CPT codes
CPT (Current Procedural Terminology) codes are the five-digit codes maintained by the American Medical Association that describe medical services and procedures — the universal language of billing for what was done.
- Maintained and licensed by the American Medical Association
- E/M codes (99202–99215) cover most visit types
- Modifier 95 marks synchronous telehealth delivery
- Required on superbills even in cash-pay programs
How CPT codes work
Every billable act maps to a code: office visits and telehealth encounters live in the evaluation-and-management (E/M) range like 99202–99215, labs and procedures have their own series, and modifiers append context — modifier 95 marks a service delivered via synchronous telehealth. Payers price contracts, adjudicate claims, and audit care against these codes.
Why cash-pay programs still need CPT
No claims does not mean no codes. Superbills require CPT codes for patients to seek reimbursement, HSA/FSA substantiation leans on them, and the moment a program adds payers or employer deals, its services must already be expressed in CPT. Getting encounter-to-code mapping right early — even when nobody is billing — keeps every later door open.
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Frequently asked questions
Who assigns the CPT code for a visit?
The clinician or the billing layer acting on their documentation — the code must match what the note supports.
Do telehealth visits have special CPT codes?
Mostly they use standard E/M codes with telehealth modifiers and place-of-service codes; a handful of telehealth-specific codes also exist.
Are CPT codes free to use?
The code set is AMA-licensed; software vendors typically carry the license. Individual superbills and claims use codes freely in practice.