The Current Procedural Terminology (CPT®) code set is a listing of descriptive terms and five-digit codes for reporting medical services and procedures performed by physicians and other qualified health care professionals. As a uniform language and widely accepted medical nomenclature, CPT codes enable stakeholders across the health care ecosystem to document, communicate and understand the care provided to patients.
Types of CPT® codes
- Category I CPT codes represent established medical procedures and services. Backed by strong clinical evidence, they are typically covered by public and commercial payers.
- Category II CPT codes describe performance measurements for quality-of-care tracking.
- Category III CPT codes track emerging medical technologies, procedures, and services, gathering data on use and effectiveness to support potential Category I conversion.
- Proprietary Laboratory Analyses (PLA) codes describe proprietary clinical laboratory analyses and can be either provided by a single (“solesource”) laboratory or licensed/marketed to multiple providing laboratories that are cleared or approved by the U.S. Food and Drug Administration (FDA).
Related resources:
Why CPT codes matter for health care innovation
Innovation in health care accelerates each year. The CPT code set supports and advances innovation by playing a foundational role in managing quality care, enabling data interoperability and accelerating the adoption of emerging technologies in health systems and physician practices that make it possible for patients to receive the right care at the right time. These codes can signal to the industry that services are legitimate and enable innovations to integrate with existing infrastructure.
The CPT Editorial Panel’s physician-led, rigorous and open process enables the codes to reflect advancements in care and to play an essential role in supporting the adoption of innovative care models. Two distinct categories of CPT codes serve complementary roles in the innovation lifecycle.
Category III CPT codes for emerging technologies help to establish the clinical utility of cutting-edge innovations by allowing for data collection and evaluation. Category I CPT codes are used for services that have established broad clinical adoption and are supported by published evidence. Category I CPT codes are used in both established physician payment pathways (e.g., fee-for-service) and new and novel payment mechanisms like value-based care. They support integration of clinical services and procedures into routine care at scale, enabling more patients to benefit from these clinical advancements.
Related resources:
- Category III codes
- Proprietary Laboratory Analyses (PLA) codes
- CPT Appendix S: AI taxonomy for medical services & procedures
CPT codes in action: Digitally enabled care
- Digital Medicine Clinical Scenarios: Coding Handbook
- Behavioral Health Coding Guide
- AMA STEPS Forward® webinar: Demystifying Digital Medicine Coding
- AMA STEPS Forward webinar: Key Behavioral Health CPT Codes in Practice
- CPT webinar: Empowering Digitally Enabled Care With the CPT Code Set
- CPT webinar: Revolutionizing Behavioral Health Services With the CPT Code Set
CPT codes in action: Value-based care
- Accelerating the Adoption of Value-Based Care
- Webinar: Accelerating the Adoption of Value-Based Care With the CPT Code Set
Learn about existing CPT codes
There are more than 11,000 codes in the CPT code set, each with a nuanced description of the medical procedure or service, and guidelines for use of the code. The most efficient way to familiarize yourself with existing CPT codes, descriptors and guidelines is to explore the current edition of CPT® Professional Edition, the only official CPT codebook with rules and guidelines from the CPT Editorial Panel. CPT Professional Edition is published each year by the AMA and is available as a print or eBook through various distributors.
Related resources:
- RBRVS DataManager Online (available as an online subscription)
How a code becomes a code
As medicine evolves with clinical innovations, the CPT code set also evolves. The process of creating, updating and removing CPT codes to reflect current medical practice and innovation is guided by the independent CPT Editorial Panel. Convened by the AMA, the 21 members of the CPT Editorial Panel volunteer their clinical expertise and real-world experience to evolving the code set to accurately describe and record the clinical care delivered to patients. Hundreds of others from industry, commercial health plans, federal agencies (the Centers for Medicare & Medicaid Services (CMS), FDA and the Centers for Disease Control and Prevention (CDC)), and physicians and other providers from more than 100 specialty organizations participate in reviewing existing codes and proposed updates.
The CPT Editorial Panel meets three times a year to review applications for new codes and revisions to existing codes. Anyone who wishes can submit a code change application for consideration. Everyone is welcome to register to attend a CPT Editorial Panel meeting.
Related resources:
- CPT Editorial Panel
- CPT code process
- Criteria for CPT Category I and Category III codes
- Summary of Panel Actions documents
- News and updates about the CPT Editorial Panel and codes
How and when to apply for a CPT code
Understanding the codes in the current CPT code set is an important step in determining whether to submit an application to create or update a CPT code. When identifying an existing code for a procedure or service, all of the language within a code descriptor should be assessed.
If you determine that no existing codes accurately describe your service or procedure, you can submit a code change application to request a new code or updates to an existing code.
Related resources:
- Code change instructions
- Code application deadlines
- How to submit a code change application with the CPT Smart App
- FAQ: CPT applications
How to attend a CPT Editorial Panel meeting
The CPT code set reflects the latest medical care available to patients because the CPT code development process is driven by direct, interactive input from representation across the health care community. See the process in action—register to attend a CPT Editorial Panel meeting in person or virtually.
Related resources:
- Register for the next CPT Editorial Panel meeting
- Calendar of upcoming CPT Editorial Panel meetings
- Calendar of upcoming PLA Editorial Panel meetings
Are you a developer looking to license the CPT code set?
To learn how to build and test innovations with CPT codes before those innovations are launched into the market, visit our CPT Developer Program webpage.
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.
