Current Procedural Terminology

The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel.[1] The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is 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 are released each October.[2] The current version is the CPT 2015. It is available in both a standard edition and a professional edition.[3][4]

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. ICD code sets also contain procedure codes but these are only used in the inpatient setting.[5]

CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS)[6] as Level 1 of the Healthcare Common Procedure Coding System.

The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA).[6]

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:[7]

Codes for evaluation and management: 99201–99499

Codes for anesthesia: 00100–01999; 99100–99150

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:

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.[9]

Category III

Major psychotherapy revisions

The CPT code revisions that affect counselors are simple and straightforward. Here is a list of psychotherapy CPT codes that will be retired, and their 2013 comparables:

90801 –> \ Family therapy codes (90847 and 90846) will remain unchanged, as will codes for psychological testing.[11]

Criticism of copyright

CPT is a registered trademark of the American Medical Association. The AMA holds the copyright for the CPT coding system.[12] However, in Practice Management v. American Medical Association[13] the U.S. Court of Appeals for the Ninth Circuit held that the AMA could not enjoin a competitor on the basis that the AMA had misused its copyright.

Despite the copyrighted nature of the CPT code sets, the use of the code is mandated by almost all health insurance payment and information systems, including the Centers for Medicare and Medicaid Services (CMS) and HIPAA, and the data for the code sets appears in the Federal Register. As a result, it is necessary for most users of the CPT code (principally providers of services) to pay license fees for access to the code.[14]

Limited CPT search offered by the AMA

The AMA offers a limited search of the CPT manual for personal, non-commercial use on its web site.[15]

See also


  1. AMA (CPT) CPT Process Archived May 11, 2016, at the Wayback Machine.
  2. Laura Southard Durham (1 June 2008). Lippincott Williams and Wilkins' Administrative Medical Assisting. Lippincott Williams and Wilkins. pp. 2–. ISBN 978-0-7817-9789-4. Retrieved 26 May 2011.
  3. Michelle Abraham; Jay T. Ahlman; Angela J. Boudreau; Judy L. Connelly; Desiree D. Evans; Rejina L Glenn (30 October 2010). CPT 2011 Standard Edition. American Medical Association Press. ISBN 978-1-60359-216-1. Retrieved 26 May 2011.
  4. American Medical Association; American Medical Association (COR); Michelle Abraham; Jay T. Ahlman; Angela J. Boudreau; Judy L. Connelly (30 October 2010). CPT 2011 Professional Edition. American Medical Association Press. ISBN 978-1-60359-217-8. Retrieved 26 May 2011.
  5. Alexander, Sherri, Pharm.D. (1 November 2003). "Overview of inpatient coding" (PDF). American Journal of Health-System Pharmacy. 60. Archived from the original (PDF) on 17 September 2012. Retrieved 30 April 2013.
  6. 1 2 Centers for Medicare and Medicaid Services Archived July 20, 2015, at the Wayback Machine.
  7. Marie A. Moisio (8 April 2009). Medical Terminology for Insurance and Coding. Cengage Learning. pp. 80–. ISBN 978-1-4283-0426-0. Retrieved 26 May 2011.
  8. "Archived copy". Archived from the original on 2016-10-05. Retrieved 2016-10-04., Anesthesia for procedures on the upper abdomen
  9. AMA coding manual
  10. CPT 2010
  11. Centore, Anthony. "2013 CPT Code Revisions". Retrieved 6 February 2013.
  12. AMA (CPT) CPT Licensing Archived October 21, 2016, at the Wayback Machine.
  13. "Archived copy" (PDF). Archived (PDF) from the original on 2016-10-21. Retrieved 2016-10-20.
  15. AMA (2012). "cpt® Code/Relative Value Search". Retrieved from "Archived copy". Archived from the original on 2016-03-26. Retrieved 2011-07-06..

External links

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