HL7 Terminology (THO)
5.0.0 - Publication World

This page is part of the HL7 Terminology (v5.0.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CodeSystem: Current Procedural Terminology (CPT®)

Official URL: http://www.ama-assn.org/go/cpt Version: 3.0.1
Active as of 2020-11-12 Responsible: American Medical Association Computable Name: CPT
Other Identifiers: : urn:oid:2.16.840.1.113883.6.12

The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.

Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.

All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.

There are various types of CPT codes:

Category I: These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.

Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.

Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.

Proprietary Laboratory Analyses (PLA) codes: These codes describe proprietary clinical laboratory analyses and can be either provided by a single (“solesource”) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).

This Code system is referenced in the content logical definition of the following value sets:

This code system http://www.ama-assn.org/go/cpt defines many codes, but they are not represented here


History

DateActionAuthorCustodianComment
2022-07-22reviseJessica BotaTSMGAdd default value of TRUE for code systems missing caseSensitive element unless otherwise specified; UP-322
2021-03-26reviseJessica BotaHTAUpdates being applied according to HTA external terminologies page;;UP-152