As a standard medical code set terminology for reporting medical services and procedures in the United States, Current Procedural Terminology (CPT®) codes, also known as Healthcare Common Procedure Coding System (HCPCS) Level I codes, help enable health technologies to reach physicians and patients by providing a uniform language of medicine and a foundation for clinical adoption.
The CPT code set evolves to reflect the latest advances in medicine through the CPT Editorial Panel (Panel) process. To help users determine the next steps for their innovation, service or procedure, the CPT Coding for Healthcare Innovation Guide outlines how to determine whether a CPT code might be appropriate, and how to prepare a complete CPT code change application.
The guide is divided into eight sections, each providing insight into a particular step in the CPT code process.
CPT codes: Defining pathways from invention to point of care
- Find out why to start considering your coding pathway early.
Does the innovation need a CPT code?
- Understand what kinds of healthcare procedures, services and technologies CPT codes describe. Learn whether the CPT code set is the right pathway for your procedure or service.
Determine whether the innovation aligns with an existing CPT code
- Before applying for a brand new CPT code, check to see if there’s already a CPT code that accurately describes your procedure or service.
CPT code categories support various stages of innovation
- The CPT code set is structured into distinct categories to support innovation at all stages and meet diverse data tracking and reporting needs. Learn more about each CPT code category and associated criteria.
CPT code change application instructions and tips
- Prepare a code change application by first reviewing guidelines.
Submitting your application via the CPT Smart App
- Code change applications for Category I, Category III and PLA CPT codes are submitted online via the CPT Smart App. Find resources to help you navigate the platform.
About the CPT Editorial Panel process
- Learn what to expect once your code change application is submitted.
Glossary of terms and acronyms
- Explore commonly encountered terms to support your understanding of the CPT code set and the CPT Editorial Panel process.
Contact us
If you have questions about the CPT code change application process or requirements, contact: [email protected].
Do you have ideas about how the AMA and the CPT Editorial Panel can continue to advance transparency throughout the Panel process, or concerns you would like to voice? Are you aware of a conflict of interest in the Panel process that you would like AMA staff to be made aware of? We welcome you to reach out to the AMA directly with information and/or feedback: [email protected].
Disclaimer: This information does not supersede specific coding guidance published in the CPT codebook, which is subject to change and further modification by the CPT Editorial Panel. Establishment of a CPT code does not imply approval, endorsement, or sponsorship of the medical procedure or service by the AMA. A CPT code does not guarantee coverage, reimbursement, or payment. The AMA disclaims responsibility for any errors or omissions and for any consequences attributable to or related to any use, reliance, or interpretation of the information herein.
CPT is a registered trademark of the American Medical Association.
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