Current Procedural Terminology (CPT)

Current Procedural Terminology (CPT)

What is a CPT code?

The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures tostreamline reporting, increase accuracy and efficiency.

The development and management of the CPT code set rely on a rigorous, transparent and open process led by the American Medical Association (AMA) CPT® Editorial Panel (Panel). The Panel ensures clinically valid codes are issued, updated and maintained on a regular basis to accurately reflect current clinical practice and innovation in medicine.

Types of codes:

CPT codes are divided into three distinct categories, each serving a unique purpose in clinical documentation, billing, and performance measurement. Understanding these categories is essential for accurate coding, data analysis, and payment.

Category I: Cat I codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.

Category II: Cat II alphanumeric tracking codes are supplemental codes used for performance measurement. 

Category III: Cat III are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.

CPT Editorial Panel

The CPT Advisory Committee has representatives from more than 90 medical specialty societies and health care organizations, including the AAP. It supports the efforts of the 18-member AMA CPT Editorial Panel in the annual process of adding, modifying and removing codes in the CPT manual.

The CPT Editorial Panel is supported by CPT Advisors, groups of physicians nominated by the national medical specialty societies represented in the AMA House of Delegates and the AMA Health Care Professionals Advisory Committee (HCPAC). As clinical experts in their fields, the primary role of CPT Advisors is to advise the CPT Editorial Panel on procedure coding and appropriate nomenclature by proposing revision to the code set, working with industry stakeholders as they consider additions and changes to CPT, and in educating their membership on the use and benefits of CPT codes.

The AAP has a CPT advisor and alternate advisor who are members of the Committee on Coding and Nomenclature.

The CPT Editorial Panel meets three times a year (February, May, and September) to review the applications for either new codes or revisions to existing codes. 

Who May Request a CPT Code?

Any individual, medical specialty society, third party payer, and other interested party may submit an application for changes to CPT for new or revised CPT codes to the CPT Editorial Panel.

How Do I Submit a CPT code?

CPT code change application can be found here.

AMA Resource: The CPT® code process | American Medical Association

Our Codes Were Approved, Now What?

Once a code is approved, it will then go to the AMA RUC to be surveyed and valued for physician work, practice expense and medical liability.

The AAP CPT Team plays a vital role in making sure pediatricians have a voice at the table.  

AAP members also play a vital role in creating new CPT codes or revising existing codes. The CPT Team will often collaborate and seek clinical expertise from AAP Committees / Councils / Sections when creating new codes and commenting on proposals from other specialty societies.  

If you’re interested in learning more about the work of COCN and the CPT Team, contact Teri Salus, AAP COCN Manager, at [email protected].