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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.
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):
The rules for assigning the appropriate code(s) are complex and require understanding of the coding rules and guidelines.
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 reserved on the CPT Health Care Professionals Advisory Committee which include a member from the American Academy of Professional Coders and the American Health Information Management Association.
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. ACR staff and advisors attend three CPT Editorial Panel meetings each year to review CPT codes and determine appropriate timing for recommending code additions, revisions, or deletions.
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CPT Copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.