Current Procedural Terminology

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Abbreviated commonly as CPT, the Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel.

CPT code set[edit | edit source]

The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services. They are designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

New editions[edit | edit source]

New editions are released each October.

CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered, rather than the diagnosis on the claim

Level 1 coding system[edit | edit source]

CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Healthcare Common Procedure Coding System.

The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA).[1]

Types of code[edit | edit source]

There are three types of CPT code: Category I, Category II, and Category III.

Category I[edit | edit source]

Category I CPT Code(s). There are six main sections:[2]

Codes for evaluation and management: 99201–99499[edit | edit source]

Codes for anesthesia: 00100–01999; 99100–99150[edit | edit source]

Codes for surgery: 10000–69990[edit | edit source]

Codes for radiology: 70000–79999[edit | edit source]

Codes for pathology and laboratory: 80000–89398[edit | edit source]

Codes for medicine: 90281–99099; 99151–99199; 99500–99607[edit | edit source]

Category II[edit | edit source]

CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel and the CPT/HCPAC Advisory Committee. The PMAG is composed of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of Category II codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies and federal regulatory agencies.

Category II codes make use of an alphabetical character as the 5th character in the string (i.e., 4 digits followed by the letter F). These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook. Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). Currently there are 11 Category II codes. They are:

  • (0001F–0015F) Composite measures
  • (0500F–0584F) Patient management
  • (1000F–1505F) Patient history
  • (2000F–2060F) Physical examination
  • (3006F–3776F) Diagnostic/screening processes or results
  • (4000F–4563F) Therapeutic, preventive or other interventions
  • (5005F–5250F) Follow-up or other outcomes
  • (6005F–6150F) Patient safety
  • (7010F–7025F) Structural measures
  • (9001F–9007F) Non-measure claims-based reporting

CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. Because CPT II codes are not associated with any relative value, they are billed with a $0.00 billable charge amount.[5]

Category III[edit | edit source]

  • Category III CPT Code(s) – Emerging technology (Category III codes: 0016T-0207T[6])

See also[edit | edit source]

External links[edit | edit source]


Current Procedural Terminology Resources
Wikipedia

Portions of content adapted from Wikipedia's article on Current Procedural Terminology which is released under the CC BY-SA 3.0.

  1. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named cms.hhs
  2. ↑
  3. ↑ "Anesthesia for Procedures on the Upper Abdomen". Archived from the original on 2016-10-05. Retrieved 2016-10-04. , Anesthesia for procedures on the upper abdomen
  4. ↑ "Anesthesia for lower abdomen". ,Anesthesia for procedures on the lower abdomen
  5. ↑ AMA coding manual
  6. ↑ CPT 2010
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