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CPT Coding

Current Procedural Terminology Codes

CPT® (Current Procedural Terminology) codes are numbers assigned to every professional 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.

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 millions in income to the AMA each year.

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

Healthcare Common Procedure Coding System

HCPCS Codes (Healthcare Common Procedure Coding System) numbers are the codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services. They are based on the CPT Codes developed by the American Medical Association.

There are two sets of codes. The first set, HCPCS Level I, are based on (and identical to) CPT codes. Level II HCPCS codes are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment. These are typically not costs that get passed through a physician's office so they must be dealt with by Medicare or Medicaid differently from the way a health insurance company would deal with them.

HCPCS Codes are numbers assigned to every task and service a medical practitioner may provide to a Medicare patient including medical, surgical and diagnostic services. Since everyone uses the same codes to mean the same thing, they ensure uniformity. For example, no matter what doctor a Medicare patient visits for an allergy injection (code 95115), that doctor will be reimbursed by Medicare the same amount another doctor in the same geographic region would be paid.

Some examples of HCPCS / CPT Codes:

• 99214 may be used for a physical
• 90658 indicates a flu shot
• 12002 may be used to stitch up a one-inch cut on a patient's arm