Current Procedural Terminology (CPT) codes are the standard language for reporting medical procedures and services on claims to US health insurance payers. The code set is maintained by the American Medical Association and organized into three categories: Category I codes for procedures and services, Category II codes for performance measurement, and Category III temporary codes for emerging technologies.
- What is a CPT code?
- A CPT (Current Procedural Terminology) code is a five-character code used to report medical, surgical, and diagnostic procedures and services to health insurance payers. Every claim line submitted to a US payer carries a CPT or HCPCS code describing the service performed.
- Who maintains CPT codes?
- The American Medical Association (AMA) creates and maintains the CPT code set, updating it annually. Payers - Medicare, Medicaid, and commercial insurers - use CPT codes to determine coverage and reimbursement.
- What is the difference between CPT and HCPCS codes?
- CPT codes (HCPCS Level I) describe procedures and services. HCPCS Level II codes are alphanumeric codes maintained by CMS covering products, supplies, drugs, and services not in CPT - such as ambulance transport, durable medical equipment, and injectable drugs.
- How do I check if two CPT codes can be billed together?
- Check CMS NCCI Procedure-to-Procedure (PTP) edits. Rette's AI search can run an NCCI PTP check between any two CPT/HCPCS codes and tell you whether a modifier allows the pair to be billed together.
- How many units of a CPT code can I bill per day?
- CMS Medically Unlikely Edits (MUEs) set the maximum units of service a provider would report for one patient on one day. Rette can look up the MUE limit for any CPT/HCPCS code for practitioner or facility claims.