The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. New editions are released each October, with CPT 2021 being in use since October 2021. It is available in both a standard edition and a professional edition.
CPT coding is similar to ICD-10-CM coding, except that it identifies the services rendered, rather than the diagnosis on the claim. Whilst the ICD-10-PCS codes also contains procedure codes, those are only used in the inpatient setting.
CPT is identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Healthcare Common Procedure Coding System. Although its use has become federally regulated, the CPT's copyright has not entered the public domain. Users of the CPT code set must pay license fees to the AMA.
Types of code
There are three types of CPT code: Category I, Category II, and Category III.
Category I
Category I CPT Code(s). There are six main sections:
Medicare specific codes (HCPCS) for Preventive evaluation and management
(G0402) - Initial Preventive Physical Examination; face-to-face visit, services limited to a new patient during the first 12 months of Medicare enrollment. (G0438) - Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit, (G0439) - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit
Codes for evaluation and management: 99201–99499
(99201–99215) Office/other outpatient services
(99217–99220) Hospital observation services
(99221–99239) Hospital inpatient services
(99241–99255) Consultations
(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
Codes for anesthesia: 00100–01999; 99100–99150
(00100–00222) head
(00300–00352) neck
(00400–00474) thorax
(00500–00580) intrathoracic
(00600–00670) spine and spinal cord
(00700–00797) upper abdomen
(00800–00882) lower abdomen
(00902–00952) perineum
(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 (01958–01969) obstetric (01990–01999) other procedures (99100–99140) qualifying circumstances for anesthesia (99143–99150) moderate (conscious) sedation