CPT® overview and code approval | American Medical Association

Current Procedural Terminology (cpt®) codes provide physicians and health care professionals with a uniform language for coding medical services and procedures to speed reporting, increase accuracy and efficiency.

cpt codes are also used for administrative management purposes, such as processing claims and developing guidelines for health care review.

Reading: What is a cpt code for insurance

cpt terminology is the most widely accepted medical nomenclature used nationwide to report medical, surgical, radiology, laboratory, anesthesiology, genome sequencing, assessment and management (e/m) services in the framework of public and private health insurance programs.

The development and management of the cpt code set is based on a rigorous, transparent and open process led by the cpt® editorial panel. Created more than 50 years ago, this ama-convened process ensures that clinically valid codes are issued, updated and maintained on a regular basis to accurately reflect current clinical practice and innovation in medicine.

designated by us. uu. department of health and human services under the health insurance portability and accountability act (hipaa) as a national coding set for medical and other professional health care services and procedures, cpt’s evidence-based codes accurately encompass the full range of health care services.

All cpt codes are five digits long and can be numeric or alphanumeric, depending on the category. cpt code descriptors are clinically focused and use common standards so that a diverse set of users can have a common understanding across the clinical healthcare paradigm.

There are several types of cpt codes:

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category i: these codes have descriptors that correspond to a procedure or service. codes range from 00100-99499 and are generally arranged into subcategories based on procedure/service type and anatomy.

Category II: These alphanumeric tracking codes are supplemental codes used to measure performance. its use is optional and not required for correct encoding.

Category III: These are temporary alphanumeric codes for new and developing technology, procedures, and services. they were created for data collection, evaluation, and, in some cases, payment for new services and procedures that do not currently meet the criteria for a category i code.

proprietary laboratory test (pla) codes: Recently added to the cpt code set, these codes describe proprietary clinical laboratory tests and may be provided by a single laboratory (“single source”) or licensed or marketed to multiple Food and Drug Administration (FDA) approved or licensed supplier laboratories). This category includes, but is not limited to, Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined in the Protect Access to Medicare Act of 2014 (PAMA).

For over 50 years, cpt has been the primary medical language used to communicate in the healthcare environment, enabling continuous processing and advanced analytics for medical procedures and services. The CPT Editorial Panel constantly updates the CPT code set with input from clinical and industry experts to reflect current clinical practice and the latest innovations to help improve care delivery.

The cpt® editorial panel, appointed by the ama board of directors, is responsible for maintaining and updating the cpt code set. the cpt editorial panel is an independent group of volunteer experts representing various sectors of the health care industry. its role is to ensure code changes undergo evidence-based review and meet specific criteria.

The CPT Editorial Panel is supported by CPT Advisors, Physician groups appointed by the National Societies of Medical Specialties represented in the AMA House of Delegates, and the AMA Healthcare Professionals Advisory Committee (HCPAC). . As clinical experts in their fields, the primary role of CPT Advisors is to advise the CPT Editorial Panel on procedure coding and proper nomenclature when proposing code set revision, work with industry stakeholders as they consider additions and changes to cpt and educate your membership on the use and benefits of cpt codes.

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The cpt® editorial panel meets three times a year to review requests for new codes or revisions to existing codes. anyone who wants to participate can submit a request to attend a panel meeting.

As medicine evolves with clinical innovations such as genomic testing and remote patient monitoring, clinicians, innovators, and any other stakeholders working in healthcare will need to assess whether a new or updated cpt code to describe your innovation.

Technology developers will need to understand how and when cpt codes are updated as they create new products, services, and systems that use cpt content.

Data drives our healthcare system with medical innovation to improve patient care. the cpt code set is primed and ready to grow and change with input from stakeholders across the healthcare landscape.

If you have questions about getting involved and participating in the cpt editorial process, please contact mark levine at [email protected].

If you have a product that needs a new cpt code, fda approval may be required. For general information on FDA regulatory oversight of medical devices, visit the Device Tips section.

Review the criteria for cpt® category i, category ii and category iii codes, access the applications and read the frequently asked questions.

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  • code change instructions
  • applications of cpt® code
  • criteria for cpt® category i and category iii codes
  • criteria for cpt® category ii codes
  • category ii application
  • sample format for required cpt® clinical vignettes

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