The Current Procedural Terminology (CPT) code set drives communication across health care by enabling seamless processing and advanced analytics for medical services and procedures. Join the discussion to learn about the CPT process, how you can get involved, and what it means for the future of medicine (including digital health, E&M, and more!).
How frequently are CPT codes updated?
A CPT code can have a number of different pathways following approval by the CPT Editorial Panel. If it is a Category I code, it will immediately go to the AMA/Specialty Society RVS Update Committee (RUC). The RUC is a volunteer group of 31 physicians who advise Medicare on how to value a physician's work. Medicare will then publish their valuation determinations in the Physician Fee Schedule.
There are also Pathology services that are approved and submitted directly to CMS for pricing on the Clinical Laboratory Fee Schedule (CLFS).
CPT codes implementation schedule
CPT Category I and II codes are updated annually and effective for use on Jan. 1 of each year. The AMA prepares each annual update so that the new CPT digital files and CPT Professional book are available in the fall of each year preceding their effective date to allow for implementation.
CPT Vaccine codes and Category III codes are released twice a year January 1 and July 1.
Molecular Pathology Tier 2 and Multianalyte Assays with Algorithmic Analyses (MAAAs) CPT codes are released three times a year – March 1, July 1 and October 1.
Finally, the newly created Proprietary Laboratory Analyses (PLA) are released on a quarterly schedule – March 1, July 1, October 1 and January 1.
As Zach mentioned, payment rates for Category 1 CPT codes assigned to the Medicare Physician Payment Schedule are based on the Resource Based Relative Value Scale (RBRVS). The Centers for Medicare and Medicaid Services (CMS) determine relative values within the RBRVS system and many commercial payors utilize this system. The AMA/Specialty Society RVS Update Committee (RUC) submits recommendations to CMS on the resource costs involved in the provision of these services, including physician work, physician time, clinical staff time, medical supplies and medical equipment. More information about the RBRVS and the RUC may be found at ama-assn.org/about/rvs-update-...
Hi Dr. Swenson,
Great question. I think you'd be best contacting someone from the American Society of Anesthesiologists to better answer your question, as this conversation is focused on the AMA's CPT. Check out this link: asahq.org/about-asa/contact-as...
If you have any more questions, feel free to message me directly. Thanks!
Does the CPT Editorial Panel set reimbursement for each CPT code? How can I participate on the CPT Editorial Panel?
No reimbursement rates are set by payers, the most notable being the Center for Medicare and Medicaid Services.
The AMA also convenes the AMA Specialty Society RVS Update Committee (RUC). The RUC is a unique multispecialty committee dedicated to describing the resources required to provide physician services which CMS considers in developing Relative Value Units (RVUs).
For more information about the RUC, please see ama-assn.org/about/rvs-update-...
On March 13, the CPT Editorial Panel approved a new CPT code 87635 to report novel coronavirus testing (SARS-CoV-2) for detection of COVID-19. The new CPT code, which was published and effective immediately, is the industry standard for reporting of novel coronavirus tests across the nation’s health care system. The CPT code was created to provide a single code solution for the various tests that are available from both commercial and government labs across the nation.
More information can be found here: ama-assn.org/practice-manageme...
In addition, the AMA has released a quick guide to reporting telemedicine. Just today, the Administration has removed existing statutory restrictions on telehealth. More details on proper reporting of these services, and how to implement them in a physician’s practice, can be found here: ama-assn.org/practice-manageme...
I recently spoke to a specialty society about an issue they are having with only being able to point to a maximum of four diagnosis codes per procedure code. This is a limitation of the current claim transaction technical specifications. At times the physicians in this specialty need to point to more than four diagnosis codes to capture all of the information related to the procedure for the purposes of risk adjustment. Is anyone else experiencing this issue? Do you have any sense of the percentage of claims where you would need to point to more than four diagnosis codes?