Current Procedural Terminology (CPT) is a coding system created by the American Medical Association (AMA) to assign codes for medical procedures. Physicians, insurance payors, medical coders, billers, and others use CPT in their practices.
CPT codes also form the basis of the Healthcare Common Procedure Coding System (HCPCS) Level I coding system as maintained by CMS. As a general rule, CPT codes describe what a provider did in a particular procedure or service, while Level II codes describe what the provider used.
However, some overlap exists between CPT/HCPCS Level I and HCPCS Level II codes. Physicians and other healthcare providers, along with medical coding and billing professionals, should be familiar with both sets of codes and the preferences of Medicare and other health insurance programs.
The Format and Categories of CPT Codes
A CPT code consists of five alphanumeric or numeric characters. CPT codes are usually divided into three categories: Category I, Category II, and Category III. The AMA has created a new category—Proprietary Laboratory Analyses (PLA) codes—for labs and manufacturers to identify their tests more precisely.
Category I codes represent the set of standard medical procedures in the U.S. Category I codes are divided into six sections:
Pathology and Laboratory
Evaluation and Management
CPTII codes are known as tracking codes, as they are used to measure the quality and performance of medical care. These alphanumeric codes are often requested for Medicare Advantage payers but not commercial or Medicare fee-for-service.
Category III codes are used for emerging technologies, procedures, and services that aren’t covered in Category I.
The CPT Editorial Panel
The AMA Board of Trustees has assigned maintenance of the CPT code set to the CPT Editorial Panel. The panel is composed of 21 members from various sectors of the healthcare industry.
The responsibilities of the CPT Editorial Panel include revising, updating, and modifying CPT codes, descriptors, rules, and guidelines.
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