The American Medical Association (AMA) CPT® Editorial Panel accepted recommendations from the CPT-5 Executive Project Advisory Group for the creation of codes in CPT to allow for the identification of new and emerging technologies and the collection of data to facilitate performance measures.
The CPT-5 Project is structured to address challenges presented by emerging user needs including changes to enhance the use of CPT by practicing physicians, managed care and other payer organizations, and researchers. The CPT-5 Project will make improvements in the structure and processes of the CPT codes with deliberate emphasis on maintaining what works and has made CPT successful, while correcting problems and extending the applicability of CPT into new areas. As part of the drive to extend the function of CPT, thus adding to its value, these new categories of CPT are being developed.
In conjunction with the acceptance of these recommendations, the Coding Change Request Form and the Instructions for completion have been revised. These forms now include coding changes for three different categories of CPT codes.
Category I CPT Codes
Category I CPT codes describe a procedure or service identified with a five-digit CPT code and descriptor nomenclature. The inclusion of a descriptor and its associated specific five-digit identifying code number in this category of CPT codes is generally based upon the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations.
In developing new and revised Category I CPT codes the Advisory Committee and the Editorial Panel requires:
- that the service/procedure receive approval from the Food and Drug Administration (FDA) for the specific use of devices or drugs;
- that the service/procedure is performed across the country in multiple locations;
- that many physicians or other health care professionals perform the service/procedure; and
- that the clinical efficacy of the service/procedure has been well established and documented.
Category II CPT Codes – Performance Measurement
Category II CPT codes are intended to facilitate data collection by coding certain services and/or test results that are agreed upon as contributing to positive health outcomes and quality patient care. This category of CPT codes is a set of optional tracking codes for performance measurement. These codes may be services that are typically included in an Evaluation and Management (E/M) service or other component part of a service and are not appropriate for Category I CPT codes. The use of tracking codes for performance measures will decrease the need for record abstraction and chart review, thus minimizing administrative burdens on physicians and survey costs for health plans.
CPT Performance Measurement codes will be assigned an alphanumeric identifier with a letter in the last field (eg, 1234A). These codes will be located in a separate section of CPT, following the Medicine section. Introductory language will be placed in this code section to explain the purpose of these codes. The use of these codes is optional, and not required for correct coding.
Requests for Category II CPT codes will be reviewed by the CPT/HCPAC Advisory Committee just as requests for Category I CPT codes are reviewed. In addition, a Performance Measurement Advisory Group will be established to perform initial review of proposals for Category II codes and then forward appropriate recommendations to the CPT/HCPAC Advisory Committee for review through the CPT Process.
The Performance Measurement Advisory Group will be comprised of representatives from various organizations involved in the development of performance measures, AMA CPT staff and clinical quality improvement staff, the CPT Editorial Panel, health services researchers and other knowledgeable experts.
The Performance Measurement Advisory Group will serve as an advisory body to the CPT/HCPAC Advisory Committee and the Editorial Panel in the development of performance measurement codes. Proposals for performance measurement codes must receive a two-thirds majority opinion at the Advisory Group level before they are passed on to the CPT/HCPAC Advisory Committee for review. In keeping with the existing procedures of the CPT Advisory Committee, at least one advisor must vote affirmatively in order to forward the proposal for a performance measurement code to the Editorial Panel.
CPT codes for performance measurement will not be referred to the AMA/Specialty RVS Update Committee (RUC) for valuation because no relative value units (RVUs) will be assigned. Since some of the performance measurement codes will be services embedded within E/M codes, the aggregate service is already valued.
CPT codes for performance measures will be released annually through the usual CPT publication process for that CPT cycle.
Category III CPT Codes – Emerging Technology
The purpose of this category of codes is to facilitate data collection on and assessment of new services and procedures. These codes are intended to be used for data collection purposes to substantiate widespread usage or in the FDA approval process. As such, the Category III CPT codes may not conform to the usual CPT code requirements that:
- services/procedures be performed by many health care professionals across the country;
- FDA approval be documented or be imminent within a given CPT cycle; and
- the service/procedure has proven clinical efficacy.
The service/procedure must have relevance for research, either ongoing or planned.
Category III CPT codes will be assigned an alphanumeric identifier with a letter in the last field (eg, 1234B). These codes will be located in a separate section of CPT, following the Medicine section. Introductory language will be placed in this code section to explain the purpose of these codes.
Requests for Category III CPT codes will follow the existing procedures for new or revised CPT codes. These codes will not require an additional advisory group. The CPT/HCPAC Advisory Committee, as it is currently constituted, is well informed of new and emerging technologies and procedures. If a particular Advisor is not aware of some new technology in their specialty, they can contact colleagues or make use of the specialty society resources. For these reasons, a separate advisory group for Category III CPT codes is not necessary.
Category III CPT codes will not be referred to the RUC for valuation because no RVUs will be assigned.
Once approved by the Editorial Panel, the newly added Category III CPT codes will be made available on a semi-annual (twice a year) basis via electronic distribution on the AMA/CPT website. The full set of Category III codes will be included in the next published edition for that CPT cycle.
These codes will be sunset after five years if the code has not been accepted for placement in the Category I section of CPT, unless demonstrated that a Category III code is still needed. These codes will not be reused.
Questions regarding the various categories of CPT codes may be directed to
CPT Editorial Research and Development staff at 312-464-4723 or via fax
at 312-464-5762, or email to the Director, Marie Mindeman.
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