Terminology owner/maintenance organisation

Name, contact details, website

American Medical Association

AMA Plaza
330 N. Wabash Ave., Suite 39300
Chicago, IL 60611-5885

312 464-4782

Formal name of the code system

Current Procedural Terminology (CPT®)

Short name or abbreviation of the code system name

CPT
Technical identifier/s for the code system 

OID: 2.16.840.1.113883.6.12
Canonical URL: http://www.ama-assn.org/go/cpt
URN:

Scope/domain statement for the code system

(Official or from HTA)

"The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice."

"Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.

All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.

There are various types of CPT codes:

Category I: These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.

Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.

Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.

Proprietary Laboratory Analyses (PLA) codes: These codes describe proprietary clinical laboratory analyses and can be either provided by a single (“solesource”) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA)."

Link to information about the code system - including how to obtain the content

To obtain the CPT code set, please see the 2021 license request form here

Arrangement or agreements with HL7 for use of content

None
Version management - timing and identification of versionsThe CPT code set is released annually with changes released periodically based on industry need. The PLA Codes are released quarterly, and emergency code updates are released according to industry need.

IP Information and Licensing Information

"CPT is copyrighted by the AMA and as such must be licensed to be used in electronic products or other forms."

"Any individual or entity using CPT content needs permission or a license (i.e., a written agreement authorizing use of CPT codes) from the AMA or an authorized distributor. 

 Examples where a license and royalty payment are required (not an exhaustive list):

  • Use of CPT content to develop, test, maintain, and service products that use or rely on CPT content
  • Use of CPT content in products that are licensed or distributed by a vendor, company or other third party
  • Distribution of products that require use of CPT content
  • Any proposed use of CPT content including the creation of derivative works of CPT content, translations or localized versions of CPT content"

For more information see here 

If you have a question or would like to license CPT content,  please see 2021 information here.

Any HL7 product referencing CPT must include the following verbiage:

"CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association."

Note: the year is always based on the publication year of the code set. The annual CPT code set releases the August prior to the effective year (e.g., CPT 2020 code set = copyright 2019 or CPT 2021 code set = copyright 2020).

HL7 users of this information - which HL7 products use this link (if known)

HL7 Financial Management Work Group

Process to request content change

"The development and management of the CPT code set rely on a rigorous, transparent and open process led by the CPT® Editorial Panel. Created more than 50 years ago, this AMA-convened process ensures clinically valid codes are issued, updated and maintained on a regular basis to accurately reflect current clinical practice and innovation in medicine.

The CPT® Editorial Panel, appointed by the AMA Board of Trustees, is responsible for maintaining and updating the CPT code set. The CPT Editorial Panel is an independent group of expert volunteers representing various sectors of the health care industry. Their role is to ensure that code changes undergo evidence-based review and meet specific criteria.

The CPT Editorial Panel is supported by CPT Advisors, groups of physicians nominated by the national medical specialty societies represented in the AMA House of Delegates and the AMA Health Care Professionals Advisory Committee (HCPAC). As clinical experts in their fields, the primary role of CPT Advisors is to advise the CPT Editorial Panel on procedure coding and appropriate nomenclature by proposing revision to the code set, working with industry stakeholders as they consider additions and changes to the CPT code set, and in educating their membership on the use and benefits of CPT codes.

The CPT® Editorial Panel meets three times a year to review the applications for either new codes or revisions to existing codes. Anyone who wishes to participate can submit an application to attend a Panel meeting."

For information on the Code Change process, see here

Other useful Information

None

Information current as at (date)

20201112 - Approved for Production Use
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2 Comments

  1. Jessica Bota Please start the UTG process to represent accurately at THO

    1. UTG ticket/content created, see  UP-152 - Getting issue details... STATUS