What Are CPT Codes in Medical Billing- Best 2026 Guide
In this article, I’ll tell you everything you need to know about CPT codes, what they are, where they’re used, the different types available, and how they form the backbone of medical billing and revenue cycle management in the United States.
Here’s what people are searching for in 2026:
| What People Search For | What They Really Want to Know |
|---|---|
| what are cpt codes | A simple explanation of medical billing language |
| cpt 99214 vs 99213 | Which office visit code to use and when |
| cpt 97110 physical therapy | How therapy codes work and what they pay |
| cpt 93000 stress test | What heart procedure codes actually mean |
| cpt 36415 blood draw | Why this code appears on every lab bill |
What Are CPT Codes?
Current Procedural Terminology (CPT) codes are a standardized set of codes developed by the American Medical Association (AMA). They describe medical, surgical, and diagnostic services to communicate uniform information.
Official Statements on CPT Codes
The Centers for Medicare & Medicaid Services (CMS) states:
The American Medical Association (AMA) emphasizes:
The Department of Health and Human Services (HHS) recognizes:
“The CPT coding system offers physicians a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.”
“CPT codes are the language of medicine today, providing the flexibility needed to accurately code medical services and procedures that save lives and improve the health of patients across the nation.”
“Standardized coding systems like CPT are essential for interoperability, quality measurement, and the efficient administration of our nation’s healthcare programs.”
Where Are CPT Codes Used?
CPT codes are the universal language of healthcare billing, appearing on virtually every medical claim processed in the United States. These five-character codes document every service, procedure, and evaluation performed across the entire healthcare delivery system. From large hospital systems to small private practices, CPT codes ensure providers get paid and insurance companies understand exactly what services were delivered.
- Physician Offices
- Hospitals
- Laboratories
- Therapy Clinics
- Imaging Centers
- Ambulatory Surgery Centers
- Home Health Agencies
- Telehealth Platforms
- Urgent Care Centers
- Dental Offices
- Skilled Nursing Facilities
- Behavioral Health Centers
- Rehabilitation Hospitals
- Diagnostic Centers
- Retail Health Clinics
- Emergency Departments
- Outpatient Surgery Centers
- Cardiac Catheterization Labs etc..
History of CPT Codes
As the AMA decided in April 1960, the Current Medical Terminology (CMT) handbook was first published in June 1962–1963 to standardize terminology and for the analysis of patient records, aided by an IBM computer. Procedural information was dropped in the transition from the SNDO to CMT, but was released separately as the Current Procedural Terminology in 1966. This marked the birth of CPT codes as we know them today.
The CPT codes revisions in 2013 were part of a periodic five-year review. Some psychotherapy codes changed numbers, with 90806 changing to 90834 for individual psychotherapy of similar duration. Add-on codes were created for the complexity of communication about procedures.
Understanding the Three Types of CPT Codes
There are three types of CPT codes:
Category I
Category II
Category III
Each serves a distinct purpose in healthcare documentation and billing.
CPT Category I Codes
What they are: The largest body of CPT codes, consisting of those commonly used by providers to report their services and procedures. These represent existing services or procedures widely used and, when appropriate, approved by the FDA.
Where they’re used: Every healthcare setting – physician offices, hospitals, laboratories, therapy clinics
The six main sections of CPT Category I CPT codes are Evaluation and Management (99201–99499), Anesthesia (00100–01999), Surgery (10004–69990), Radiology (70010–79999), Pathology and Laboratory (80000–89398), and Medicine (90281–99607).
CPT Category II Codes
What they are: Supplemental tracking CPT codes used for performance management. Category II CPT codes describe clinical components usually included in evaluation and management of clinical services and are not associated with any relative value. They consist of four numbers followed by the letter F.
Where they’re used: Quality reporting programs, performance measurement, patient outcome tracking
Category II CPT codes are reviewed by the Performance Measures Advisory Group (PMAG), composed of experts from AHRQ, AMA, CMS, the Joint Commission, NCQA, and the Physician Consortium for Performance Improvement.
CPT Category III Codes
What they are: Temporary CPT codes used to report emerging and experimental services and procedures. These are depicted with four numbers and the letter T.
Where they’re used: Clinical trials, research settings, innovative procedures not yet widely adopted
Temporary CPT codes describing new services and procedures can remain in Category III for up to five years. If they meet Category I criteria, they’ll be reassigned Category I CPT codes. The AMA releases new or revised Category III CPT codes semiannually.
CPT Modifiers
A CPT modifier consists of two numbers, two letters, or a number and a letter. Many situations require a coder to append modifiers to a CPT code to further describe the service or procedure provided.
| Modifier | Meaning | When to Use |
|---|---|---|
| -25 | Significant E/M service | Office visit and procedure same day |
| -59 | Distinct procedural service | Two procedures together |
| -50 | Bilateral procedure | Both sides performed |
| -51 | Multiple procedures | Multiple surgeries |
| -52 | Reduced services | Partially completed |
| -TC | Technical component | Equipment portion |
| -26 | Professional component | Interpretation portion |
| -RT | Right side | Procedure on right |
| -LT | Left side | Procedure on left |
CPT Codes and Other Code Sets
| Code Set | Full Name | What It Does |
|---|---|---|
| CPT | Current Procedural Terminology | Reports procedures and services performed |
| HCPCS Level II | Healthcare Common Procedure Coding System Level II | Reports supplies, equipment, drugs |
| ICD-10-CM | International Classification of Diseases | Reports patient diagnoses |
| ICD-10-PCS | ICD-10 Procedure Coding System | Reports inpatient procedures |
Complete Guide to Most Searched CPT Codes in 2026
| CPT Code | What It Is | Where Used | Category |
|---|---|---|---|
| 99213 | Established patient office visit, low complexity | Primary care, follow-ups | E/M |
| 99214 | Established patient office visit, moderate complexity | Chronic care management | E/M |
| 99215 | Established patient office visit, high complexity | Complex medical decisions | E/M |
| 99203 | New patient office visit, low complexity | Initial evaluations | E/M |
| 99204 | New patient office visit, moderate complexity | Comprehensive new visits | E/M |
| 99232 | Subsequent hospital care | Daily hospital rounds | E/M |
| 97110 | Therapeutic exercises | Physical therapy | Medicine |
| 97530 | Therapeutic activities | Functional task training | Medicine |
| 97140 | Manual therapy | Hands-on treatment | Medicine |
| 36415 | Routine venipuncture | Blood draws | Pathology/Lab |
| 93000 | Routine ECG with interpretation | Cardiac evaluation | Medicine |
| 99396 | Preventive visit, age 40-64 | Annual physicals | Preventive Medicine |
State-by-State CPT Code Usage
California
Most used CPT codes: 99213, 99214, 97110. Major payers: Blue Shield of California, Health Net, Anthem Blue Cross. Many California providers use Automation Anywhere and UiPath for claims processing. California has strict timely filing limits of 365 days for most commercial plans. California Department of Insurance regulates payer compliance.
Texas
Most used CPT codes: 99213, 99214, 93000. Major payers: Blue Cross Blue Shield of Texas, UnitedHealthcare, Cigna. Texas providers increasingly use Blue Prism for denial management. Texas has a 95-day filing limit for Medicare. Texas Medical Board provides physician verification.
Florida
Most used CPT codes: 99213, 99214, 36415. Major payers: Florida Blue, AvMed, UnitedHealthcare. Florida providers use UiPath for eligibility verification. Florida Office of Insurance Regulation oversees compliance.
New York
Most used CPT codes: 99214, 99213, 99396. Major payers: Empire Blue Cross, UnitedHealthcare, Fidelis Care. New York providers use Automation Anywhere for prior authorization. New York Department of Financial Services regulates insurance.
Illinois
Most used CPT codes: 99213, 97110, 99214. Major payers: Blue Cross Blue Shield of Illinois, UnitedHealthcare, Cigna. Illinois providers use Blue Prism for claims processing. Illinois Department of Insurance provides regulatory guidance.
Pennsylvania
Most used CPT codes: 99213, 99214, 93000. Major payers: Highmark, Independence Blue Cross, UPMC Health Plan. Pennsylvania providers use UiPath for revenue cycle management. Pennsylvania Insurance Department oversees payer compliance.
Ohio
Most used CPT codes: 99213, 97110, 36415. Major payers: Medical Mutual of Ohio, Anthem Blue Cross, UnitedHealthcare. Ohio providers use Automation Anywhere for payment posting. Ohio Department of Insurance regulates insurance.
Georgia
Most used CPT codes: 99213, 99214, 97110. Major payers: Blue Cross Blue Shield of Georgia, Cigna, UnitedHealthcare. Georgia providers use Blue Prism for denial prevention. Georgia Office of Insurance provides oversight.
North Carolina
Most used CPT codes: 99213, 99214, 93000. Major payers: Blue Cross NC, UnitedHealthcare, Cigna. North Carolina providers use UiPath for eligibility. North Carolina Department of Insurance regulates payers.
Michigan
Most used CPT codes: 99213, 97110, 99214. Major payers: Blue Cross Blue Shield of Michigan, Priority Health, UnitedHealthcare. Michigan providers use Automation Anywhere for claims. Michigan Department of Insurance and Financial Services oversees compliance.
Massachusetts
Most used CPT codes: 99214, 99213, 99396. Major payers: Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Harvard Pilgrim. Mass General Brigham uses UiPath, Automation Anywhere, and Blue Prism with CodaMetrix for radiology coding. Massachusetts Division of Insurance regulates insurance.
Automation Solutions for Medical Billing
| Automation Tool | Application in Medical Billing |
|---|---|
| UiPath Healthcare | Eligibility verification, claims processing, denial management, prior authorization |
| Automation Anywhere | Payment posting, data entry, claims processing, revenue cycle automation |
| Blue Prism | Complex workflow automation, back-office operations, system integration |
| Epic | EHR integration, patient record matching, document indexing |
| CodaMetrix | AI-powered medical coding for radiology, pathology, surgery |
Resources for Medical Billing Professionals
| Resource | Website | What You’ll Find |
|---|---|---|
| American Medical Association | ama-assn.org | Official CPT code set, coding guidelines, annual updates |
| Centers for Medicare & Medicaid Services | cms.gov | Medicare coverage, fee schedules, regulatory guidance |
| Cureintent | cureintent.com | Coding certification, education, code lookup tools |
| AHIMA | ahima.org | Medical Billing and coding services |
| HFMA | hfma.org | Revenue cycle management, healthcare finance |
| CMS Physician Fee Schedule | cms.gov/medicare/physician-fee-schedule | E/M code reimbursement rates |
| CMS Clinical Laboratory Fee Schedule | cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched | Lab code reimbursement rates |
Final Thoughts
Understanding CPT codes is the foundation of accurate medical billing and efficient revenue cycle management. Whether you’re just starting your coding career or managing a practice’s billing operations, mastering these codes ensures proper reimbursement and compliance with payer requirements. As healthcare continues to evolve with new technologies and automation tools like UiPath, Automation Anywhere, and Blue Prism, the fundamental importance of CPT coding remains constant.
For organizations looking to implement medical billing automation solutions, Cureintent offers expert medical billing services and healthcare-related software development. Visit Cureintent.com to learn more about our medical billing expertise, healthcare automation services, and software development capabilities. Let us help you achieve transformative results in your revenue cycle operations.
Explore Our Complete Medical Billing Blog Series
| Topic | Focus | Read More |
|---|---|---|
| CPT Codes Guide | What Are CPT Codes? Complete Guide to Common Medical Billing Codes | (You Are Here) |
| CPT 99214 | What is CPT 99214? Complete Guide to Established Patient Office Visits | Read Guide |
| CPT 99213 | What is CPT 99213? Complete Guide to Low Complexity Office Visits | Read Guide |
| CPT 99232 | What is CPT 99232? Complete Guide to Subsequent Hospital Care | Read Guide |
| CPT 99215 | What is CPT 99215? Complete Guide to High Complexity Office Visits | Read Guide |
| CPT 99203 | What is CPT 99203? Complete Guide to New Patient Office Visits | Read Guide |
| CPT 99204 | What is CPT 99204? Complete Guide to Moderate Complexity New Visits | Read Guide |
| CPT 97110 | What is CPT 97110? Complete Guide to Therapeutic Exercises | Read Guide |
| CPT 97530 | What is CPT 97530? Complete Guide to Therapeutic Activities | Read Guide |
| CPT 97140 | What is CPT 97140? Complete Guide to Manual Therapy | Read Guide |
| CPT 36415 | What is CPT 36415? Complete Guide to Routine Venipuncture | Read Guide |
| CPT 93000 | What is CPT 93000? Complete Guide to Routine ECG | Read Guide |
| CPT 99396 | What is CPT 99396? Complete Guide to Preventive Visits Age 40-64 | Read Guide |
