What is CPT®?

CPT® codes are the United States’ standard for how medical professionals document and report medical, surgical, radiology, laboratory, anesthesiology, and evaluation and management (E/M) services. All healthcare providers, payers, and facilities use CPT® codes.

The five-character CPT® codes are used by insurers to help determine the amount of reimbursement that a practitioner will receive for services provided.

Current Procedural Terminology (CPT®) codes were first published in 1966 and are developed, maintained, and copyrighted by the American Medical Association (AMA). Thousands of CPT® codes are in use, and they are updated annually. They fall into three categories:

  • Category I – These five-digit codes have descriptors which correspond to a procedure or service. Codes range from 00100 - 99499.
  • Category II – These alphanumeric tracking codes are used for execution measurement. Using them is often optional.
  • Category III – These are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures.

Two-character modifiers are appended to CPT® codes to report special circumstances and to clarify or modify the description of the procedure. These modifiers are developed by the AMA and the Centers for Medicare & Medicaid Services (CMS).

The rules for assigning appropriate code(s) are complex, and although CPT® codes are standardized, the amount various practitioners are reimbursed for their services or procedures are not necessarily the same. In Medicare, CPT® is Level I of the Healthcare Common Procedure Coding System (HCPCS) code system and accompanied by the HCPCS Level II supply and service codes.

Medical terminology, anatomy, insurance payer rules, procedural bundling rules, and proper modifier usage are all essential elements to know when reporting CPT® codes. To ensure coding accuracy, individuals who are responsible for determining and reporting CPT® codes on medical claims should receive proper training and credentials.

See the full list of CPT® codes.

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