CPT® - Current Procedural Terminology® Medical Code Set (00000-99999, -F, -M, -T, -U)

The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel.  The CPT code set accurately 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. The current version is the CPT 2024.  The CPT code set is also known as the HCPCS Level I codes for Medicare/Medicaid purposes.

Structure

• Category I  codes are used for reporting services or procedures performed by physicians and other healthcare providers, tests and drugs (including vaccines) required for the performance of a service or procedure.
• Category II  codes are used for reporting performance measures reducing the necessity for chart review and medical records abstraction.
• Category III  codes are used for reporting emerging technology in a number of capacities including services or procedures recently performed on humans, clinical trials, etc.

CPT Codes by Section

• Anesthesia:  00100 - 01999; 99100 - 99140
• Surgery:  10004 - 69990
• Radiology:  70010 - 79999
• Pathology and Laboratory:  0002M - 0013M, 0001U - 0171U, 80047 - 89398
• Evaluation and Management (E&M):  99091, 99202 - 99499
• Medicine:  90281 - 99199, 99500 - 99607
• Category II (Performance Measures):  0001F - 9007F
• Category III (Emerging Technology):  0042T - 0586T

Recent History

• 2004  Introduction of Category III codes that end with T (temporary codes for emerging technologies)
• 2005  Introduction of Category II codes that end with F (used for supplemental tracking for performance measurement)
• 2010  The AMA changed the method of only "grouping" or "relating" codes for similar procedures, and instituted the use of codes from other sequences, these codes became known as resequenced codes
• 2015  Multianalyte Assays with Algorithmic Analysis (MAAA) codes end with M (in Appendix O)
• 2017  Proprietary laboratory analyses codes end with U, in the Pathology and Laboratory section (this category comes after code 89398)

HCPCS Codes - Procedures, DMEs, Supplies (A0000-Z9999)

HCPCS - Level II is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.  Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items.  The development and use of level II of the HCPCS began in the 1980's.  Level II codes are also referred to as alphanumeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.