CPT Codes by Category

The Three Categories of CPT Codes

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Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of health care services provided by physicians, hospitals and other health care professionals. These codes are utilized to communicate with: other physicians, hospitals, and insurers for claims processing.

There are three categories of CPT: Category I, Category II, and Category III.

Category I CPT Codes

Category I CPT codes are used for reporting devices and drugs (including vaccines) required for the performance of a service or procedure, services or procedures performed by physicians and other health care providers, services or procedures performed intended for clinical use, services or procedures performed according to current medical practice, and services or procedures that meet CPT requirements.These codes are billable for reimbursement.

There are 10 main sections

00000-09999: Anesthesia Services

10000-19999: Integumentary System

20000-29999: Musculoskeletal System

30000-39999: Respiratory, Cardiovascular, Hemic, and Lymphatic System

40000-49999: Digestive System

50000-59999: Urinary, Male Genital, Female Genital, Maternity Care, and Delivery System

60000-69999: Endocrine, Nervous, Eye and Ocular Adnexa, Auditory System

70000-79999: Radiology Services

80000-89999: Pathology and Laboratory Services

90000-99999: Evaluation & Management Services

The Category I Vaccine Codes are updated twice yearly rather than yearly, on July 1 and January 1.

Category II CPT Codes

Category II CPT codes are used for reporting performance measures reducing the necessity for chart review and medical records abstraction.

These codes provide the data needed by the Performance Measures Advisory Group (PMAG). The PMAG is comprised of performance measures experts representing the AMA, the Centers of Medicare and Medicaid Services (CMS), the Agency of Healthcare Research and Quality (AHRQ), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Physician Consortium for Performance Improvement.  This data is used to collect information about the quality of care to help establish and improve performance measures.  These codes are not billable for reimbursement.

Composite measures

0001F-0015F

Patient management

0500F-0575F

Patient history

1000F-1220F

Physical examination

2000F-2050F

Diagnostic/screening processes or results

3006F-3573F

Therapeutic, preventive or other interventions

4000F-4306F

Follow-up or other outcomes

5005F-5100F

Patient safety

6005F-6045F

Structural Measures

7010F-7025F

Category III CPT Codes

Category III CPT codes are used for reporting emerging technology in a number of capacities including services or procedures recently performed on humans, clinical trials and etc.  These codes are temporary codes and must be accepted for placement in Level I within five years, be renewed for another five more years, or be removed from the book.

 Another feature of Category III CPT codes is that they are listed in numerical order instead of anatomical location. 

Emerging Technology 0016T-0207T

CPT Code Revisions

These codes are constantly being removed, revised, updated and added to each October with the exception of emerging technology and vaccines, which are updated every six months.

CPT Code Resources

CPT is a registered trademark of the American Medical Association and holds the copyright of the CPT coding system.  Providers of service must pay a license fee to have access to these codes. However, patients and other users can register on their website and perform up to 12 searches.

Medical coders and organizations buy the CPT Professional Edition yearly from the AMA to use as their reference for the codes.

Source:

American Medical Association, CPT 2010 Standard Edition. Retrieved from https://www.ama-assn.org/

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