(Learn about what CPT codes look like and where to find them before you look them up.)
As patients, we don't have the thousands of dollars it costs to tap into the extensive database information required for the entire body of CPT codes. But the AMA does offer us an easy way to look up one code at a time, for free.
When you do a CPT lookup, you can learn four things:
- You can use a CPT code to find out what service or procedure it represents.
- You can use a service or procedure to look up the CPT codes that might apply.
- You can find out how much Medicare pays a doctor and a facility in your area for that service or procedure (based on the RVU - see below).
- You can find out the average amount paid across the United States for that code.
Here's how to do your look-up:
- Step 1: Link to the AMA website
- Step 2: You'll find an End-Use License. In essence it tells you that you may look up these codes only for your personal information and that you cannot sell them to anyone else. Further, it tells you that if they think you are using the system too much, they may limit your searches and/or limit the number of CPT codes you look up at one time. There is additional legaleese which you should probably read. You can also print the agreement.
- Step 3: Click on ACCEPT or DECLINE. If you click on DECLINE, you will not be allowed access to the code lookup.
- Step 4: The next page is your search page. Choose your state and city. If your city isn't there, there will be a choice that makes sense. For example, if you live in Tampa, Florida, you'll find that Tampa isn't listed (only Miami and Ft. Lauderdale are listed) but there is a designation for "Rest of Florida."
- Step 5: If you already have the CPT code and want to see what it means: Simply input the 5-digit CPT code to the field, hit SUBMIT, and you'll get your result on the next page. Included will be the RVU - see below.
Step 6: If you do not have the CPT code, but you know what the procedure or service was, you can do a search to try to figure out the right code. This can get tricky, though.
Try using the term you would use to describe the procedure or service. For example, you can use "hysterectomy" and you'll get a handful of results.
But sometimes it's more difficult. I did a search for "knee replacement" and came up with nothing. When I tried just "replacement" I got several pages of services and codes for replacement of many body parts. If that happens for you, you'll have to weed through the codes that are there.
Another way to find just the right code is to look up the medical word for whatever the procedure is. For example, what we call a jaw, doctors call a temporomandibular joint. Looking up temporomandibular joint, I find code 21243 - which is the code for having a jaw replaced.
Continue looking up the codes you need. Record the information you need depending on what you will use them for.
Using RVUs to Determine How Much Your Provider Was Paid
Each CPT code is given a value - an amount of money Medicare will pay a hospital or a physician for that service as an average. Then, cities and other geographic areas are assigned an RVU - relative value amount - that is a percentage, higher or lower, of the average CPT payment.
Here's how that works: Depending on what state and city you live in, the RVU will be higher or lower than the average, based on the cost of doing business. So, for example, say CPT Code X is worth an average of $100 across the United States. The RVU for New York City might be 1.3 which means Code X is worth $130. In Birmingham, Alabama, which has a much lower cost of doing business, the RVU might be .75 - making that CPT code worth $75 in Birmingham, Alabama.
Remember, these values reflect Medicare payment amounts. If you have private insurance, the amount paid to your doctor or hospital may be more or less depending on their negotiations.
Link to the instructions for:
- Using CPT codes to review your medical bills.
- Comparing your medical bills to your insurance company's Estimate of Benefits (EOB)
- If you believe your doctor is billing for services not provided to you, or is billing for a higher level of service than you received, you'll want to know what to do about this practice, called Upcoding.