Reimbursement
CPT Codes(CPT)
In one line
AMA-maintained codes that describe medical procedures and services.
Definition
Current Procedural Terminology codes are five-digit numeric codes maintained by the American Medical Association that describe physician and other professional services. Category I codes are permanent; Category III codes are temporary tracking codes for emerging services.
Payment for a CPT code depends on its setting: Physician Fee Schedule values for professional work, OPPS APCs for hospital outpatient care and ASC rates for surgery centers. Using the wrong code or an unlisted code can delay payment. Device companies often support customers with coding guides, but these must be accurate and avoid suggesting codes that do not fit the service.
Why it matters
Without an applicable CPT code, physicians cannot bill for procedures involving a new device. Securing a Category III code is often the first reimbursement milestone; conversion to Category I follows demonstrated utilization and evidence.
Common pitfalls
- •Assuming an existing CPT code adequately describes a novel procedure - payers can deny based on miscoding.
Sources