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92 Free Medical Billing & RCM Tools

Explore billing checklists, illustrative financial calculators and EDI parsers. Each tool states its review status and requires confirmation against current payer policies.

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Pediatric Hirschsprung Pull-Through Scrubber

Audit aganglionic megacolon pull-through procedures (45120/45112), intraoperative leveling biopsies (+44150-59), laparoscopic mobilization (49320-59), and staged diversion (Mod -58).

Open tool Head & Neck Oncologic Reconstruction

Head & Neck Free Flap Reconstruction Scrubber

Audit microvascular fibula (20955) and ALT free flaps (15756), mandibular plating (+21247-59), operating microscope (+69990), neck dissection (+38724-59), and dual-surgeon co-surgery.

Open tool Pediatric Surgery & Neonatology

Pediatric TEF & Esophageal Atresia Scrubber

Audit neonatal esophageal atresia and tracheoesophageal fistula repairs (43305/43312), rigid bronchoscopy (+31622-59), gastrostomy (+43653-59), and staged Foker elongation (Modifier -58).

Open tool Plastic & Reconstructive Surgery

DIEP Flap Breast Reconstruction Scrubber

Audit autologous microvascular DIEP breast reconstructions (19364), bilateral reconstruction (19364-50), operating microscope (+69990), ICG angiography (+15860), and venous rescue (35201-59).

Open tool Pediatric Oncology & Neonatal Surgery

Pediatric SCT & Coccygectomy Scrubber

Audit sacrococcygeal teratoma excision (49220/45120), en-bloc coccygectomy (27075-59), combined abdominoperineal staging (49000-59), and pelvic floor levatorplasty.

Open tool Surgical Oncology & Multivisceral Resection

Adult Retroperitoneal Sarcoma & Multivisceral Scrubber

Audit radical retroperitoneal sarcoma excision (49203–49205), contiguous radical nephrectomy (50240-59), adrenalectomy (60540-59), and IVC replacement (35281-59).

Open tool Pediatric Congenital Cardiac Surgery

Pediatric Single-Ventricle Norwood & Glenn Scrubber

Audit Stage 1 Norwood arch reconstruction (33619), Sano/BT shunts (33766/33750), branch pulmonary artery angioplasty (+33688), and staged Modifier -58 defenses.

Open tool Minimally Invasive Spine Deformity

Adult Spine Deformity & Multi-Level LLIF Scrubber

Audit multi-level lateral lumbar interbody fusion (22558, +22552), anterior longitudinal ligament release (ALLR +Mod 22), percutaneous instrumentation (+22842–+22843), and S2AI screws (+22848).

Open tool Pediatric Pancreas & Islet Transplant

Pediatric TPIAT & Islet Isolation Scrubber

Audit total pancreatectomy (48155), cGMP clean-room islet isolation (48805), intraportal autotransplantation (+48554), and portal vein catheterization.

Open tool Endoscopic Skull Base & Neurosurgery

Endoscopic Skull Base Pituitary & Odontoid Scrubber

Audit transnasal odontoidectomy (61575), transsphenoidal hypophysectomy (61548), vascularized Hadad nasoseptal flaps (+15730), and ENT/Neurosurgery Modifier -62.

Open tool Pediatric Oncology & Radiopharmaceuticals

Pediatric Targeted MIBG & Radiopharmaceutical Scrubber

Audit therapeutic I-131 MIBG administration (79445), HCPCS A9508 isotope invoice pass-through, medical physics consultation (+77336), and autologous stem cell rescue (+38240).

Open tool Abdominal Wall Reconstruction & Robotic Surgery

Complex Robotic Hernia & TAR Component Separation Scrubber

Audit modern CPT 2023+ anterior abdominal wall hernia repairs (49591–49618), transversus abdominis release (TAR add-on +49622), and retrorectus mesh placement (+49623).

Open tool Biochemical Genetics & Rare Disease

Pediatric Biochemical Genetics & Metabolic Formula Scrubber

Audit tandem mass spectrometry amino acid panels (82139/82136), urine organic acids (83918), prolonged visits (+99417), and defend medical formula prior-auth (B4162/B4157).

Open tool Cerebrovascular & Skull Base

Complex EC-IC Cerebrovascular Bypass & Aneurysm Scrubber

Audit STA-MCA microvascular bypass (61711), unbundle orbitozygomatic approaches (61592), defend autologous graft harvest (+35500/35600), and capture microscope add-ons (+69990).

Open tool Pediatric Neurosurgery & Neuromodulation

Pediatric DBS & Cranial Neuromodulation Scrubber

Audit stereotactic lead placement with microelectrode recording (61867/+61868 vs 61863), suppress headframe bundling (20660), defend dual-channel IPGs (61886-59/58), and capture intraoperative neuroprogramming (95983).

Open tool Craniofacial Trauma & OMFS

Panfacial Trauma & Multi-Level Fracture Reconstruction Scrubber

Audit complex midface Le Fort I/II/III repairs (21422–21435), ZMC fractures (21365), mandibular plating (21462), intermaxillary fixation bundling (21110-59), and orbital blowout reconstructive implants (21390).

Open tool Pediatric IR & Vascular Anomalies

Pediatric Vascular Malformations & Sclerotherapy Scrubber

Audit image-guided sclerotherapy (37241/49185), high-flow AVM embolization (37242), off-label Bleomycin (J9040) appeals, dual imaging (+76937/+77002), and Modifier -58 staging.

Open tool Orthopedic Oncology & Sarcoma

Orthopedic Oncology & Limb Salvage Mega-Prosthesis Scrubber

Audit radical bone tumor resections (27075/27645), defend modular oncologic mega-prostheses (27599/27299-22), unbundle rotational muscle flaps (15734-59), and recover catastrophic implant invoices.

Open tool Pediatric General & Critical Care Surgery

Pediatric CDH & Neonatal ECMO Repair Scrubber

Audit neonatal CDH repair (39503), defend Gore-Tex patch reconstruction (+49568-59), unbundle VA-ECMO cutdown cannulation (+33946-59), and safeguard staged silo closure (49605-58).

Open tool Vascular & Endovascular Surgery

Complex Fenestrated/Branched EVAR (FEVAR) & TAAA Scrubber

Audit multi-vessel visceral aortic endografts (34841-34848), defend open Crawford TAAA resections (33877), unbundle lumbar CSF drainage (62272-59), and coordinate Modifier -62.

Open tool Pediatric Craniofacial & Neurosurgery

Pediatric Cranial Vault Remodeling & Synostosis Scrubber

Audit fronto-orbital advancement (21175), complex multi-suture CVR (21180), co-surgeon Modifier -62 coordination, split-calvarial bone grafts (20900-59), and helmet DME (L0112).

Open tool Robotic Urologic Oncology

Robotic Urologic Oncology & Complex Reconstructive Scrubber

Audit robot-assisted radical prostatectomy (55866), defend extended pelvic lymphadenectomy (+38572-59), robotic partial nephrectomy (50543), intracorporeal urinary diversions, and Modifier -22.

Open tool Pediatric Orthopedic Surgery

Pediatric Early-Onset Scoliosis (EOS) & Growing Rod Scrubber

Audit magnetically controlled growing rods (MCGR), staged surgical lengthenings (22849-58), VEPTR rib distraction, pelvic anchors (+22848), and outpatient distraction clinics.

Open tool Surgical Oncology

Cytoreductive Surgery & HIPEC Perfusion Scrubber

Audit extensive peritonectomy (49205), defend 90-min heated chemoperfusion (+96560), coordinate co-surgeon Modifier -62, and safeguard concomitant bowel resections (44140-51).

Open tool Adult Congenital Cardiac Surgery

Adult Congenital Heart Disease (ACHD) & Fontan Conversion Scrubber

Scrub complex Fontan conversion (33737), defend redo sternotomy adhesiolysis add-ons (+33530), safeguard concomitant arrhythmia cryoablation Maze (+33257/+33258), and audit pulmonary valve replacements.

Open tool Pediatric Craniofacial Surgery

Pediatric Facial Reanimation & Free Gracilis Scrubber

Audit dynamic smile reanimation for congenital Moebius syndrome and pediatric facial palsy, staged Modifier -58 on Stage 2 free gracilis transfer (15756), masseteric transposition (64864-51), and +69990.

Open tool Skull Base Surgery

Lateral Skull Base & Acoustic Neuroma Co-Surgeon Scrubber

Audit translabyrinthine and retrosigmoid acoustic neuroma approaches (61526, 61530), validate dual-attending Modifier 62 matching, defend operating microscope (+69990), and secure facial nerve monitoring.

Open tool Pediatric Otolaryngology

Pediatric Laryngotracheal Reconstruction (LTR) Scrubber

Audit single/double-stage LTR (31587, 31590) and cricotracheal resection (31584), defend autologous costal cartilage rib graft (+20902-59), and safeguard staged surveillance bronchoscopy (Modifier -58).

Open tool Cardiothoracic Surgery

Durable LVAD Implantation & Cardiac Reoperation Scrubber

Audit durable continuous-flow LVAD implants (33979), defend redo sternotomy add-ons (+33530), validate concomitant tricuspid/aortic valve repairs, and prevent RV failure critical care clawbacks.

Open tool Pediatric Neurosurgery

Pediatric Hemispherotomy & Stereo-EEG Scrubber

Audit stereo-EEG robotic depth electrode placements (61760), defend cranial neuronavigation (+61781), enforce staged hemispherotomy Modifier -58 compliance, and safeguard continuous video-EEG (95724).

Open tool Spine Surgery

Vertebral Column Resection (VCR) & Spine Deformity Scrubber

Audit 3-column osteotomy (22206/22207), additional vertebral segments (+22208), long-construct arthrodesis (22843/22844), pelvic fixation (+22848), and defend Modifier -62 co-surgeon billing.

Open tool Pediatric Transplant

Pediatric Solid Organ Transplant & Intestinal Rehabilitation Scrubber

Audit STEP enteroplasty (44130), intestinal/liver allotransplantation (44135/47135), defend Worksheet D-4 organ acquisition carve-outs, back-table vascular bench surgery (+44720), and Modifier -24 post-op critical care.

Open tool Pancreatic Surgery

Whipple Procedure & Pancreatic Resection Scrubber

Audit classic (48150) vs pylorus-preserving (48153) pancreaticoduodenectomy, defend mesenteric vein reconstruction (+35221), feeding jejunostomies (44010), and Modifier -62 co-surgeons.

Open tool Pediatric Craniofacial

Pediatric Craniofacial & Cleft Palate Scrubber

Audit cleft palatoplasty (42200-42210), midface LeFort I osteotomy (21141), defend bone graft inclusivity, enforce Modifier -58 staged sequencing, and overturn cosmetic denials.

Open tool Colorectal Surgery

Colorectal Surgery & Pelvic Exenteration Scrubber

Audit total mesorectal excision (45119/45110), pelvic exenteration (45126), defend protective loop ileostomy unbundling (44320-XE), and validate Modifier -62 co-surgeon billing.

Open tool Pediatric Neurosurgery

Pediatric Brain Tumor & Intraoperative Monitoring Scrubber

Audit posterior fossa craniotomy (61518/61520), intraoperative neurophysiological monitoring (95940/95941), defend external ventricular drain unbundling (61107-59), and protect stereotactic neuronavigation add-ons (+61781).

Open tool Hepatobiliary Surgery

Hepatobiliary Resection & Biliary Reconstruction Scrubber

Audit extended hepatic trisegmentectomy (47125), lobectomy (47130), defend payer downcoding to partial wedge (47120), safeguard vascular reconstruction (+35221), and unbundle Roux-en-Y biliary reconstruction (47760).

Open tool Pediatric Oncology

Pediatric Stem Cell & CAR-T Cellular Therapy Scrubber

Audit autologous CAR-T cell infusions (0540T/Q2042), prior authorization dossiers, severe Cytokine Release Syndrome (CRS) critical care (99291), and restaging lumbar puncture unbundling (96450 vs 38222).

Open tool Trauma Surgery

Trauma & Open Abdomen Damage Control Scrubber

Audit staged damage control laparotomy (49000, 49002), secondary fascial closure (13160), bedside vascular access unbundling, and enforce Modifier 58 vs 78 compliance.

Open tool Pediatric Pulmonology

Pediatric Pulmonology, Allergy & CFTR Estimator

Audit pediatric pulmonary spirometry and plethysmography (94010/94060/94726), prevent unbundling clawbacks, sweat chloride testing (82435), and verify CFTR targeted modulator prior authorizations.

Open tool Cardiothoracic

Cardiothoracic Bypass & Cannulation Scrubber

Audit CABG arterial-venous graft combinations (33533 + +33517 add-ons), endoscopic vein harvest (+33508), concomitant valve replacements (33405/33430), and ECMO/ECLS cannulation bundling rules.

Open tool Pediatric Orthopedics

Pediatric Scoliosis & Multi-Rod Deformity Scrubber

Audit spinal deformity arthrodesis (22800, 22802, 22804), prevent payer interspace downcoding, safeguard pelvic fixation (+22848 S2AI screws), and validate multi-level Ponte osteotomy claims.

Open tool Spine Surgery

Spine Arthrodesis & Multi-Level Instrumentation Scrubber

Audit complex spinal fusions (TLIF 22633, ACDF 22551, ALIF 22558), detect NCCI laminectomy bundling (63047), audit Modifier -62 co-surgery rules, and validate instrumentation & bone graft add-ons.

Open tool Urogynecology

Urogynecology & Pelvic Floor Reconstruction Scrubber

Audit sacrocolpopexy (57425) and mid-urethral sling (57288) bundling, prevent routine cystoscopy (52000) unbundling clawbacks, validate POP-Q prolapse staging, and stack multi-channel urodynamics (UDS).

Open tool Ophthalmology

Anti-VEGF Intravitreal Injection & Bilateral Scrubber

Audit anti-VEGF dosage and wastage (Modifiers JW/JZ), calculate Medicare Part B bilateral modifier logic (-50 vs -RT/-LT), and enforce 28-day LCD frequency limits.

Open tool Vascular Surgery

Endovascular & PAD Revascularization Scrubber

Enforce CPT vascular territory hierarchy (iliac, fem/pop, tibial/peroneal), suppress bundled angioplasties and catheter placements (36245–36248), and audit diagnostic angiography exemptions.

Open tool Cardiac EP

Cardiac Electrophysiology & Catheter Ablation Scrubber

Audit AFib/VT catheter ablation (93656/93653) bundling against diagnostic EP studies (93619/93620), capture 3D mapping and ICE add-ons, and verify remote telemetry 90-day interval cadence.

Open tool Plastic Surgery

Reconstructive vs Cosmetic Prior-Authorization Scrubber

Calculate Schnur sliding scale BSA thresholds for breast reduction (19318), audit blepharoplasty visual field criteria (15823), verify panniculectomy indications (15830), and validate federal WHCRA mandates.

Open tool NICU / PICU

NICU & Pediatric Critical Care Scrubber

Validate inpatient per-day neonatal critical care codes (CPT 99468–99476), weight-banded intensive step-down tiers (99477–99480), and scrub out CPT bundled catheterizations (36510/36660) and intubations.

Open tool Radiation Oncology

Radiation Oncology IMRT Bundling & Fraction Scrubber

Audit IMRT planning (CPT 77301) bundling edits against simulation and dosimetry, compute CPT 77427 weekly treatment management fraction math, and generate ANSI X12 837P claim lines.

Open tool Nephrology

Dialysis Monthly Capitation Payment (MCP) Tier Calculator

Compute physician allowable reimbursement under CPT 90951–90962 and 90966, calculate inpatient hospital stay pro-rations, and model downcoding revenue recovery.

Open tool FQHC / RHC

FQHC PPS Encounter Rate & Same-Day Service Scrubber

Calculate CMS FQHC PPS encounter rates with GAF geographic adjustments, validate same-day mental health statutory exceptions (Modifier 59/XE), and model Medicaid wrap-around reconciliations.

Open tool Ambulance / EMS

Ambulance & EMS Fee Schedule Calculator

Compute Medicare Ambulance Fee Schedule reimbursement for BLS, ALS1, ALS2, and SCT, apply statutory rural mileage multipliers, and validate 2-character origin/destination modifier pairs.

Open tool MolDX

Molecular Diagnostics MolDX® Z-Code & LCD Scrubber

Verify DEX Z-Codes and LCD coverage criteria for molecular pathology, next-generation sequencing panels, and PGx under CMS MolDX requirements.

Open tool Wound Care

Skin Substitute & CTP Wastage Modifier JW / JZ Calculator

Calculate single-use skin substitute administered vs discarded sq cm, determine mandatory Modifiers JW and JZ, and generate dual-line 837P Loop 2400 snippets.

Open tool Critical Care

Emergency & Critical Care Time Documentation Scrubber

Evaluate CPT 99291 and 99292 time thresholds, automatically deduct bedside procedure times, and verify split/shared visit substantive portion rules.

Open tool Concurrency

Anesthesia Concurrency & Medical Direction Auditor

Audit operating room concurrency logs under 42 CFR § 415.110. Model 1:4 TEFRA direction rules, verify Modifiers QK, QY, QX, QZ, and calculate Modifier AD penalties.

Open tool Global Surgery

Surgical Global Period & Post-Op Modifier Scrubber

Scrub surgical follow-ups against 0-day, 10-day, and 90-day global fee packages under CMS Ch. 12 § 40.1. Validate Modifiers 24, 58, 78, 79, 54, and 55.

Open tool DMEPOS Rules

DMEPOS Medical Necessity & Prior Auth Validator

Validate Medicare DMEPOS claims across Oxygen, CPAP, Mobility Assistive Equipment, and Orthotics. Verify SWO, Face-to-Face timing, and DME MAC jurisdiction routing.

Open tool MSP Rules

Medicare Secondary Payer (MSP) Determination Engine

Evaluate statutory primary vs secondary liability under Section 1862(b) of the Social Security Act across Working Aged, Disability, ESRD 30-mo coordination, and No-Fault/WC.

Open tool Clinical Trials

Clinical Trial Billing & Coverage Analysis Scrubber

Separate Medicare routine care (Modifier Q1 + Z00.6) from sponsor-funded investigational items under CMS NCD 310.1 and FDA IDE Category A/B rules.

Open tool Risk Adjustment

CMS HCC Risk Adjustment & RAF Score Benchmarker

Model risk score erosion transitioning from CMS-HCC v28 to v24. Estimate Medicare Advantage capitation changes, capture disease interactions, and review MEAT criteria.

Open tool MIPS QPP

CMS MIPS Performance Score & Penalty Forecaster

Forecast MIPS composite scores out of 100 points. Model Part B payment penalties (up to -9.0%) or positive incentive bonuses across Quality, Interoperability, Improvement Activities, and Cost.

Open tool Appeal Predictor

Denial Appeal Readiness & Review Checklist

Review documentation for common CARC denials and identify policy references to confirm before appeal.

Open tool Prompt Pay

50-State Prompt-Payment Statute & Penalty Matrix

Look up electronic clean-claim deadlines (15–30 days), compute accrued annual interest penalties (12%–18%), and generate formal demand notices across 50 states.

Open tool Contract Audit

Payer Contract Underpayment & Variance Analyzer

Calculate silent PPO fee schedule downcoding, compare contracted allowable vs actual paid rates, and compute state prompt-pay statutory interest penalties.

Open tool Appeals

Payer Dispute & Electronic Appeals Directory

Directory of 16+ national commercial, Medicare Advantage, and Medicaid payers with Level 1 & 2 appeal deadlines, electronic dispute portal URLs, and clearinghouse escalation contacts.

Open tool Prior Auth

Prior-Auth Requirement & Payer Gold-Card Matrix

Inspect mandatory prior auth triggers, statutory review SLAs under CMS-0057-F, peer-to-peer deadlines, and state Gold Card exemption rules across 20+ procedures.

Open tool Compliance

Modifier 25 & 59 / X{EPSU} Compliance Engine

Evaluate same-day E/M visits and surgical unbundling against CMS NCCI guidelines. Generate legal audit-defense attestations and eliminate CARC 97 recoupments.

Open tool Anesthesia RVG

Anesthesia ASA Unit & Reimbursement Calculator

Calculate total ASA anesthesia units (Base + 15-Min Time + Physical Modifiers + Qualifying Circumstances) and model CMS medical direction concurrency splits (AA, QZ, QK, QX).

Open tool Telemetry

Browser Performance & Telemetry Measurements

Measure this browser page load with the Navigation Timing API. Clearinghouse infrastructure is not connected.

Open tool Compliance

No Surprises Act GFE Generator

Generate CMS-compliant Good Faith Estimates (45 CFR § 149.610) for self-pay and uninsured patients with statutory dispute disclaimers and PDF export.

Open tool Financial

Patient Out-of-Pocket Liability Estimator

Calculate exact point-of-service patient financial responsibility: remaining deductibles, coinsurance splits, copays, and bad-debt risk indicators.

Open tool EDI Parser

ANSI X12 270/271 Eligibility Validator

Decode raw ANSI X12 271 real-time eligibility responses. Parse EB benefit segments, remaining deductibles, and prevent CO-27 eligibility denials.

Open tool EDI Scrubber

ANSI X12 837 Claim File Scrubber

Diagnostic syntax scrubber for 837P (Professional) and 837I (Institutional) claims. Catch missing NPIs, invalid modifiers, and prevent 277CA rejections.

Open tool Benchmark

MGMA Practice Health Index & Scorecard

Benchmark your practice against official MGMA / HFMA standards. Calculate overall Practice Health Score (0–100) and quantify annual recoverable cash lift.

Open tool Onboarding

Provider Credentialing Timeline Estimator

Map CAQH, Medicare PECOS, state Medicaid, and commercial payer enrollment timelines to prevent billing freezes for newly hired physicians.

Open tool Scrubber

CMS NCCI Claim Scrubber

Test CPT code pairs against official CMS PTP bundling rules. Check modifier -25 and -59/-XS indicators to prevent CARC 97 denials.

Open tool Playbook

Appeal Letter Generator

Generate legal-grade, formal appeal letters with statutory citations (ERISA, ACA § 2719, CMS NCCI) for CARC 50, 197, 16, 29, 97, and 22.

Open tool Proposal

Custom Practice Proposal Wizard

Build a tailored revenue cycle proposal in 3 minutes. Calculate estimated collections lift, target AR days, and transparent performance pricing.

Open tool Calculator

Fee Schedule Benchmarker

Compare your commercial payer reimbursement allowances against 2026 Medicare and regional PPO percentiles to quantify underpayments.

Open tool Parser

835 ERA Remittance Decoder

Parse raw 835 EDI segments (CLP, CAS, SVC). Translate adjustment reason codes (CO, PR, OA) into clear financial allocations and action items.

Open tool Reference

Multi-Payer Timely Filing Matrix

Compare initial claim deadlines, corrected claim cutoffs, and appeal windows across 50 state Medicaid programs and commercial PPOs.

Open tool Reference

Denial Code Lookup (1,283+ Codes)

Search CARC/RARC denial codes and get plain-English reasons, how to work each one, and how to prevent it.

Open tool Self-assessment

Clean-Claim Scorecard

Score your front-end, coding, and submission workflow against 14 controls — and see which denials each gap invites.

Open tool Calculator

A/R Days Cost Calculator

See the cash tied up in slow A/R and the yearly carrying cost of staying above your target days-in-A/R.

Open tool Calculator

Timely Filing Calculator

Enter a date of service and the payer filing limit to get the exact submission deadline, days remaining, and a risk flag.

Open tool Self-assessment

Eligibility & Prior-Auth Checklist

Score your pre-visit verification against the checks that prevent CO-27, CO-197, and eligibility denials before they happen.

Open tool Calculator

Denial Cost Calculator

See what denials really cost — lost reimbursement plus rework — per week, month, and year, and the combined annual impact.

Open tool Calculator

RVU Payment Calculator

Turn work, PE, and malpractice RVUs into an estimated Medicare allowed amount using GPCI and the conversion factor.

Open tool Reference

Payer Manual & Policy Finder

Jump straight to provider manuals, medical/payment policies, credentialing, and eligibility pages for 200+ payers, Medicaid programs, and Medicare MACs.

Open tool Knowledge Base

Healthcare RCM & Billing Glossary

Authoritative clinical and financial dictionary covering 30+ core terms: EDI 837/835, NCCI PTP edits, CARC/RARC denial codes, and RVU benchmarks.

Open tool

Looking for our national clearinghouse directory? Explore timely-filing limits, EDI capabilities, and electronic routing IDs.

Open 10,600+ Payer Directory

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