CPT codes are developed, maintained and copyrighted by the AMA (American Medical Association.) As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes are discarded. Thousands of codes are in use, and they are updated annually. Development and maintenance of these codes is overseen by editorial boards at the AMA, and the publications of all the software, books and manuals needed by those who use them brings millions in income (*see note below) to the AMA each year It should be noted, however, that uniformity in understanding what the service is, and the amount different practitioners get reimbursed will not necessarily be the same. For example, Doctor A may perform a physical check up (99396) and be reimbursed $100 by your insurance company. If you went to Doctor B, his reimbursement by your insurance company for that same checkup, Code 99396, might only be $90. | CPT (Current Procedural Terminology) codes are numbers assigned to every task and service a medical practitioner may provide to a patient (although not a Medicare patient - see note below) including medical, surgical and diagnostic services. They are then used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer when he or she performs that service. Since everyone uses the same codes to mean the same thing, they ensure uniformity. |
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You can use a CPT code to find out what service or
procedure it represents. You can use a service or procedure to look up the CPT codes that might apply. You can find out how much Medicare pays a doctor and a facility in your area for that service or procedure (based on the RVU - see below). You can find out the average amount paid across the United States for that code. ~ |