Understanding CPT Codes

How CPT codes work and how to use them.

CPT (Current Procedural Terminology) is sets of codes or numbers that were developed by the American Medical Association (AMA) designed to track and assign every task medical service providers provide and then be used by medical insurance companies to determine reimbursement that medical service providers receive from their insurers. There are several types of CPT codes: mainly Type I, Type II – Performance Management and Type III CPT Code(s) – Emerging Technology. While CPT codes are identified and the Center for Medicare and Medicaid Services, they are developed, maintained and owned by the America Medical Association and this enables the organization earn a substantial amount as well as to provide a uniform system that enables the industry to have a clear description of medical services provided and their reimbursement amount to service providers.

Looking up CPT codes is also important to patients as well, especially since knowing CPT codes and their implications can help you or a loved one to able to assess medical charges. The sheer number of overwhelming CPT codes makes it generally difficult to find a particular code especially since the list of codes is not available in its entirety to the general public.

Some examples of CPT codes may look something like this:

3006F maybe used for an x-ray

99214 for a flu shot

You can find additional information about examples of codes on websites like about.com and others.

Accessing the Code

While access to these lists can prove indispensable, most people are not able to find the CPT code easily. With the growth of the medical industry, the AMA has to at times, modify and develop new codes. This can create a problem for anyone who may need information on a particular CPT code. The process can be tedious as it may involve contacting your medical provider or your medical insurer. If you need to look up the CPT codes, you can head over to the AMA website. However the online tool does limit the number of codes one can look up and does not provide helpful information. If you need helpful information, you should contact your medical insurer or service provider who will contact the AMA and for a fee, provide the information you need.

There are some other alternatives; there are medical groups that have been licensed to publish the codes in books. Certain groups have obtained licenses to the CPT code lists and do make them available, albeit at a fee.

People insured with Medicare, also use CPT codes but in a different manner. The CPT codes used by Medicare are referred to as HCPCS codes. HCPCS stands for Healthcare Common Procedure Coding System.

If you are unsure of which CPT codes your insurance uses, you can speak to your medical practitioner or insurance representative to find out. Also you can do some research, so you can find out what the CPT codes mean and which ones are used and also do some searching for books or guides that offer more information about the CPT codes; especially if you are not sure about the type of service.


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