Back to Reimbursement & Market Access
CPT Codes
AMA-maintained codes that describe medical procedures and services.
Reviewed by Christian Espinosa, Founder, Blue Goat CyberLast reviewed May 5, 2026
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. What the regulation says
CPT is an AMA-maintained coding standard, not a device approval or a guarantee of reimbursement. The HIPAA Transactions and Code Sets final rule, published August 17, 2000, and effective October 16, 2000, adopted the combined HCPCS and CPT code sets under 45 CFR 162.1002 for reporting physician and other health care services in covered electronic transactions. The AMA updates CPT annually and publishes coding instructions. Category I codes describe established services; Category III codes support tracking of emerging technologies, services and procedures. Neither category automatically establishes coverage or payment.
For Medicare, professional services are generally paid under the Physician Fee Schedule, hospital outpatient services under the Outpatient Prospective Payment System through ambulatory payment classifications, and eligible surgery center procedures under the ASC payment system. Payment also depends on coverage policies, documentation, applicable edits and whether services are separately payable or packaged. An unlisted code may be appropriate when no specific code describes the service, but can require additional documentation and payer review. MedTech coding guides should accurately reflect the service performed, current AMA instructions and payer requirements, without suggesting unsupported codes or implying that a CPT code ensures reimbursement.What this means in practice
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.Examples
- A surgeon performs a common appendectomy, and the billing department uses the appropriate Category I CPT code to submit the claim for reimbursement.
- A hospital introduces a novel diagnostic imaging service. Initially, they may seek a Category III CPT code to track its use and gather evidence for future Category I consideration.
- During a patient visit, a physician provides an evaluation and management service; a specific CPT code describes this service and supports billing based on its complexity.
Common pitfalls
- •Assuming an existing CPT code adequately describes a novel procedure - payers can deny based on miscoding.
Frequently asked questions
Category I CPT codes are permanent, five-digit codes describing established procedures with widespread adoption and typically an associated Medicare payment rate, while Category III codes are temporary tracking codes assigned to new or emerging procedures and technologies to collect utilization data before the AMA and CMS decide whether the procedure warrants a permanent code. A new MedTech procedure generally must accumulate sufficient utilization and clinical evidence under a Category III code before it can be considered for conversion to Category I, and many procedures never make that conversion if utilization and evidence remain limited.
Related terms
Grouped by themeEditor's picks
· Hand-selected related conceptsReimbursement
HCPCS Codes(HCPCS)
CMS-maintained codes for products, supplies, and services not in CPT.
Reimbursement
New Technology Add-On Payment(NTAP)
Supplemental Medicare payment for inpatient use of qualifying new technologies.
Reimbursement
Category III CPT Code
Temporary CPT code for emerging technologies and services.
Reimbursement & Market Access
· From this learning pathReimbursement
Current Procedural Terminology Codes(CPT)
AMA-maintained codes used to report medical procedures and services for billing.
Adjacent lesson
Reimbursement
Budget Impact Model(BIM)
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
Reimbursement
Health Technology Assessment(HTA)
Systematic evaluation of clinical and economic value of a health technology.
Reimbursement
ICD-10-CM / ICD-10-PCS
Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims.
More in Reimbursement
· Same category Cited by
Where this term appears across MedTech Terms.
Learning paths (1)
- Reimbursement & Market AccessLesson 2 of 14
Ecosystems (1)
Latest in MedTech
Sources
2 sourcesEvery citation below opens the original document. Each is graded against our source-tier hierarchy so you can see what rests on binding law versus commentary.
Tier 4Trade press and expert commentary· 2
Link health: 2 verified· last checked 2026-06-20
AMA·1AdvaMed·1
- 1AMA CPTTier 4 VerifiedAMAama-assn.org
- 2AdvaMed - Payment & CoverageTier 4 VerifiedAdvaMedadvamed.org
Inline markers like [1] jump to the matching reference above.