An Overview of CPT Codes in Medical Billing

We have heard the word CPT often in DME billing and coding. What is so unique about these CPT codes, and why they play a prominent role in the process of DME medical billing and coding? CPT stands for standard procedural technology are number codes assigned to any service provided by a medical practitioner to a patient. It includes services such as medical, surgical, and diagnosis. These CPT codes are prominently used by insurers to decide and declare the reimbursement amount that a practitioner receives for a particular service.

Medical Coding Services
Medical Coding Services

It would be best to remember that both CPT and HCPCS are healthcare codes but serve different purposes. In general, DME billing uses CPT codes, whereas if you use Medicare, it uses HCPCS codes.

How to understand CPT codes?

A CPT code appears mostly in numbers of integers as a 5-digit code and sometimes, can even appear in alpha-numeric. Depending on reasons what you claim for, the CPT code varies. There are specific standard CPT codes used for everyday activities performed by a practitioner such as general check-ups.

The American Medical Association owns the complete copyrights of these CPT codes and even maintained by them. Since changes are frequent in any industry, healthcare is not least in that aspect. When new services are introduced, the CPT codes keep revising, and obsolete codes are replaced with new codes sometimes.

The amount of reimbursement may vary depending on the service you provide, and even the contracts between insurers and individual providers may also impact. To make it more simple and clear, CPT codes have different categories, which include the following:

Category 1 contains devices and drugs, along with vaccines, category 2 consists of performance measures and quality of care; category 3 consists of services and procedures that use emerging technology. Under category 4, you have PLA codes, which come in alpha-numeric and used for lab testing.

Some sample CPT codes for your knowledge

  • 99214 for an office visit
  • 99397 for a preventive exam in case the patient is more than 65 years of age
  • 90658 for validation of a flu shot
  • 90716 for chickenpox vaccine and more

How to use CPT codes properly?

CPT codes directly impact how much a patient pays for hospitals, medications, offices, and other medical facilities. Depending on these factors, the AMA stringently creates and follows CPT codes. The CPT coding process is generally handled by certified and professional medical billing and coding service providers to ensure that procedures are followed appropriately.

Let us take a look at the steps involved in a medical coding process when outsourced.

Initial coding

There are two ways that a practitioner follows to initiate the medical coding process at their end. Either to manually write down the code then and there when you visit or maintain electronic health record (EHR) and enter it in the system by identifying the code with the help of service name.

Verification and submission

Your records are analyzed, reviewed, and then assigned with correct codes by your practitioner. Lastly, your practitioner’s billing department submits the list of services you were offered to the insurer.

Claim processing

To process the claim, the CPT codes are more important, and your insurer uses it. Based on the codes, your reimbursement amount is entirely dependent, and in this stage, your insurer will decide how much to pay the doctor and how much to pay the patient.


Insurance companies and government statisticians use coding data to estimate future healthcare costs or charge for their patients. Moreover, the trend in medical coding can be tracked through performing intensive research.

Where to look for CPT codes?

Wherever you find documentation while the transition of your healthcare records, you can find CPT codes. Also, you can find CPT codes in the discharge paperwork provided by the doctor. You can see the summary report filled with numeric code, which is called a CPT code that appears in five characters.

Similarly, you can find CPT codes in your medical/service bills from the doctor and explain the benefits of your insurer.


CPT codes are not complicated but quite challenging to differentiate between ICD codes, and them. Anytime, suppose you need help on DME medical coding & billing process. In that case, you can directly approach the experts’ team of 24/7 Medical Billing Services, the best healthcare company to outsource your coding and billing processes.

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