- 11,025 CPT codes with RVU, conversion factor, status indicator, global period, and effective date
- 70,000+ ICD-10-CM diagnosis codes with billable status and clinical category
- 308 CARC denial codes plus the full RARC remittance remark code library
- 1.7M+ active NCCI Procedure-to-Procedure (PTP) bundling edits with modifier indicators
- 15,000+ MUE (Medically Unlikely Edit) limits per CPT/HCPCS code per day
- Geographic Practice Cost Index (GPCI) data for locality-adjusted fee calculations
- Specialty-specific code mappings linking 25+ medical specialties to their most-billed CPTs
The database is rebuilt on each primary-source update cycle. Every page generated from this data passes through the indexability classifier described below, which emits noindex on any page whose template cannot render meaningfully against the underlying data.
Who reviews this content?
The data sources are public. The editorial review that turns those sources into accurate, current, AAPC-certified content is what separates this site from a scraper or AI-aggregated content farm. See our editorial team and their credentials.
Meet the medical coding teamMethodology FAQ
Questions about how we source, verify, and update the data on this site.
Trust the data. Get your billing right.
Free billing assessment from AAPC-certified coders working from the same primary sources documented above.