What is CPT®?

Current Procedural Terminology (CPT®) is a listing of standardized descriptions and five-character, alphanumeric codes that medical coders and billers use to report health care services and procedures to payers for reimbursement. The purpose of CPT® is to provide a uniform language accurately describing medical, surgical, and diagnostic services. It serves as an effective means for reliable nationwide communication within the health care industry.

The American Medical Association (AMA) developed and published the first edition of CPT® in 1966. It contained primarily surgical procedures, with limited sections on medicine, radiology, and laboratory procedures. The second edition was published in 1970, and presented an expanded system of terms and codes to designate diagnostic and therapeutic procedures in surgery, medicine and the specialties. At that time, a five-digit coding system was introduced, replacing the former four-digit classification. Another significant change was a listing of procedures relating to internal medicine.

The fourth edition, published in 1977, represented significant updates in medical terminology. A system of periodic updating was also introduced to keep pace with the rapidly changing medical environment. In 1983, CPT® was adopted as part of the Centers for Medicare & Medicaid Services (CMS). With this adoption, CMS mandated the use of Healthcare Common Procedure Coding System (HCPCS) to report services for Medicare Part B. CPT® is sometimes referred to as HCPCS Level I. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT® for reporting outpatient hospital surgical procedures. CPT® codes and descriptions are owned and copyrighted by the American Medical Association.

CPT® codes fall into three categories:

• Category I CPT® codes describe a procedure or service identified with a five-digit CPT® code and descriptor nomenclature.
• Category II CPT® codes are supplemental tracking alphanumeric codes that can be used for performance measurement. The use of these codes is usually optional. The codes are not required for correct coding and many not be used as a substitute for Category I codes.
• Category III CPT® codes are a temporary set of tracking alphanumeric codes for new and emerging technologies. These codes are intended to facilitate data collection on and assessment of new services and procedures. Category III codes may not conform to the usual Category I CPT® code requirements.

Modifiers are sometimes appended to these codes to report special circumstances.