CPT Guide
CPT Updates: How Annual CPT Changes Work and What Coders Should Check
How the AMA updates CPT each year, how Category I, II, III and PLA codes differ, and a practical checklist for implementing CPT changes on January 1.
In this article
CPT® — Current Procedural Terminology — is the code set physicians and other qualified health care professionals use to report procedures and services. It is owned and maintained by the American Medical Association (AMA). This guide explains how CPT changes are made and released, and how to implement them. It does not reproduce CPT descriptors; use official AMA publications for code text.
Who decides CPT changes?
Changes are made through the CPT Editorial Panel, an independent panel convened by the AMA. Anyone — specialty societies, manufacturers, individual clinicians — can submit a code change application. The panel reviews applications at regular meetings, with advice from specialty society advisors. Approved changes are scheduled for a future code set release.
What kinds of CPT codes are there?
| Category | Purpose | Release pattern |
|---|---|---|
| Category I | Established procedures and services in widespread use | Annual code set, effective January 1 |
| Category II | Supplemental tracking codes for performance measurement | Released more often; reporting is optional |
| Category III | Temporary codes for emerging technology, services and procedures | Released twice a year, with a waiting period before they take effect |
| Proprietary Laboratory Analyses (PLA) | Specific branded or single-lab tests | Quarterly |
When do annual CPT changes take effect?
The annual Category I changes take effect on January 1. The AMA typically makes the next year's code set available in the late summer or autumn, which gives organizations a few months to update systems, charge masters and templates.
How does Medicare treat new CPT codes?
For each calendar year, CMS assigns status indicators and (where applicable) relative value units to new codes in the Medicare Physician Fee Schedule (MPFS) final rule and assigns payment status under the OPPS for hospital outpatient services. A code may be valid but bundled, not covered, or carrier-priced. Always check the status indicator for the year of service. See our CMS updates hub.
Implementation checklist
Category III codes deserve attention
Category III codes exist so emerging services can be tracked. When a Category III code describes the service, it should generally be reported instead of an unlisted Category I code. Payer coverage for Category III services varies widely, so coverage verification and advance beneficiary notices may be relevant.
Copyright reminder
CPT is a registered trademark of the AMA, and CPT descriptors are copyrighted. Organizations that use CPT in software or publications generally need a license. MedicalCodingUpdates.com summarizes changes in original language and directs readers to the AMA for official text.
Source
American Medical Association — CPT
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Additional references
Medical coding trainer and author with more than 22 years of experience, an AHIMA Approved ICD-10 Trainer, and the managing editor of MedicalCodingUpdates.com.
Educational information only. Verify coding decisions against current official guidelines, code sets and applicable payer policies. Read the full disclaimer.
