What Is CPT (Current Procedural Terminology)?
CPT is the five-digit procedural code set developed and maintained by the American Medical Association that describes medical, surgical, and diagnostic services performed by physicians and qualified health professionals; it is HIPAA-named for use in claims.
- Practices must license current-year CPT codes annually from the AMA (or via EHR/PM system that bundles licensing).
- Coding from a prior year's CPT book is a common audit finding that creates billable services using deleted codes, which deny universally.
CPT (Current Procedural Terminology)
Also known as: Current Procedural Terminology; HCPCS Level I; AMA CPT
CPT is the five-digit procedural code set developed and maintained by the American Medical Association that describes medical, surgical, and diagnostic services performed by physicians and qualified health professionals; it is HIPAA-named for use in claims.
Definition
First published in 1966 by the AMA, CPT is the standard procedural code set named under HIPAA Transactions and Code Sets (45 CFR 162.1002). It is organized into Category I (five-digit codes for established services), Category II (supplemental tracking codes for performance measurement), and Category III (temporary T-codes for emerging technology). Updates publish each October for January 1 implementation. The AMA CPT Editorial Panel governs additions, deletions, and revisions. Most commercial payers and CMS use CPT for outpatient and physician services; CMS overlays HCPCS Level II codes for items not in CPT.
Example
CPT 99213 (established patient office visit, low-to-moderate complexity, ~30 minutes) is among the most-billed CPT codes in family medicine. CPT 92928 (percutaneous coronary intervention with stent) is a major cardiology procedural code paid through the OPPS APC system in hospital outpatient settings.
Common Misconceptions
CPT codes do not establish coverage — payment depends on the payer's coverage policy, the diagnosis code, place of service, and modifier combination. Adding a CPT code to a claim does not guarantee reimbursement.
Practical Application
Practices must license current-year CPT codes annually from the AMA (or via EHR/PM system that bundles licensing). Coding from a prior year's CPT book is a common audit finding that creates billable services using deleted codes, which deny universally.
Related Terms
HCPCS Level I/II
HCPCS is the two-tier code set used to identify medical services and items: Level I is identical to AMA CPT codes; Level II is alphanumeric codes maintained by CMS for products, supplies, and services not covered by CPT.
Read definition arrow_forwardICD-10-CM
ICD-10-CM is the U.S. clinical modification of the WHO's ICD-10 diagnosis code set, maintained by the CDC's National Center for Health Statistics, used to report diagnoses on all HIPAA-covered claims.
Read definition arrow_forwardNCCI (National Correct Coding Initiative)
NCCI is a CMS-published set of code-pair edits and per-day unit limits that prevent improper payment when incorrect code combinations are submitted; it includes Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUE).
Read definition arrow_forwardRVU (Relative Value Unit)
An RVU is a unit of measure in the Medicare Resource-Based Relative Value Scale (RBRVS) representing the relative resources required to perform a CPT/HCPCS service, comprising work, practice expense, and malpractice components.
Read definition arrow_forwardModifier 25
Modifier 25, defined by the AMA CPT, indicates a significant, separately identifiable evaluation and management (E/M) service performed by the same physician on the same day as another procedure or other service.
Read definition arrow_forwardWhere This Applies on MedPrecision
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