On this page
- CPT Codes
HCET Home > On-line Training > Money Matters > CPT Codes
2. CPT CodesCPT codes are vital elements in determining costs and maximizing reimbursement. Current Procedure Terminology (CPT) of the American Medical Association is a listing of descriptive terms and five‑digit numeric identifying codes (and modifiers) for reporting medical services. Appropriate coding is based on GOOD documentation. Note that:
- Wisconsin providers, since January 2003, have had performance-based contracts that require the counting of patients receiving services with the use of CPT and ICD-9 codes
- Wisconsin's Medicaid Family Planning Waiver also facilitates reimbursement with this coding and classification system
- for reference
- as a basis for documentation of diagnostic procedures performed
- to facilitate financial and patient record keeping
- Detail of the history
- Comprehensiveness of the exam
- Complexity of the decision making
- Presenting problem
- Counseling/coordination of care
- Face-to-face time with the patient and/or family
- E/M guidelines focus on office visits by new and established patients
- CPT 99201-99205 for new (initial) clients
- CPT 99211-99215 for established clients
- CPT 99203 is probably the most accurate for family planning providers to use for a comprehensive initial visit
- One of the examples for this code is "initial visit for 21-year-old female desiring counseling and evaluation of the initiation of contraception"
- Programs may also decide to use the E/M Preventive Services codes for routine family planning visits
- These codes are age-based for new and established clients
- Family planning programs would, generally, use:
- Codes 99384-99386 (new) covering clients from 12-64 years of age.
- Codes 99394-99396 (established) covering clients from 12-64 years of age.
| Initial | 99203 |
| Annual | 99214 |
| Intermediate | 99213 |
| Brief | 99212 |
| Supply | 99211 |
| Counseling | 99401 |
