How are CPT codes used in medical billing?

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CPT codes (Current Procedural Terminology codes) are a standardized set of medical codes used in the United States to describe medical, surgical, and diagnostic services. They play a critical role in medical billing by helping healthcare providers communicate with insurance companies, Medicare, and other payers.

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🔹 What Are CPT Codes?

• Developed by the American Medical Association (AMA).

• Each CPT code is a 5-digit numeric code (e.g., 99213 for an office visit).

• Codes represent specific procedures or services performed by a healthcare provider.

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🔹 How CPT Codes Are Used in Medical Billing:

1. Service Documentation
   When a healthcare provider performs a service (e.g., a check-up, surgery, lab test), it’s documented in the patient’s record.

2. Code Assignment
   The provider or medical coder assigns a CPT code that best describes the service provided.

3. Claim Submission
   The CPT code is included in a medical claim submitted to the insurance company.

4. Reimbursement
   The insurance company reviews the CPT codes and determines how much to pay the provider based on their contract and the patient’s coverage.

5. Billing Patients
   If any part of the service isn’t covered, the remaining balance may be billed to the patient.

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