The Three Categories of CPT Codes

CPT Codes

current procedural terminology meaning: Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of healthcare services provided by physicians, hospitals, and other healthcare professionals. These codes are utilized to communicate with other physicians, hospitals, and insurers for claims processing.

There are three categories of CPT Codes: Category I, Category II, and Category III.

1. Category I CPT Codes:

CPT codes are used for reporting devices and drugs (including vaccines) required for the performance of a service or procedure, services or procedures performed by physicians and other health care providers, services or procedures performed intended for clinical use, services or procedures performed according to current medical practice, and services or procedures that meet CPT requirements. These codes are billable for reimbursement.

There are 10 main sections:

00000-09999Anesthesia Services
10000-19999Integumentary System
20000-29999Musculoskeletal System
30000-39999Respiratory, Cardiovascular, Hemic, and Lymphatic System
40000-49999Digestive System
50000-59999Urinary, Male Genital, Female Genital, Maternity Care, and Delivery System
60000-69999Endocrine, Nervous, Eye and Ocular Adnexa, Auditory System
70000-79999Radiology Services
80000-89999Pathology and Laboratory Services
90000-99999 Evaluation & Management Services
Related Articles:

Deleted, Revised, and New CPT Codes for 2023

AMA Releases CPT 2021

 

2. Category II CPT Codes:

Category II CPT Codes are used for reporting performance measures reducing the necessity for chart review and medical records abstraction.

These cpt codes provide the data needed by the Performance Measures Advisory Group (PMAG). The PMAG is comprised of performance measures experts representing the AMA, the Centers of Medicare and Medicaid Services (CMS), the Agency of Healthcare Research and Quality (AHRQ), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Physician Consortium for Performance Improvement.  This data is used to collect information about the quality of care to help establish and improve performance measures.  These codes are not billable for reimbursement.

Composite measures0001F-0015F
Patient management0500F-0575F
Patient history1000F-1220F
Physical examination2000F-2050F
Diagnostic/screening processes or results3006F-3573F
Therapeutic, preventive or other interventions4000F-4306F
Follow-up or other outcomes5005F-5100F
Patient safety6005F-6045F
Structural Measures7010F-7025F

 

3. Category III CPT Codes:

Category III cpt codes are used for reporting emerging technology in a number of capacities including services or procedures recently performed on humans, clinical trials and etc.  These cpt codes are temporary codes and must be accepted for placement in Level I within five years, be renewed for another five years or be removed from the book.

Another feature of Category III CPT codes is that they are listed in numerical order instead of anatomical location.

Emerging Technology 0016T-0207T

CPT Code Revisions: These cpt codes are constantly being removed, revised, updated, and added each October with the exception of emerging technology and vaccines, which are updated every six months.

CPT Code Resources: CPT is a registered trademark of the American Medical Association and holds the copyright of the CPT coding system.  Providers of service must pay a license fee to have access to these codes. However, patients and other users can register on their websites and perform up to 12 searches.