Current Procedural Terminology (CPT)

Key facts

Owned by

American Medical Association (AMA), which holds the copyright

Maintained by

AMA CPT Editorial Panel

HIPAA status

Standard code set for physician and other health care services, 45 CFR 162.1002

Code categories

Category I (5 digits), Category II (4 digits + F), Category III (4 digits + T)

Update cycle

Annual release effective January 1; some code types update more often

What is CPT?

CPT is the common language U.S. clinicians and payers use to describe what was done during a patient encounter: an office visit, a knee replacement, a lab panel, an imaging study. Each service has a code and a standardized descriptor, so a claim from one practice means the same thing to every payer that receives it.

The American Medical Association (AMA) first published CPT in 1966. Under the Health Insurance Portability and Accountability Act (HIPAA), CPT is a required code set for reporting physician and other professional services in standard electronic transactions. It also forms Level I of the Healthcare Common Procedure Coding System (HCPCS).

CPT is copyrighted. The AMA licenses the codes and descriptors, and government files that contain them, such as Medicare fee schedules, carry AMA license terms.

How CPT codes are organized

CPT codes fall into three categories, plus specialized code types:

Codes can be refined with two-character modifiers, for example to show that only the professional component of a service was performed or that a procedure was bilateral.

• Category I: five-digit numeric codes for established services and procedures, grouped into sections such as Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.
• Category II: supplemental tracking codes (four digits followed by F) used for performance measurement, such as documenting that a quality measure was met. They are generally not paid.
• Category III: temporary codes (four digits followed by T) for emerging technology, services and procedures, which may later become Category I codes.
• Proprietary Laboratory Analyses (PLA) codes: four digits followed by U, for specific branded lab tests.

Why CPT codes matter

Because the code set changes every year, analyses that span several years need to account for deleted, added and revised codes.

• Medicare Physician Fee Schedule payments are set per CPT or HCPCS code using relative value units (RVUs).
• Procedure-level claims and Medicare utilization files show which clinicians perform a given service and how often, which drives provider targeting for device and diagnostics companies.
• Price transparency files published by hospitals and health plans list negotiated rates by CPT code.
• Coverage policies, prior authorization lists and medical necessity rules are written against specific CPT codes.

CPT vs HCPCS Level II and ICD-10-CM

CPT covers mainly professional services and procedures. Drugs, supplies, durable medical equipment, ambulance services and other items that CPT does not describe are coded with HCPCS Level II codes, which CMS maintains. A single claim often combines both, for example a CPT code for an infusion service and a HCPCS J-code for the drug infused.

CPT describes what was done. The ICD-10-CM diagnosis codes on the same claim describe why it was done.