What are CPT codes used for?

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CPT codes (Current Procedural Terminology) are used to document and bill medical procedures and services performed by healthcare providers in the United States. Maintained by the American Medical Association (AMA), these codes ensure standardized communication between providers, payers, and institutions.

Main Uses of CPT Codes:

1. Medical Billing
   CPT codes are submitted on insurance claims to describe what service or procedure was provided (e.g., office visit, surgery, lab test). Insurers use these codes to determine payment or reimbursement.

2. Clinical Documentation
   They provide a standardized way to record the services rendered during a patient encounter, helping maintain clear and consistent medical records.

3. Data Collection & Analysis
   CPT codes are used in research, public health tracking, and quality measurement by enabling comparison of procedures across providers and time.

CPT Code Categories:

1. Category I – Most common codes for medical procedures and services (e.g., 99213: office visit).

2. Category II – Optional tracking codes for performance measurement (e.g., preventive care).

3. Category III – Temporary codes for emerging technologies or experimental procedures.

Example:

• 99213 – Office/outpatient visit for an established patient (15–29 minutes)

• 93000 – Electrocardiogram (ECG) with interpretation and report

Summary:

CPT codes are essential for accurate billing, compliance, and communication across the healthcare system. They work alongside ICD-10-CM codes, which describe the diagnosis, while CPT codes describe the treatment or service provided.

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