Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of health care services provided by physicians, hospitals and other health care professionals. These codes are utilized to communicate with: other physicians, hospitals, and insurers for claims processing.
There are three categories of CPT Codes: Category I, Category II, and Category III.
1. Category I CPT Codes:
CPT codes are used for reporting devices and drugs (including vaccines) required for the performance of a service or procedure, services or procedures performed by physicians and other health care providers, services or procedures performed intended for clinical use, services or procedures performed according to current medical practice, and services or procedures that meet CPT requirements. These codes are billable for reimbursement.
There are 10 main sections:
|30000-39999||Respiratory, Cardiovascular, Hemic, and Lymphatic System|
|50000-59999||Urinary, Male Genital, Female Genital, Maternity Care, and Delivery System|
|60000-69999||Endocrine, Nervous, Eye and Ocular Adnexa, Auditory System|
|80000-89999||Pathology and Laboratory Services|
|90000-99999||Evaluation & Management Services|
The Category I Vaccine Codes are updated twice yearly rather than yearly, on July 1 and January 1.
2. Category II CPT Codes:
Category II CPT Codes are used for reporting performance measures reducing the necessity for chart review and medical records abstraction.
These codes provide the data needed by the Performance Measures Advisory Group (PMAG). The PMAG is comprised of performance measures experts representing the AMA, the Centers of Medicare and Medicaid Services (CMS), the Agency of Healthcare Research and Quality (AHRQ), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Physician Consortium for Performance Improvement. This data is used to collect information about the quality of care to help establish and improve performance measures. These codes are not billable for reimbursement.
|Diagnostic/screening processes or results||3006F-3573F|
|Therapeutic, preventive or other interventions||4000F-4306F|
|Follow-up or other outcomes||5005F-5100F|
3. Category III CPT Codes:
Category III CPT codes are used for reporting emerging technology in a number of capacities including services or procedures recently performed on humans, clinical trials and etc. These codes are temporary codes and must be accepted for placement in Level I within five years, be renewed for another five more years, or be removed from the book.
Another feature of Category III CPT codes is that they are listed in numerical order instead of anatomical location.
Emerging Technology 0016T-0207T
CPT Code Revisions: These codes are constantly being removed, revised, updated and added each October with the exception of emerging technology and vaccines, which are updated every six months.
CPT Code Resources: CPT is a registered trademark of the American Medical Association and holds the copyright of the CPT coding system. Providers of service must pay a license fee to have access to these codes. However, patients and other users can register on their website and perform up to 12 searches.