As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. These codes, among the rest of the CPT code set, are clinically valid and updated on a regular basis to accurately reflect current clinical practice and innovation in medicine.
The clinical examples and their procedural descriptions, which reflect typical clinical situations found in the health care setting, are included in this text with many of the codes to provide practical situations for which the codes would be appropriately reported. It is important to note that these examples do not suggest limiting the use of a code instead, they are meant to represent the typical patient and service or procedure. In addition, they do not describe the universe of patients for whom the service or procedure would be appropriate.
An adult undergoes psychotherapy due to anxiety and depressive symptoms. Psychosocial stressors at work and home have increased anxiety and depression since a recent hospital discharge.
During the visit, face-to-face therapeutic communication is conducted with the patient and/or the patient's family. Objective information and an interval history are obtained. The patient's mental state is examined, including an evaluation and exploration of the intensity and complexity of the patient's symptoms, feelings, thoughts and behaviors in the context of the patient's psychosocial and health stressors and coping styles. A range of psychotherapy approaches are used to reduce the patient's distress and morbidity, and ongoing behavioral and mental status changes in the patient are addressed.
Medical knowledge and science are constantly advancing, so the CPT Editorial Panel manages an extensive process to make sure the CPT code set advances with it. The Panel obtains broad input from practicing physicians and the health care community to ensure that the CPT code set reflects the coding demands of digital health, precision medicine, augmented intelligence and other aspects of a modern health care system. This rigorous process keeps the CPT code set current with contemporary medical science and technology, so it can fulfill its vital role as the language of medicine today and the code to its future.
- Find more CPT coding resources.
- Visit the AMA Store to purchase authoritative reference sources.
- Learn more about licensing CPT content.
Disclaimer: Information provided by the AMA contained within this resource is for medical coding guidance purposes only. It does not (i) supersede or replace the AMA’s Current Procedural Terminology manual (“CPT® Manual”) or other coding authority, (ii) constitute clinical advice, (iii) address or dictate payer coverage or reimbursement policy, and (iv) substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.
CPT® is a registered trademark of the American Medical Association.
Essential CPT® Tools & Resources
COVID-19 vaccine CPT® codes tool
E/M Checklist: Prepare your practice for office visit changes