CPT 101: A quick guide to Current Procedural Terminology

Need a brief refresher on the basics of what Current Procedural Terminology (CPT) codes are and how they work? We’ve got you covered. Take a few minutes to brush up on the coding system with our CPT 101 guide.
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Current Procedural Terminology

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 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).

How is CPT 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:

Category I

  • 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

Category II

  • 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

Category III

  • 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 into CPT terms? Check out the recording of our latest webinar
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