that the suggested service/procedure is not requested as a means to report extraordinary circumstances related to the performance of a service/procedure already having a specific CPT code.ĬPT Category II codes are supplemental tracking codes that can be used for performance measurement.that the suggested service/procedure is neither a fragmentation of an existing service/procedure nor currently reportable by one or more existing codes and.that the clinical efficacy of the service/procedure is well established and documented in U.S.
that the suggested service/procedure is a distinct service performed by many physicians/practitioners across the United States.that the service/procedure has received approval from the Food and Drug Administration (FDA) for specific use of devices or drugs.
In developing new and revised CPT codes, the CPT Editorial Panel require:
CPT CODEBOOK CODE
The inclusion of a descriptor and its associated specific five digit identifying code number in this category of CPT is generally based upon the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. For a history and overview of the CPT Editorial Panel and its objectives, please refer to the following guide taken from the AMA website.Ĭategory I CPT codes describe a procedure of service identified with a five digit CPT code and descriptor. The Panel is authorized to revise, update, or modify the codes. The CPT Editorial Panel is responsible for maintaining the CPT "code set". The system was devised and is maintained by the American Medical Association (AMA), in cooperation with national medical specialty societies. It is also a key component in almost all physician payment arrangements. The CPT coding system is a listing of codes and descriptors for reporting services and procedures performed by physicians.
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