BCBS CPT Classifications

Current Procedural Terminology (CPT) is used in medical billing to report medical services and procedures performed. Commonly referred to as the CPT Codebook, CPT codes are a series of numbers given to hospitals and insurance providers by the American Medical Association (AMA) that represent various services offered by hospitals. Instead of writing the entire procedure on a bill, hospitals only need to input the CPT code associated with the procedure to receive payment. While Blue Cross Blue Shield has hundreds of CPT codes, all of the codes fall under three categorical classifications.

Category I

• Category I CPT classifications are numeric codes that represent procedures consistent with contemporary medical practice. Such procedures are widely performed and are approved by the Food and Drug Administration (FDA). In addition, Category I procedures have documented evidence of clinical efficacy. Examples of such procedure include X-rays, urine samples, EKGs and open heart surgery. While some services are more serious than others, all of these procedures have a track record of efficiency and are practiced in medical offices nationwide.

Category II

• While Category I codes are used for billing purposes, the primary purpose of CPT Category II codes is to measure the performance of new technologies and practicing methods. Category II codes essentially serve as filters that weed out ineffective procedures while encouraging new and innovative ideas in medical practice.

Category III

• Category III codes are temporary classifications given to emerging medical procedures and practices. Procedures falling under this classification do not require an established track record of clinical efficacy or approval from the Food and Drug Administration, but do require development and constant involvement in research. The primary purpose of Category III codes is to identify services that may not be performed by many health care professionals and assist researchers in establishing widespread usage and clinical efficacy of new techniques.

BCBS Example

• Blue Cross Blue Shield customers can find an array of CPT codes at the company's website. Such codes cover a variety of services from oxygen to injections. Blue Cross Blue Shield of Texas, for instance, uses CPT codes to classify imaging services that encompass heart, abdomen and chest examinations along with cervical, pelvis and spine imaging. It is important for BCBS customers to be aware of the CPT codes for their state because Blue Cross Blue Shield will not remit payment for unclassified procedures.