CPT Code: Current Procedural Terminology
CPT codes are AMA-maintained 5-digit numeric codes that describe medical, surgical, and diagnostic services — forming the universal language between clinicians and payers for professional fee billing.
What are CPT Codes?
Current Procedural Terminology (CPT) codes are published and maintained by the American Medical Association (AMA). First developed in 1966, CPT codes are the standard for describing clinical services on professional claims submitted to Medicare, Medicaid, and commercial payers. There are approximately 10,000 CPT codes, updated annually each January.
Three Categories of CPT Codes
- Category I: The main body of codes (00100–99607). Covers evaluation and management, anesthesia, surgery, radiology, pathology, and medicine.
- Category II: Supplemental tracking codes (ending in F) for performance measurement and quality reporting. Used for MIPS quality measure reporting without replacing Category I codes.
- Category III: Temporary codes (ending in T) for emerging technologies and services awaiting Category I assignment.
E&M Codes: The Most Critical CPT Codes
Evaluation and Management (E&M) codes represent the majority of primary care and specialist visit billing:
- 99202–99205: New patient office visits (Level 2 through Level 5)
- 99211–99215: Established patient office visits (Level 1 through Level 5)
- 99213 (Level 3): Approximately 1.3 work RVUs; 2024 Medicare rate ~$78
- 99214 (Level 4): Approximately 1.92 work RVUs; 2024 Medicare rate ~$111
The difference between billing 99213 vs 99214 across a busy primary care practice seeing 20 patients/day represents approximately $240/day or ~$60,000/year in additional revenue — making E&M code level distribution one of the highest-value analytics targets in outpatient practice management.
CPT Codes in Quality Reporting
Category II CPT codes and specific Category I procedure codes serve as numerator completions for MIPS quality measures. For example, CPT 3046F (most recent A1C level less than 7%) documents diabetic control for NQF measure 0059. Analysing your CPT code mix — both Category I for revenue and Category II for quality — provides a comprehensive view of clinical and financial performance.