To support innovation at all stages and meet diverse data tracking needs, the Current Procedural Terminology (CPT®) code set is structured into distinct categories. Explore the CPT code categories to learn what each category describes and what criteria the codes in each category must meet.
Category I and Category III CPT codes
Category I and Category III CPT codes describe medical services and procedures supported by different levels of clinical evidence. Before applying for a CPT code, review the general and specific criteria.
- Temporary CPT codes for emerging medical technologies, procedures and services.
- Help collect data on utilization, effectiveness and clinical adoption to support potential Category I conversion.
- Published three times a year.
- Effective for five years, but can be renewed for additional years.
- Applications to convert Category III CPT codes to Category I CPT codes can be submitted sooner if Category I criteria can be met.
- Do not go through the AMA/Specialty Society RVS Update Committee (RUC) valuation process (are typically carrier-priced by Medicare).
- The most widely recognized and commonly used codes for established technologies, procedures and services.
- Must meet a high standard of clinical evidence.
- Published once a year, and generally ordered into sub-categories based on procedure/service type and anatomy.
- Permanent status in the CPT code set, but reviewed and refined over time to reflect current practice.
- Typically go through the RUC valuation process and are often covered by both public and commercial payers.
Category II CPT codes
Category II CPT codes are supplemental tracking codes that can be used for performance measurement. These codes are intended to facilitate data collection about quality of care by coding certain services and/or test results that support performance measures and that have been agreed upon as contributing to good patient care. Using these CPT codes is optional.
Learn more about Category II CPT codes.
CPT PLA codes
CPT Proprietary Laboratory Analyses (PLA) codes allow labs or manufacturers to more specifically identify their advanced diagnostic laboratory tests (ADLTs) or FDA-cleared/approved clinical diagnostic laboratory tests (CDLTs), especially in cases where no applicable Category I CPT code exists.
Before applying for a CPT PLA code, review the specific requirements for PLA codes.
Unlisted CPT codes
Category I and Category III CPT codes describe the vast majority of procedures and services currently performed in the United States, and should be used to report these procedures and services that are accurately described in existing CPT codes. There may be services or procedures performed by physicians and other qualified healthcare professionals (QHPs) that are not found in the CPT code set.
Unlisted CPT codes can be used by physicians and other QHPs to document services that don’t have a specific CPT code. When an unlisted code is used, the service or procedure should be described according to specific guidelines for the section of the CPT code set that the unlisted code relates to.
Unlisted codes are not associated with relative value units (RVUs) and are not assigned a payment rate under the Medicare Physician Fee Schedule, so reimbursement is determined on a case-by-case basis requiring individual review by the payer.
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.
