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Insurance Language 101:

CPT codes and HCPCS numbers

Insurance is a love / hate concept. The public is constantly seeing advertisements that either a) make a potential insurer seem like the best friend the consumer never had, or b) make the consumer fear they will be doomed without the potential insurer (i.e., Allstate’s Mayhem commercials). It’s a slippery slope. Then there’s health insurance. You either don’t have it but want it. Have it and complain about it. Or just catch the snippets of political debates dealing with it. But haven’t you ever wondered how it works?

Current Procedural Technology (CPT) codes developed by the American Medical Association (AMA) are the backbone that make medical insurance run smoothly. They are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services. CPT codes are then used by insurers to determine the amount of reimbursement that a practitioner will receive from an insurer. Since everyone uses the same codes to mean the same thing, they ensure uniformity.

Below are some examples. However, because the AMA controls the publication of CPT codes, you can not readily find what every code represents.

  • 99214 may be used for a physical
  • 90658 indicates a flu shot
  • 90716 may be used for chicken pox vaccine
  • 12002 may be used to stitch up a one-inch cut on a patient’s arm

For patients who use Medicare, CPT codes have been modified into Healthcare Common Procedure Coding System (HCPCS) numbers. In many cases, HCPCS numbers are similar, and serve the same purpose as CPT codes.

Many times Medical Administrative Assistants are responsible for completing the coding process so that the medical facility, patient, and insurance company are on the same page. CPT and HCPCS codes obviously don’t make paying medical bills any more fun, but at least there is a solid and uniform procedure in practice.