Current Procedural Terminology (CPT) codes help healthcare providers track and report medical services and procedures.
Insurers use CPT codes to determine how much money to pay providers.
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What Are CPT Codes?
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A CPT code is a number used to identify a medical service or procedure.
CPT codes are used by healthcare providers for reporting, billing, and administration purposes.
Some CPT codes are only used occasionally, and some are not really used at all.
Verywell / Laura Porter
Other CPT codes are used frequently.
Current CPT codes can also be revised and unused codes thrown out.
Thousands of CPT codes are used and updated every year.
Types of CPT Codes
CPT codes are five digits.
Most consist of only numbers but some have numbers and letters.
Provider offices, hospitals, and other medical facilities are strict about how CPT coding is done.
They hire professional medical coders or coding services to confirm that services are coded correctly.
Whats the Difference Between a CPT Code and a ICD Code?
CPT codes have different uses thanICD codes.
CPT codes identify the services provided to a patient, and ICD codes identify diagnoses.
What are the six sections of CPT codes?
Each of the six sections also has sections within it that offer more detail about services.
That said, the AMA does provide consumers with a way to look up the CPT codes.
Some patient advocacy groups say that nearly 80% of bills for medical care contain minor errors.
These simple mistakes can have a big impact on your wallet.
In fact, the wrong CPT code can mean that your insurance will not cover any of the costs.
Always review your bill carefully and compare it with your EOB to check for mistakes.
On the other hand, “unbundling” is when bundled services or procedures are billed as separate charges.
It could be a simple mistake that the billing department can fix.
If you use Medicare, you’ll see HCPCS codes in your paperwork instead of CPT codes.
HCPCS codes are used and maintained by the Centers for Medicare & Medicaid Services (CMS).
They are used to bill Medicare, Medicaid, and many other third-party payers.
HCPCS Code Levels
HCPCS level II codes start with a letter and have four numbers.
They may also have extra modifierseither two letters or a letter and a number.
Examples of items billed with level II codes are medical equipment, supplies, andambulance services.
HCPCS level II code lists can be found on theCMS website.
Level I codes, however, are copyrighted by the AMA just like CPT codes.
Summary
CPT codes are combinations of letters and numbers that match up with healthcare services and supplies.
The insurer or payer then reimburses the provider based on the CPT codes.
you’re free to see the codes on your discharge paperwork, bills, and benefit statements.
It’s a good idea to check the codes when you receive a bill or statement.
American Medical Association.CPT purpose & mission.
American Medical Association.CPT international.
American Medical Association.CPT overview and code approval.
American Medical Association.New CPT code for COVID-19 testing: What you should know.
Definitive Healthcare.Top 25 physician procedures.
American Association of Professional Coders.What is CPT?
Kaiser Family Foundation.Studies find high rates of errors on medical billing.
Centers for Medicare & Medicaid Services.HCPCS coding questions.
