Continue reading for answers to commonly asked questions around CPT codes. Use the table of contents below to jump ahead to any question.
Table of Contents
What is Current Procedural Terminology?
CPT stands for Current Procedural Terminology. It is a set of codes created by the American Medical Association (AMA®) to standardize how medical procedures are recorded in a medical chart.
Why is CPT code used?
CPT codes are one of the primary ways that both public and private medical providers and healthcare institutions can report the services they have provided to patients to the government and insurance companies for reimbursement purposes. CPT codes are part of the national coding system under the Health Information Portability and Accountability Act (HIPAA).
Want to learn more about standardized code sets including CPT, LOINC®, SNOMED®, ICD-10-CM? Check out this downloadable guide.
How are CPT codes maintained?
CPT codes are maintained by the CPT Editorial Board, a part of the AMA, and are updated once a year. The new codes are released annually in November, and go into effect on the following January 1. The editorial board meets three times a year to review applications for new codes.
What do CPT codes look like?
CPT codes are five characters long and are usually numeric, although some may be alphanumeric depending on what category they fall into.
What are the “categories” you mentioned?
The CPT manual is divided into three categories, each with distinct purposes outlined below:
- Used to report the devices and drugs used during a procedure
- Used to report the procedure itself to the billing department
- Contains the billable codes needed for reimbursement
- Designed for reporting performance measures
- Used to provide data to regulatory agencies
- Does not contain billing codes
- Primarily thought of as “quality of care” codes
- Codes for documenting new procedures, clinical trials and emerging technologies
- Must be either added to Category I or deleted within five years of being added
Ready to dig a little deeper? Check out this article that covers why correct CPT codes are key to securing prior authorization.
CPT is a registered trademark of the American Medical Association. All rights reserved.
SNOMED and SNOMED CT® are registered trademarks of SNOMED International.