CPT (Current Procedural Terminology) codes are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. They are then used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer. Since everyone uses the same codes to mean the same thing, they ensure uniformity.
It should be noted, however, that uniformity in understanding what the service is, and the amount different practitioners get reimbursed will not necessarily be the same. For example, Doctor A may perform a physical check up (99396) and be reimbursed $100 by your insurance company. If you went to Doctor B, his reimbursement by your insurance company for that same checkup, Code 99396, might only be $90. (This is not true for Medicare patients. Medicare uses HCPCS codes instead.)
(There is another set of codes used by physicians and facilities, too. These are called ICD codes, like ICD-9 or ICD-10 codes. They do not relate directly to billing, so are described separately.)
CPT codes are developed, maintained and copyrighted by the AMA (American Medical Association.) As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes are discarded. Thousands of codes are in use, and they are updated annually. Development and maintenance of these codes is overseen by editorial boards at the AMA, and the publications of all the software, books and manuals needed by those who use them brings an estimated $70 million in income to the AMA each year.
Because these particular codes mean so much income for the AMA, it is difficult to find lists of them that are accessible to the public. In fact, groups that have tried to make them public have been cited for violations and fines by the AMA and have been forced to remove them from the Internet. Many groups license the lists of codes from the AMA, however, and then publish them online or in books. They are allowed to charge for access since they are also paying that licensing fee.
Examples of CPT Codes:
- 99214 may be used for a physical
- 90658 indicates a flu shot
- 90716 may be used for chicken pox vaccine (varicella)
- 12002 may be used to stitch up a one-inch cut on a patient's arm
If you use Medicare, you'll see CPT codes, but used a bit differently. Medicare uses HCPCS codes (Healthcare Common Procedure Coding System.)
Matching CPT Codes to the Services They Represent
Until recently it was difficult to find out what certain CPT codes meant without contacting your insurance company or doctor's office.
However, now you can use this CPT code lookup on the AMA website.
