What are CPT Codes?
Current Procedural Terminology, more commonly known as CPT codes, refers to a set of medical codes used by physicians/providers, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform.
Specifically, CPT codes are used to report procedures and services to federal and private payers (Insurance Companies) for reimbursement of rendered healthcare services.
In 1966, the American Medical Association (AMA) created CPT codes to standardize reporting of medical, surgical, diagnostic services and procedures performed in inpatient and outpatient settings. Each CPT code represents a written description of a procedure or service rendered, which eliminates the subjective interpretation of what was provided to the patient.
To accommodate the evolving world of healthcare the AMA updates the CPT code set annually, releasing new, revised, and deleted codes, as well as changes to current CPT coding guidelines. The AMA also releases smaller updates to certain sections of the CPT code set throughout the year.
How to Recognize CPT Codes?
CPT codes consist of five characters. Most of the codes are numeric, but some codes have a fifth alpha character, such as A, F, T, or U.
Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed.
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose.
Chest X-ray results documented and reviewed (CAP).
Removal of sinus tarsi implant.
Comparative DNA analysis using multiple selected single-nucleotide polymorphisms (SNPs), urine and buccal DNA, for specimen identity verification.
Understanding the Types of CPT Codes
Medical Coders assign a code for every service or procedure a provider/physician performs. CPT even includes codes called unlisted codes for those procedures and services not specifically named in another defined CPT code.
Due to vast number of procedures and services, the AMA has organized CPT codes logically, beginning with classifying them into three types:
CPT Category I:
The largest body of codes, consisting of those commonly used by providers to report their procedures and services.
CPT Category II:
Supplemental tracking codes used for performance management.
CPT Category III:
Temporary codes used to report emerging and experimental procedures and services.
Category I CPT Codes:
The 6 main sections of CPT Category I codes are:
Evaluation & Management (99202–99499)
Surgery (10021–69990) — further broken into smaller groups by body area or system within this code range
Radiology Procedures (70010–79999)
Pathology and Laboratory Procedures (80047–89398)
Medicine Services and Procedures (90281–99607)
CPT Codes for Evaluation and Management: 99201–99499
(99201–99215) Office/other outpatient services
(99217–99220) Hospital observation services
(99221–99239) Hospital inpatient services
(99281–99288) Emergency department services
(99291–99292) Critical care services
(99304–99318) Nursing facility services
(99324–99337) Domiciliary, rest home (boarding home) or custodial care services
(99339–99340) Domiciliary, rest home (assisted living facility), or home care plan oversight services
(99341–99350) Home health services
(99354–99360) Prolonged services
(99363–99368) Case management services
(99374–99380) Care plan oversight services
(99381–99429) Preventive medicine services
(99441–99444) Non-face-to-face physician services
(99450–99456) Special evaluation and management services
(99460–99465) Newborn care services
(99466–99480) Inpatient neonatal intensive, and pediatric/neonatal critical, care services
(99487–99489) Complex chronic care coordination services
(99495–99496) Transitional care management services
(99499) Other evaluation and management services
CPT Codes for Anesthesia: 00100–01999; 99100–99150
(00600–00670) spine and spinal cord
(00700–00797) upper abdomen
(00800–00882) lower abdomen
(01112–01190) pelvis (except hip)
(01200–01274) upper leg (except knee)
(01320–01444) knee and popliteal area
(01462–01522) lower leg (below knee)
(01610–01682) shoulder and axillary
(01710–01782) upper arm and elbow
(01810–01860) forearm, wrist and hand
(01916–01936) radiological procedures
(01951–01953) burn excisions or debridement
(01990–01999) other procedures
(99100–99140) qualifying circumstances for anesthesia
(99143–99150) moderate (conscious) sedation
CPT Codes for Surgery: 10000–69990
(10040–19499) integumentary system
(20000–29999) musculoskeletal system
(30000–32999) respiratory system
(33010–37799) cardiovascular system
(38100–38999) hemic and lymphatic systems
(39000–39599) mediastinum and diaphragm
(40490–49999) digestive system
(50010–53899) urinary system
(54000–55899) male genital system
(55920–55980) reproductive system and intersex
(56405–58999) female genital system
(59000–59899) maternity care and delivery
(60000–60699) endocrine system
(61000–64999) nervous system
(65091–68899) eye and ocular adnexa
(69000–69979) auditory system
CPT Codes for Radiology: 70000–79999
(70010–76499) diagnostic radiology
(76500–76999) diagnostic ultrasound
(77001–77032) radiologic guidance
(77051–77059) breast mammography
(77071–77084) bone/joint studies
(77261–77999) radiation oncology
(78000–79999) nuclear medicine
CPT Codes for Pathology and Laboratory: 80000–89398
(80000–80076) organ or disease-oriented panels
(80100–80103) drug testing
(80150–80299) therapeutic drug assays
(80400–80440) evocative/suppression testing
(80500–80502) consultations (clinical pathology)
(85002–85999) hematology and coagulation
(86850–86999) transfusion medicine
(88000–88099) anatomic pathology (postmortem)
(88230–88299) cytogenetic studies
(88300–88399) surgical pathology
(88720–88741) in vivo (transcutaneous) lab procedures
(89049–89240) other procedures
(89250–89398) reproductive medicine procedures
CPT Codes for Medicine Services: 90281–99099; 99151–99199; 99500–99607
(90281–90399) immune globulins, serum or recombinant prods
(90465–90474) immunization administration for vaccines/toxoids
(90476–90749) vaccines, toxoids
(92502–92700) special otorhinolaryngologic services
(93875–93990) noninvasive vascular diagnostic studies
(95004–95199) allergy and clinical immunology
(95803–96020) neurology and neuromuscular procedures
(96101–96125) central nervous system assessments/tests (neuro-cognitive, mental status, speech testing)
(96150–96155) health and behavior assessment/intervention
(96360–96549) hydration, therapeutic, prophylactic, diagnostic injections and infusions, and chemotherapy and other highly complex drug or highly complex biologic agent administration
(96567–96571) photodynamic therapy
(96900–96999) special dermatological procedures
(97001–97799) physical medicine and rehabilitation
(97802–97804) medical nutrition therapy
(98925–98929) osteopathic manipulative treatment
(98940–98943) chiropractic manipulative treatment
(98960–98962) education and training for patient self-management
(98966–98969) non-face-to-face non-physician services
(99000–99091) special services, procedures and reports
(99170–99199) other services and procedures
(99500–99602) home health procedures/services
(99605–99607) medication therapy management services
Category II CPT Codes:
Physicians/Providers use Category II codes to track specific information about their patients, such as whether they use tobacco, to help deliver better healthcare and achieve better outcomes for patients.
(0001F–0015F) Composite measures
(0500F–0584F) Patient management
(1000F–1505F) Patient history
(2000F–2060F) Physical examination
(3006F–3776F) Diagnostic/screening processes or results
(4000F–4563F) Therapeutic, preventive or other interventions
(5005F–5250F) Follow-up or other outcomes
(6005F–6150F) Patient safety
(7010F–7025F) Structural measures
(9001F–9007F) Non-measure claims-based reporting
Category III CPT Codes:
Category III CPT codes are temporary codes that represent new technologies, procedures and services.
(0016T-0207T) Emerging technology
Where can I find CPT codes?
Visit the AMA Store for coding resources from the authoritative source on the CPT code set. You’ll find print and digital versions of the codebook, online coding subscriptions, data files and coding packages.
What is the difference between ICD and CPT codes?
Current Procedural Terminology (CPT) is a medical code manual published by the American Medical Association while the International Classification of Diseases (ICD) is a medical code manual published by the World Health Organization.
What is the latest version of CPT codes?
The current version is the CPT 2020. It is available in both a standard edition and a professional edition.
We provide Personalized Medical Billing Consultation and project management services to…..
Acute Care Micro Hospitals
Freestanding Emergency Rooms
Urgent Care Centers
Solo Practioners & Physicians
For more information, feel free to write to us at firstname.lastname@example.org