CPT - Category II Codes

Current Procedural Terminology (CPT) Category II codes contains a set of supplemental tracking codes for performance measurement and in turn decrease the need for record abstraction and chart review to minimize administrative burden on physicians, other health care professionals, hospitals and entities seeking to measure the quality of patient care. These codes do not serve any purpose in the reimbursement since the use of these codes is optional.

These codes describe clinical components only and they are never to be used as a substitute for category I codes as these codes may be typically included in the category I codes and also these codes do not have a relative value associated with them. Category II codes has an alphabetical character as the 5th digit in the series i.e., 4 digits followed by the letter F [for example initial examination of the involved joints (osteoarthritis) would be coded as 2004F] and are arranged according to the following categories derived from standard clinical documentation format:

1. Composite Measures -codes from 0001F to 0015F

2. Patient Management -codes from 0500F to 0575F

3. Patient History -codes from 1000F to 1220F

4. Physical Examination -codes from 2000F to 2050F

5. Diagnostic/Screening Processes or Results -codes from 3006F to 3573F

6. Therapeutic, Preventive or Other Interventions -codes from 4000F to 4320F

7. Follow-up or Other Outcomes -codes from 5005F to 5100F

8. Patient Safety -codes from 6005F to 6045F

9. Structural Measures -codes from 7010F to 7025F

To be noted: Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel and the CPT/HCPAC Advisory Committee. The PMAG is comprised of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organization (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement.

The release and implementation dates for Category II codes may be accessed at www.ama-assn.org/go/cpt