Healthcare innovations have the potential to empower physicians and improve patient outcomes, but they need to earn clinical confidence first. Before adopting new technologies, physicians want to know: Does this technology work? Will it fit within my workflow? Will insurance cover it for my patient?
Current Procedural Terminology (CPT®) codes enable health technologies and innovative care models to reach physicians and patients by providing a foundation for clinical adoption.
Structured and trusted standards
The CPT code set is a uniform language for describing clinical services, allowing new technologies and models of care to fit seamlessly into existing clinical workflows and administrative processes. By providing a single, trusted framework, CPT codes help reduce variation and confusion, support interoperability, and limit the need for custom documentation and tracking between physicians, payers and innovators. This standardization facilitates a shared understanding of what the technology enables and how it fits into service delivery, helping to accelerate adoption and improve patient care.
Driving evidence generation & clinical adoption
CPT codes can be used for new technologies and models of care to be tested and validated by physicians and patients. Through a bi-annual electronic release, the CPT Editorial Panel introduces temporary Category III codes for emerging technologies, services and procedures that show clinical promise but need additional real-world evidence to support wider adoption. The evidence generated through CPT coding helps stakeholders understand what’s driving impact and where improvements may need to be made. Because CPT codes enable physicians and other qualified healthcare professionals to report services and procedures on claims, they can be an important step for effective technologies to gain broader clinical adoption.
Supporting payment pathways
CPT codes provide the infrastructure for routine reimbursement through Category I codes. These codes signal clinical validation, are used in established payment pathways and value-based care arrangements, and can support broader clinical adoption. Payers often rely on CPT-coded claims data to understand delivered services and assess performance.
Continuous evolution of the code set
The CPT Editorial Panel follows an open and evidence-based process to keep the code set current with innovations and technologies in care delivery. Its adaptable structure allows impactful technologies and new care models to reach physicians and patients soon after they emerge. The CPT code set also evolves through specialized collaborative workgroups and committees that bring together clinical and market perspectives to understand emerging trends and inform the development of coding frameworks to support the future of medicine.
Applying for a CPT code
If you are interested in applying for a CPT code, explore CPT code change application instructions and guidance and criteria for CPT codes. You will submit your application online via the CPT Smart App. Once the code change application is submitted, it will be reviewed by AMA staff, CPT Advisors and the CPT Editorial Panel through a comprehensive process.
Are you looking to license the CPT code set?
The AMA is attacking dysfunction in healthcare by removing obstacles and burdens that interfere with patient care. With CPT content, our focus is on making technology an asset in the delivery of health care, not a burden.
Learn more about licensing and new uses for the terminology. To learn how to build and test innovations with CPT content before those innovations are launched into the market, visit the AMA’s 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.
