CPT (Current Procedural Terminology) is a medical billing coding system created by the American Medical Association (AMA) with the sole purpose of charging insurance companies for health care services and putting royalty money in the AMA's pocket. It's an artifact of the pay for service reimbursement system that has caused the US to spend the most on healthcare while delivering mediocre patient results.
If a CPT code does not exist for a service, chances are your physician won't do it. Wonder why adverse drug reactions are under reported? There is no CPT code for that.
There is absolutely no relationship between good CPT coding and good patient care. And there is no relationship between CTP code reimbursement rates and what those services actually costs a provider. (Just ask the CEO of any hospital how much it costs them to perform a hip replacement.)
Sad but true.
The insurance companies are basically a cost plus business, so they focus on reducing the price paid per CPT. The American Medical Association makes a from licensing the codes, so they have no incentive to change it.
Hopefully new "pay for performance" mandates in PPACA will shift the power to patient care quality / results from this very broken system. And the AMA will have to find other ways to make money.
CPT® is registered trademark of the American Medical Association.
