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CPT Code: Definition and Healthcare Context
Full name: Current Procedural Terminology Code
Current Procedural Terminology (CPT) codes are a proprietary set of medical codes maintained by the American Medical Association (AMA) that describe medical, surgical, and diagnostic procedures and services. CPT codes are required under HIPAA for reporting outpatient procedures on insurance claims. Each five-character code maps to a specific procedure. CMS assigns Relative Value Units (RVUs) to CPT codes in the Medicare Physician Fee Schedule, which determines physician payment rates.
- Source file
- Not reported
- Published
- Not reported
- Retrieved
- Not reported
- Snapshot
- Not retained for this reference page
- Re-check
- AMA: CPT overview
- Data as of
- Not reported
Last updated: 2026-07-11Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- CMS QPP MIPS: MIPS quality measures are often defined as CPT-code-based reporting denominators — clinicians are eligible for a measure when billing specific CPT codes.
- Healthcare Cost Report Information System (HCRIS): facility cost reports aggregate charges by revenue code, which can be traced back to the underlying CPT-coded procedures.
Frequently asked questions
- What is a CPT code?
- A CPT code is a five-character American Medical Association code that identifies a specific medical, surgical, or diagnostic procedure for billing and documentation purposes.
- Are CPT codes required on Medicare claims?
- Yes. CPT codes are required on outpatient Medicare claims under HIPAA's standard transaction requirements.
- Who maintains CPT codes?
- The American Medical Association (AMA) owns and maintains CPT codes, updating the code set annually.