What is a CPT code?
And why do insurance companies require them to process a claim?
CPT codes are an important part of the medical billing process. They describe what type of care has been provided. There are CPT codes for almost everything a licensed medical provider can do and more are created each year. At Better, we validate the accuracy of the CPT codes on every claim we file.
A Guide to CPT Codes
Current Procedural Terminology (CPT) codes, also known as service codes, are a universal system that identifies medical procedures. Each procedure is given its own unique five digit code that identifies to health insurance companies what type of care was provided. For example, the code 90387 has a description of “Individual Psychotherapy. 60 minutes.”
For private pay practices, the correct CPT code must be included on the superbill or insurance companies will deny the claim.
A Very Brief History of CPT
The system was first developed in 1966 by the American Medical Association and continues to be administered by them. The original purpose was to codify only surgical procedures but in 1983 the system was adopted by Medicare to report all provider services under the Health Care Financing Administration (HCFA), now known as the Centers for Medicare & Medicaid Services (CMS). In 1996, the Health Insurance Portability and Accountability Act (HIPAA) established rules for the electronic storage and transmission of health data and adopted the CPT system to identify medical procedures.
CPT Codes are different than ICD-10 codes, which identify diagnoses of medical conditions, not what treatment was provided. These codes area also necessary for billing insurance companies as they explain why the treatment described by the CPT code was provided. You can learn more in our guide to ICD-10 codes.
Three Categories of CPT codes
- Category I — This is a list of codes assigned to medical procedures that are accepted as standard medical practice across the United States. They are proven to be effective in treatment of particular diagnoses, supported by medical literature, and been cleared by governing bodies like the US Food and Drug Administration or the CMS.
- Category II — These are not billing codes. They are tracking codes which enable performance measurement. These codes are four digits followed by the letter “F”.
- Category III — These are temporary CPT codes that are used for new or emerging technologies or procedures. There is a five-year limit on Category III codes after which they will either be adopted in the Category I system, reapply for Category III status, or be rejected.
How To Find CPT Codes
CPT codes are available to providers in several ways. The American Academy of Professional Coders (AAPC) provides a subscription resource that provides detailed explanations of CPT codes and a code generator tool that matches codes to specific medical treatments.
The AMA offers 5 free searches per day, if a user creates a free account on their site.
Also, the AMA publishes an annual reference manual, the CPT 2019 Professional Edition, that contains all the applicable codes for the year. In our work here at Better, we find these books to be an invaluable reference.
CPT Codes Change Every Year
A panel of 11 physicians nominated by various medical and insurance stakeholders advise on annual changes to the CPT codes to keep up with current medical procedures. These changes are announced in September by the AMA and become effective on January 1 of the following year. It is very important for all practices to be aware of any code changes in their field because using outdated CPT codes on a superbill will mean that the client’s claim will automatically be rejected. Please feel free to reach out to support@getbetter.co if you have questions about CPT code changes.
Better Can Help You
We hope this brief guide proves useful. If you have any billing or coding questions, we are here to help.
If you are a healthcare provider and you need Better brochures for your practice, request them online or get in touch via providers@getbetter.co
