Current Procedural Terminology

The Current Procedural Terminology (CPT) is a medical code set maintained by the American Medical Association (AMA) through the CPT Editorial Panel. The CPT code set is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations.

History[edit]

The CPT code set was first developed and published by the American Medical Association in 1966. It was created to provide a uniform language that accurately describes medical, surgical, and diagnostic services, thereby serving as an effective means for reliable nationwide communication among physicians, patients, and third parties.

Structure[edit]

CPT codes are divided into three categories:

Category I[edit]

Category I CPT codes are the most commonly used codes and consist of five numeric digits. These codes represent procedures that are consistent with contemporary medical practice and are widely performed. They are organized into six sections:

Category II[edit]

Category II CPT codes are supplemental tracking codes that can be used for performance measurement. These codes are optional and are not required for correct coding. They consist of four digits followed by the letter "F."

Category III[edit]

Category III CPT codes are temporary codes for emerging technology, services, and procedures. These codes consist of four digits followed by the letter "T."

Usage[edit]

CPT codes are used by healthcare providers to report medical procedures and services to payers for reimbursement. They are also used for administrative management purposes such as claims processing and developing guidelines for medical care review.

Updates[edit]

The CPT code set is updated annually to reflect changes in medical practice. The CPT Editorial Panel meets three times a year to consider proposals for new codes and revisions to existing codes.

Relation to Other Code Sets[edit]

CPT codes are used in conjunction with other code sets such as the International Classification of Diseases (ICD) codes and the Healthcare Common Procedure Coding System (HCPCS) codes. While ICD codes are used to describe diagnoses, CPT codes describe the procedures and services provided.