CPT

The Current Procedural Terminology (CPT®) developed and published by the American Medical Association is the standard code set used by physicians and healthcare providers to report all medical procedures and services to CMS and third-party payers. CPT codes are also used for administrative management purposes, which includes claims processing, medical education, as well as developing guidelines for medical care review.

CPT codes are an integral part of the billing process and work in tandem with ICD diagnostic codes to create a full picture of the work performed in the physician office.

Structure of CPT Codes

A CPT code is a five digit numeric code used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services for physicians, hospitals, and other health care providers. There are approximately 7,800 CPT codes ranging from 00100-99499. There are also two-digit modifiers included within CPT which may be appended when appropriate to clarify or modify the description of a procedure.

CPT codes are divided into three categories (Category I, II and III):

  • Category I codes are the main codes in CPT which recognize procedures and services widely performed by physicians and health care professionals
  • Category II codes are supplementary tracking codes that are used for performance measures. The use of these codes are optional and cannot be used as a substitute for any Category I codes.
  • Category III codes are temporary codes for emerging technology, services, and procedures.

The rules for assigning the appropriate code(s) are complex and require understanding of the coding rules and guidelines.

CPT Process

All CPT codes are reviewed and maintained by the AMA CPT Editorial Panel, which is comprised of 17 members from the AMA; physician advisors nominated by their national medical society; and at least one physician from the Blue Cross Blue Shield Association, the American Health Insurance Plans, the American Hospital Association, and the Centers for Medicare & Medicaid Services. There are also two seats served for the CPT Health Care Professionals Advisory Committee which include a member from the American Academy of Professional Coders.

The Panel works with national medical societies and other stakeholders on the procedural code set on appropriate nomenclature as it is relevant to the specialty using the code. National societies and other vendors work with the AMA CPT Editorial Panel annually to address requests to add or delete codes in use or revise existing language for accuracy in billing for procedures. If applying for a Category I or Category III code, the CPT Editorial Panel votes and determines into which category the code(s) should be assigned.

The ACR works cooperatively with the CPT Editorial Panel and other specialty societies to establish and/or revise CPT codes for new/existing procedures relevant to the practice of rheumatology. Representatives and advisors attend three CPT Editorial Panel meetings held each year to review CPT code and determine appropriate timing for recommending code additions, revisions, or deletions. Learn more about the process >

CPT Copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.