CPT index

The CPT index gives a listing of all the codes. The different methods you may use to find a code in the index are:

1. Name of the procedure 

2. Anatomic site or organ 

3. Condition 

4. Eponym – the name of the person who developed the procedure or service or who it is named for 
5. Symptom

6. Common abbreviation

Category I codes are used for reimbursement of physician services and procedures. However, use of a CPT Category I code does not guarantee payment. Each carrier may have specific reimbursement guidelines that will indicate that a Category I code is not payable. For example, CMS (Medicare) will not pay for a spirometry (94010) and a flow-volume curve (94375) when they are performed on the same day.

Category II codes provide information on performance measures and data collection. There is no monetary value for these codes. Category II codes are not required for submission of claims for reimbursement at this time. PQRS (Physician Quality Reporting System) is currently optional but it is proposed to be a required component of coding in the future by Centers of Medicare and Medicaid Services. For 2015, CMS has proposed taking a small percentage of deductions from their allowed amount of payment on claims if the PQRS information is not provided by the providers. For other payers, however, it may or may not be necessary to include these codes on a claim when submitting for reimbursement.

Category III codes are used to track new procedures and technology. These codes are not recognized by payers as payable codes. These codes need to be used in addition to an unlisted procedure code to indicate to the payer/carrier the type of service being provided. The payer/carrier then may make a determination as to whether it chooses to reimburse for the new procedure and/or technology. Two category codes that may be used in the allergy practice are the following:

• 0243T – Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluations(s), with interpretation and report 

• 0244T – Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation for three to 24 hours, with interpretation and report

The codes above have a sunset of January 2016. If there is not sufficient acceptance and use as a standard of care by January 2016, these codes will be deleted.