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Defining Current Procedural Terminology [CPT®] Codes

What they are – How they work

By Staff Reportersdhimc-book

The American Medical Association’s Physicians’ Current Procedural Terminology® is contained in the CPT user guide. The maintenance of these codes is the responsibility of the American Medical Association with consultation from the AMA CPT Editorial Panel, Advisory Committee, and the AMA CPT Health Care Professionals Advisory Committee. Procedure codes in the CPT user guide are reviewed and revised annually. The Health Care Financing Administration’s – now CMS – Common Procedure Coding System [HCPCS] lists three levels:  

Level I National Codes

CPT codes are five-character, all numeric configurations (e.g., 99215). Contact the American Medical Association to obtain a current copy of the CPT® Users Manual.

Level II National Codes

The HCPCS Level II National codes are contained in the HCPCS user’s guide and are published in the Federal Register. The maintenance of these codes is the responsibility of the Health Care Financing Administration [CMS]. Procedure codes in the HCPCS user guide are reviewed and revised annually. HCPCS codes are five characters with one alpha and four numeric configurations (e.g., A0042). Contact any publishing company that provides medical coding reference books to obtain a current copy of the current HCPCS User Manual.

Level III Medicare Local Codes*

Historically, local Medicare carriers developed local procedure codes which were published in the local Medicare Newsletters. The maintenance of these codes was the responsibility of the local Medicare carrier. Medicare local procedure codes were all five-character configurations with the following alpha/numeric configuration: one alpha, (W, X, Y or Z) with four numeric configurations (e.g., Y5523); and two alphas, (W, X, Y or Z) same character with three numeric identifiers (e.g., XX001). Contact your local Medicare carriers to obtain their Medicare Newsletters.

* Note: Due to HIPAA (Health Insurance Portability and Accountability Act) requirements, Medicare Local codes and the Office of Medicare Assistance Program Unique [OMAPU] codes were replaced with national standard procedure codes. 


For more terminology information, please refer to the Dictionary of Health Economics and Finance.


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5 Responses

  1. CPT Codes® AudioCast

    I just found this Chicago Public Radio [CPR] audiocast on CPT® codes.
    If you can spare some time, do yourself a favor by listening to it on NPR’s extraordinary show, This American Life.




  2. On CPT® Codes, Service Volume and Doctor Income

    The only trend that can reduce consumption of health care is to reduce the volume of medical services.

    The current system of CPT® code billing and reimbursement based on a price fixed system has resulted in providers using their only method of getting paid, i.e. increasing services volume.

    So, reduce volume by rationing care with applicable patient education, or put the doctor’s on salary. I see no other way to reduce costs.



  3. Coding sucks
    [Coding in healthcare is a disappointment]

    “Text Searches of EHRs Returns More Hits Than Billing Code Queries”


    “Searches for certain words and phrases in electronic health records can help identify more cases of postoperative surgical complications than queries for numeric billing codes, according to a study published in the Journal of the American Medical Association, Bloomberg reports…

    … In a commentary piece accompanying the study, Ashish Jha — an associate professor at the Harvard School of Public Health’s division of health policy and management — wrote that the study highlights the potential benefits of using EHRs to track medical data.

    Jha wrote, ‘Currently the EHR remains a tool with vast potential but a limited set of current capabilities. Natural-language process has the potential for many new applications such as automated quality assessment to assisting in the performance of comparative effectiveness research.’

    He added that the study ‘suggests that these benefits may be closer than ever, but only if the power of computing is harnessed to understand the vast amount of written data that currently needs a pair of eyes and a human brain to comprehend.’”

    Darrell K. Pruitt DDS


  4. How much more data space is required for descriptive names of diseases versus 5-character alphanumeric identifiers that must be translated? In addition, descriptive names are less susceptible to significant keystroke errors.

    Dare I ask, is coding obsolete?

    Darrell K. Pruitt DDS


  5. AMA Releases 2013 CPT Code Set

    The American Medical Association has released the Current Procedural Terminology, or CPT, code set for 2013, which the Chicago-based organization says reflects a better understanding of molecular-based disease, as well as physician-practice changes and improvements in cardiology, neurologic testing, and psychiatry.

    Effective for claims filed as of Jan. 1, 2013, the CPT codes are also supposed to better account for the work involved to manage patients with complex chronic conditions in newer models of care, such as patient-centered medical homes, accountable care organizations, and other integrated delivery systems. Practicing physicians, allied health professionals, and more than 100 medical specialty societies worked on the changes for 2013.

    Source: Jessica Zigmond, Modern Healthcare [9/17/12]


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