CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.0.0 - STU1

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 1.0.0). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

ValueSet: Current Procedural Terminology (CPT) - Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes - Procedure Modifier Codes

Summary

Defining URL:http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers
Version:1.0.0
Name:AMACPTCMSHCPCSModifiers
Title:Current Procedural Terminology (CPT) - Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes - Procedure Modifier Codes
Status:Active as of 2020-11-23T16:49:10+00:00
Definition:

The Value Set is a combination of two Code Systems: CPT (HCPCS I) and HCPCS II procedure code modifiers. Modifiers help further describe a procedure code without changing its definition.

The target set for this value set are the procedure code modifiers from the CPT and HCPCS files.

The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.

Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.

All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.

There are various types of CPT codes:

Category I: These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.

Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.

Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.

Proprietary Laboratory Analyses (PLA) codes: Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).

To obtain CPT, please see the license request form here

The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.

General information can be found here: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo

Releases can be found here: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets

These files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.

Publisher:HL7 Financial Management Working Group
Copyright:

CPT is copyrighted by the AMA and as such must be licensed to be used in electronic products or other forms.

Any individual or entity using CPT content needs permission or a license (i.e., a written agreement authorizing use of CPT codes) from the AMA or an authorized distributor.

Examples where a license and royalty payment are required (not an exhaustive list):

  • Use of CPT content to develop, test, maintain, and service products that use or rely on CPT
  • Use of CPT content in products that are licensed or distributed by a vendor, company or other third party
  • Distribution of products that require use of CPT content
  • Any proposed use of CPT content including the creation of derivative works of CPT content, translations or localized versions of CPT content

For more information see here

If you have a question or would like to license CPT content, please see here.

Any HL7 product referencing CPT must include the following verbiage:

CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.

Note: the year is always based on the publication year of the code set. CPT releases the August prior to the effective year (e.g., CPT 2020 code set = copyright 2019 or CPT 2021 code set = copyright 2020).

See information on the use of HCPCS Level I (proprietary and owned by American Medical Association) and Level II codes here

Source Resource:XML / JSON / Turtle

References

Logical Definition (CLD)

This value set includes codes based on the following rules:

 

Expansion

This value set contains 0 concepts

CodeSystemDisplay

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code