CPT code

Current Procedural Terminology belongs to the American Medical Association, which maintains it and republishes updated codes every year. CMS treats CPT as Level I of HCPCS, a numeric system of five digits, and adds its own Level II codes for what CPT leaves out¹. CPT is also one of the code sets HIPAA names for electronic transactions².

The number travels on the claim; the words behind it are licensed. CMS uses CPT under a royalty-free AMA license that limits the agency to Medicare, Medicaid and its other programs, prints an AMA copyright notice wherever CPT content appears, and dates that copyright one year before the codebook year. The same notice says fee schedules, relative value units and conversion factors are not assigned by the AMA and are not part of CPT³.

Each professional service line needs a procedure code from the release in effect on the date of service. Item 24D of the CMS-1500 takes the code and up to four two-character modifiers but no narrative description⁴, and the 837P carries it on the service line, in loop 2400⁵.

Two habits cause avoidable trouble. One is billing from an old charge list after the yearly update has deleted or replaced a code. The other is copying official descriptors into your own forms, templates or website as if they were free text. Refer to codes by number, describe services in your own words, and keep a current licensed codebook or coding software for the descriptor text.