The Current Procedural Terminology or commonly called as CPT is mostly used in medical billing, when filing claims. CPT codes are mainly used in clinics, as prescribed by American Medical Association or AMA to describe medical tests, various surgeries, evaluations, and any other medical procedure performed by a registered healthcare provider on a patient. Keeping in mind that the CPT code set is large, and includes the codes for thousands upon thousands of medical procedures.
What are CPT® Codes and Their Utilization in Medical Billing?
The Current Procedural Terminology (CPT®) codes provide a standardized language for healthcare professionals to code medical services and procedures. This uniformity enhances reporting, accuracy, and efficiency in medical practices.
Administrative Functions
CPT codes are essential for administrative management, playing a key role in claims processing and the establishment of guidelines for medical care review.
Widespread Acceptance
CPT terminology is recognized as the most widely used medical nomenclature in the United States. It is utilized for reporting a variety of services, including medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, and evaluation and management (E/M) services across public and private health insurance programs.
Development and Management
The creation and oversight of the CPT code set is governed by a rigorous and transparent process led by the CPT® Editorial Panel. Established over 50 years ago, this process convened by the AMA ensures that codes are clinically valid and are regularly updated to accurately reflect advancements in clinical practice and medical innovation.
Step-By-Step Guide to Create a New CPT Code
Step 1: Initial Review by AMA Staff
The AMA staff first assesses whether the request for a new code is indeed a new issue. If the request has already been evaluated, the applicant will be informed of the prior decision. If the request introduces significant new information, it advances to the next step.
Step 2: Evaluation by the CPT Advisory Committee
Next, the application is sent to the CPT Advisory Committee for detailed evaluation and feedback. AMA staff allocate a minimum of three months to compile and distribute all submitted materials for review. The process concludes when all necessary comments from CPT Advisors are received.
Step 3: Presentation to the CPT Editorial Panel
The 17-member CPT Editorial Panel convenes three times a year to review applications, addressing around 350 major topics annually. Prior to each meeting, AMA staff prepare an agenda that includes the application and CPT Advisor feedback, ensuring panel members have adequate time to consult with experts.
Step 4: Decision-Making by the CPT Editorial Panel
During the panel meeting, members vote on the application and classify the new code as either Category I or Category III. The panel may choose from four outcomes:
- Approve a new or revised code for inclusion in the upcoming CPT volume.
- Refer the application to a workgroup for further study.
- Postpone the decision for future meetings.
- Reject the request outright.
Step 5: Notification of the Panel’s Decision
Following the panel’s decision, the AMA staff informs the applicant. If the outcome is unfavorable, applicants can request a reconsideration of the decision, with details available on the AMA/CPT website.
Step 6: Referral to the RUC for Value Assessment
Once the CPT Editorial Panel approves the new or revised codes, the codes are forwarded to the AMA/Specialty Society Relative Value Update Committee (RUC). The RUC conducts surveys among qualified healthcare professionals to assess the work involved in the service or procedure, which informs relative value recommendations.
Step 7: Implementation of the New CPT Code
The new Category I service and procedure codes become effective annually on January 1, with the updated CPT book released in the fall. Category II codes are introduced quarterly, effective three months post-release, while Category III codes are rolled out semi-annually, effective six months after their announcement.
Commonly Used CPT Codes in Clinics by Healthcare Providers
What Does CPT Code 99283 Mean?
CPT 99283 refers to an office or other outpatient visit for an established patient, requiring a medically appropriate history and examination. It typically involves moderate complexity in medical decision-making.
What Does CPT Code 99233 Mean?
CPT 99233 describes an office or other outpatient visit for an established patient, requiring a medically appropriate history and examination with high complexity in medical decision-making. This code is often used for patients needing more intensive management.
What Does CPT Code 99232 Mean?
CPT 99232 indicates an office or other outpatient visit for an established patient that requires a medically appropriate history and examination, with moderate complexity in medical decision-making. This code is commonly used for follow-up appointments.
What Does CPT Code 99222 Mean?
CPT 99222 represents an office or other outpatient visit for a new patient, requiring a comprehensive history and examination, with moderate complexity in medical decision-making. It is often used for initial evaluations.
What Does CPT Code 99211 Mean?
CPT 99211 is for an office or other outpatient visit for an established patient, typically requiring only a problem-focused history and examination, with minimal complexity in medical decision-making. This code is often used for routine follow-ups or check-ins.
What Does CPT Code 97535 Mean?
CPT 97535 refers to the evaluation of a patient’s ability to perform activities of daily living (ADLs) through therapeutic interventions. This code is often used in occupational therapy settings to assess functional capacity.
What Does CPT Code 97140 Mean?
CPT 97140 pertains to manual therapy techniques such as mobilization and manipulation, usually provided by a physical therapist. This code is used to describe hands-on treatment to relieve pain and improve mobility.
What Does CPT Code 93880 Mean?
CPT 93880 is for a transcranial doppler ultrasound, which assesses blood flow in the brain’s major arteries. This non-invasive test helps diagnose conditions like stroke and other cerebrovascular diseases.
What Does CPT Code 90471 Mean?
CPT 90471 is used for the administration of a vaccine, including the related counseling provided to the patient or guardian. This code applies to the first vaccine given during a session.
What Does CPT Code 85025 Mean?
CPT 85025 refers to a complete blood count (CBC) with a differential white blood cell count. This code is commonly used in diagnostic evaluations to assess a patient’s overall health and detect a variety of disorders.
What Does CPT Code 77067 Mean?
CPT 77067 describes a diagnostic mammography procedure, particularly focused on evaluating breast tissue. It is commonly used for screening or diagnosing potential breast abnormalities.
What Does CPT Code 72148 Mean?
CPT 72148 is for an MRI of the lumbar spine with contrast material. This imaging procedure helps diagnose conditions affecting the lower back, including disc issues or nerve compression.
What Does CPT Code 71250 Mean?
CPT 71250 refers to a CT scan of the chest with contrast material. This imaging study is used to evaluate lung conditions, chest trauma, or tumors within the thoracic cavity.
What Does CPT Code 64483 Mean?
CPT 64483 indicates the injection of an anesthetic agent into the facet joint or a related structure, often used to relieve pain in the spine or surrounding areas.
What Does CPT Code 43235 Mean?
CPT 43235 refers to an upper gastrointestinal endoscopy, including a biopsy when necessary. This procedure allows for direct visualization of the upper digestive tract and is used to diagnose and treat various gastrointestinal conditions.
What Does CPT Code 99417 Mean?
CPT 99417 refers to an add-on code for prolonged services performed in the office or outpatient setting. It is used when the time spent in a visit exceeds the typical duration for a specified evaluation and management (E/M) service.
What Does CPT Code 99396 Mean?
CPT 99396 is for a preventive medicine evaluation and management service for an established patient, typically involving a comprehensive history, examination, and counseling. It is designed for patients aged 65 years and older.
What Does CPT Code 99395 Mean?
CPT 99395 denotes a preventive medicine evaluation and management service for an established patient, usually involving a comprehensive history and examination. This code is used for patients aged 18 to 39 years.
What Does CPT Code 99291 Mean?
CPT 99291 is used for critical care services provided to a patient in a critical condition. It involves a high level of medical decision-making and requires at least 30 minutes of direct patient care.
What Does CPT Code 99222 Mean?
CPT 99222 represents an office or other outpatient visit for a new patient, requiring a comprehensive history and examination, with moderate complexity in medical decision-making. It is often used for initial evaluations.
What Does CPT Code 99212 Mean?
CPT 99212 is for an office or other outpatient visit for an established patient, requiring a problem-focused history and examination, with straightforward medical decision-making. This code is often used for routine follow-ups.
What Does CPT Code 99203 Mean?
CPT 99203 refers to an office or other outpatient visit for a new patient, requiring a medically appropriate history and examination, with moderate complexity in medical decision-making. This code is often used for initial evaluations.
What Does CPT Code 97535 Mean?
CPT 97535 refers to the evaluation of a patient’s ability to perform activities of daily living (ADLs) through therapeutic interventions. This code is often used in occupational therapy settings to assess functional capacity.
What Does CPT Code 97161 Mean?
CPT 97161 is for a physical therapy evaluation, low complexity, which includes a problem-focused history, examination, and the establishment of a treatment plan. This code is commonly used for initial assessments.
What Does CPT Code 93880 Mean?
CPT 93880 is for a transcranial doppler ultrasound, which assesses blood flow in the brain’s major arteries. This non-invasive test helps diagnose conditions like stroke and other cerebrovascular diseases.
What Does CPT Code 92507 Mean?
CPT 92507 refers to speech, language, and hearing therapy services. This code is used for the treatment of speech and language disorders and requires the use of techniques to improve communication skills.
What Does CPT Code 90837 Mean?
CPT 90837 denotes a psychotherapy session that lasts 60 minutes with a patient. This code is used by mental health professionals for providing focused therapeutic interventions.
What Does CPT Code 90792 Mean?
CPT 90792 is for a psychiatric diagnostic evaluation, including medical services. This code is used by psychiatrists or other mental health professionals to assess and diagnose mental health conditions.
What Does CPT Code 85025 Mean?
CPT 85025 refers to a complete blood count (CBC) with a differential white blood cell count. This code is commonly used in diagnostic evaluations to assess a patient’s overall health and detect various disorders.
What Does CPT Code 83036 Mean?
CPT 83036 is for a glucose tolerance test, used to assess how well the body processes glucose. This test is important for diagnosing diabetes and other metabolic conditions.
What Does CPT Code 80053 Mean?
CPT 80053 denotes a comprehensive metabolic panel, which includes various tests to evaluate a patient’s metabolism, kidney function, liver function, and electrolyte levels.
What Does CPT Code 77080 Mean?
CPT 77080 refers to a diagnostic mammography procedure, typically focused on evaluating breast tissue. It is commonly used for screening or diagnosing potential breast abnormalities.
What Does CPT Code 77067 Mean?
CPT 77067 describes a diagnostic mammography procedure, particularly focused on evaluating breast tissue. It is commonly used for screening or diagnosing potential breast abnormalities.
What Does CPT Code 64483 Mean?
CPT 64483 indicates the injection of an anesthetic agent into the facet joint or a related structure, often used to relieve pain in the spine or surrounding areas.
What Does CPT Code 43235 Mean?
CPT 43235 refers to an upper gastrointestinal endoscopy, including a biopsy when necessary. This procedure allows for direct visualization of the upper digestive tract and is used to diagnose and treat various gastrointestinal conditions.
CPT Code 73721 Description by American Medical Association
CPT 73721 is used for an MRI of the lower extremity (leg), specifically focused on joints and soft tissues. This imaging helps doctors diagnose issues like tears, swelling, or other abnormalities in the leg.
CPT Code 43239 Description by American Medical Association
CPT 43239 refers to an endoscopy procedure where the doctor examines the upper digestive system, including the esophagus, stomach, and part of the small intestine. It can also involve taking biopsies to check for problems.
CPT Code 99284 Description by American Medical Association
CPT 99284 is for an office visit for an established patient requiring a detailed history and examination. This visit usually involves high complexity in medical decision-making, often for urgent medical issues.
CPT Code 99233 Description by American Medical Association
CPT 99233 describes an office or outpatient visit for an established patient, requiring a medically appropriate history and examination with high complexity in medical decision-making. It is commonly used for patients needing more intensive management.
CPT Code 99232 Description by American Medical Association
CPT 99232 indicates an office or outpatient visit for an established patient that requires a medically appropriate history and examination, with moderate complexity in medical decision-making. This code is often used for follow-up appointments.
CPT Code 96372 Description by American Medical Association
CPT 96372 is used for the injection of a therapeutic substance, such as medication, through the skin into a muscle or vein. This is commonly done in outpatient settings.
CPT Code 96138 Description by American Medical Association
CPT 96138 refers to the administration of a standardized test to evaluate a patient’s cognitive function and emotional health. This code is often used in mental health assessments.
CPT Code 88305 Description by American Medical Association
CPT 88305 is for a pathology examination, specifically the microscopic examination of tissue samples to diagnose diseases, including cancer. This is an essential part of many medical evaluations.
CPT Code 80053 Description by American Medical Association
CPT 80053 denotes a comprehensive metabolic panel blood test that checks for various health issues, such as kidney function, liver function, and electrolyte balance. It is commonly used in routine health screenings.
CPT Code 74177 Description by American Medical Association
CPT 74177 is for a CT scan of the abdomen and pelvis with contrast material. This imaging helps doctors diagnose issues related to the organs in these areas.
CPT Code 97112 Description by American Medical Association
CPT 97112 refers to therapeutic procedures to improve movement and function, often used in physical therapy settings. It helps patients regain strength and mobility.
CPT Code 90834 Description by American Medical Association
CPT 90834 is for a psychotherapy session lasting 45 to 60 minutes. It’s used by mental health professionals to provide therapeutic treatment and support to patients.
CPT Code 90471 Description by American Medical Association
CPT 90471 is for administering a vaccine and includes any necessary counseling provided to the patient or their guardian. This code applies to the first vaccine given during a visit.
CPT Code 17304 Description by American Medical Association
CPT 17304 is used for the destruction of benign skin lesions using a method like cryotherapy or electrosurgery. This helps to remove unwanted skin growths.
CPT Code J2919 Description by American Medical Association
CPT J2919 is for a medication that is injected, often used in various medical treatments. This code helps identify specific drugs used in patient care.
CPT Code J1010 Description by American Medical Association
CPT J1010 is for a specific injectable medication used in the treatment of certain health conditions. It helps healthcare providers document the administration of this medication.
CPT Code 99203 Description by American Medical Association
CPT 99203 is for an office visit for a new patient, requiring a medically appropriate history and examination with moderate complexity in medical decision-making. This is often used for initial evaluations.
CPT Code 97530 Description by American Medical Association
CPT 97530 refers to therapeutic activities designed to improve a patient’s functional performance. This is often used in rehabilitation settings.
CPT Code 96372 Description by American Medical Association
CPT 96372 is repeated here and is used for the injection of a therapeutic substance through the skin into a muscle or vein, commonly done in outpatient settings.
CPT Code 99213 Description by American Medical Association
CPT 99213 is for an office visit for an established patient, requiring a problem-focused history and examination, with low complexity in medical decision-making. This code is often used for routine follow-ups.
CPT Code 99211 Description by American Medical Association
CPT 99211 is for a quick office visit for an established patient, typically requiring only a brief check-up and minimal medical decision-making. It’s often used for very simple follow-ups.
CPT Code 93306 Description by American Medical Association
CPT 93306 refers to a comprehensive echocardiogram, which is an ultrasound of the heart. This test helps doctors assess heart function and check for any problems.
CPT Code 99214 Description by American Medical Association
CPT 99214 is for an office visit for an established patient, requiring a detailed history and examination, with moderate complexity in medical decision-making. This code is often used for ongoing management of a patient’s condition.
CPT Code 97530 Description by American Medical Association
CPT 97530 is repeated here and refers to therapeutic activities designed to improve a patient’s functional performance, commonly used in rehabilitation.
CPT Code 97140 Description by American Medical Association
CPT 97140 is for manual therapy techniques provided by a therapist, such as joint mobilization or manipulation. This is used to relieve pain and improve movement.
CPT Code 36415 Description by American Medical Association
CPT 36415 refers to the collection of a blood sample by venipuncture. This is commonly done for various laboratory tests to assess a patient’s health.
CPT Code 99213 Description by American Medical Association
CPT 99213 is repeated here and is for an office visit for an established patient, requiring a problem-focused history and examination, with low complexity in medical decision-making.
CPT Code 96372 Description by American Medical Association
CPT 96372 is repeated here and is used for the injection of a therapeutic substance, commonly done in outpatient settings.
CPT Code 99204 Description by American Medical Association
CPT 99204 is for an office visit for a new patient, requiring a comprehensive history and examination, with moderate complexity in medical decision-making. This code is often used for initial assessments.
CPT Code 99203 Description by American Medical Association
CPT 99203 is repeated here and is for an office visit for a new patient, requiring a medically appropriate history and examination with moderate complexity in medical decision-making.
CPT Code 99213 Description by American Medical Association
CPT 99213 is repeated here again and is for an office visit for an established patient, requiring a problem-focused history and examination, with low complexity in medical decision-making.
CPT Code 99214 Description by American Medical Association
CPT 99214 is repeated here and is for an office visit for an established patient, requiring a detailed history and examination, with moderate complexity in medical decision-making.
Conclusion
While the Current Terminology Procedures or CPT are not just ordinary medical codes approved by the American Medical Association (or AMA), there is whole science behind it. These are not just organized and structured by medical specialists but also approved by a committee. When a new CPT code is to be approved by a medical association, there has to be certain criteria in shaping a new code.
The main purpose of having a code in a procedure is to hide it from the general public and to give privacy and secrecy to ones suffering from any particular disease to eliminate all sorts of racism or hatred that a patient could potentially face. CPT codes are mainly in order but not every person could read them or rather understand them. Hence, only a specific set of procedures are studied by professionals belonging to, let’s say orthopedics and gynecologists will remember the codes that are necessary for them to carry out procedures.
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