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

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

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

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).<ref name="cms.hhs" />

Types of code

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

Category I

Category I CPT Code(s). There are six main sections:<ref name="Moisio2009">{{{last}}}, 

 Marie A. Moisio, 
  
 Medical Terminology for Insurance and Coding. online version, 
  
 Cengage Learning, 
  
  
  
 ISBN 978-1-4283-0426-0, 
  
  
  
 Pages: 80–,</ref>

Codes for evaluation and management: 99201–99499

Codes for anesthesia: 00100–01999; 99100–99150

Anesthesia for Procedures on the Upper Abdomen(link). {{{website}}}.




, Anesthesia for procedures on the upper abdomen</ref>

  • (00800–00882) lower abdomen<ref>

Anesthesia for lower abdomen(link). {{{website}}}.




,Anesthesia for procedures on the lower abdomen </ref>

Codes for surgery: 10000–69990

Codes for radiology: 70000–79999

Codes for pathology and laboratory: 80000–89398

Codes for medicine: 90281–99099; 99151–99199; 99500–99607

Category II

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.<ref>AMA coding manual</ref>

Category III

  • Category III CPT Code(s) – Emerging technology (Category III codes: 0016T-0207T<ref>CPT 2010</ref>)

See also

External links


Medical classification
Topographical codes
Diagnostic codes
general:
specialized:
Procedural codes
Pharmaceutical codes
Outcomes codes
* NOC


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