CPT
Current Procedure Terminology
What is CPT?
Current Procedural Terminology (CPT) is a standardized code set developed by the American Medical Association (AMA) to describe medical procedures and services performed by healthcare providers. CPT codes are used for billing purposes and are recognized by healthcare payers, including Medicare and private insurance companies. For example
Outpatient visit for evaluation and management of established patient with minimal presenting problem - 99211
Removal of implant from tunnel on outer side of foot (sinus tarsi) - 0510T
Insertion of permanent leadless pacemaker using imaging guidance - 33274
According to the American Medical Association , CPT is the most widely accepted medical nomenclature used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance programs.
The first edition of CPT was published in 1966 and was focused on surgery. Subsequent editions expanded the scope and were published periodically up through the fourth edition. The fifth edition, CPT-5 was a major effort to meaningfully expand the content to new procedures and services. iIn 2000, CPT became the national coding standard for reporting medical services and procedures and was adopted by CMS for Medicare claims processing.
What content is in CPT?
Each CPT code represents a specific medical service, procedure, or test, and includes detailed information such as the type of service, location, and time required. CPT codes are updated annually to reflect changes in medical procedures and advances in medical technology.
Given the vast number of services and procedures, CPT codes are classified into three types:
CPT Category I: codes commonly used by providers to report their services and procedures
CPT Category II: Supplemental tracking codes used for performance management
CPT Category III: Temporary codes used to report emerging and experimental services and procedures
Category 1 have five numeric characters, are arranged in numerical order and are organized to be clustered together to assist coders by making “nearby” codes more easily available.
There are 6 main sections of Category I codes:
Evaluation & Management (99202–99499)
Anesthesia (00100–01999)
Surgery (10021–69990)
Radiology Procedures (70010–79999)
Pathology and Laboratory Procedures (80047–89398)
Medicine Services and Procedures (90281–99607)
How is CPT used in the United States?
The use of CPT codes helps to ensure accurate and consistent billing and reimbursement for medical services, and also facilitates the tracking and analysis of healthcare utilization and costs. Additionally, CPT codes are used in health information exchange and can support data exchange and analysis across different healthcare settings.
CPT codes are widely used in the United States and are an important component of the healthcare industry's efforts to standardize medical billing and reimbursement processes.
How is CPT related to other healthcare standards efforts?
CPT codes are integrated with other standardized code sets, such as ICD-10 codes for diagnoses, and HCPCS (Healthcare Common Procedure Coding System) codes for medical equipment and supplies. This helps to ensure accurate and complete representation of medical services and procedures.
They are also are used in compliance with federal regulations, such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA), to support the reporting and analysis of healthcare utilization and costs.