CPT code
A CPT (Current Procedural Terminology) code reports the medical, surgical, or diagnostic service a provider performed — the “what was done” on a claim.
Updated
CPT — Current Procedural Terminology — is a standardized code set, maintained by the American Medical Association (AMA), that describes the procedures and services a healthcare provider performs. On a claim, a CPT code tells the payer what service was delivered so it can be priced and adjudicated.
CPT is one of the two core code sets on a professional claim: the CPT (or HCPCS) code reports the service, and the diagnosis code reports the condition that makes the service necessary.
In practice
Because payers reimburse against the reported service, a CPT code that is inaccurate or unsupported by the documentation can be denied or paid at a rate other than the one expected. Each adopted code set is valid only within the dates its maintaining organization specifies, so code selection has to track the version in effect on the date of service rather than the version in use when the claim is worked.
Commonly confused with
- ICD-10-CM code: CPT reports what was done (the procedure); ICD-10-CM reports why it was needed (the diagnosis).
- HCPCS Level II code: HCPCS Level II reports supplies, drugs, and services not described by CPT — for example, durable medical equipment.