AMA and CPT Codes: A Beginner’s Guide to the Medical Billing Language

Wait, What Are All These Codes?

If you’ve ever stared at a medical bill or claim form and thought, “What do all these numbers mean?”—you’re not alone. CPT codes feel like a foreign language unless you’ve spent years in medical billing. And even then, they can be tricky.

So here’s a simple truth: understanding AMA and CPT codes can save your practice time, money, and frustration. This guide is designed to give you the basics—no confusing jargon or deep coding knowledge needed.

CPT Codes in Plain English

CPT stands for Current Procedural Terminology. Basically, it’s a big list of codes that describe medical services and procedures. Everything from a routine check-up to a complex surgery has a code attached to it.

These codes are developed and published by the American Medical Association (AMA). They’re updated every year based on changes in healthcare practices, technology, and billing requirements.

Here’s what they look like in practice:

• 99213 = 15-minute office visit
  
• 99457 = Remote patient monitoring
  
• 93000 = Electrocardiogram
  

These codes help providers tell insurance companies exactly what was done, so claims can be processed—and paid—accurately.

📎 More on CPT from the AMA

The 3 Types of CPT Codes (And Why They Matter)

CPT codes are sorted into three categories. Knowing the difference helps you bill correctly and avoid mix-ups.

1. Category I – The Basics

Used for common, approved medical procedures. This is what most providers use daily.

2. Category II – Tracking Codes

Optional and used mainly for performance reporting and quality initiatives.

3. Category III – Experimental/Temporary

Used for newer, emerging services or procedures not yet widely adopted.

Each code type plays a role in how services are tracked, billed, and reimbursed.

Why You Should Care (Even If You Don’t Do the Billing)

Here’s the thing—CPT codes impact your practice’s revenue even if someone else handles billing.

When you use the right codes:

• ✅ You get paid faster
  
• ✅ You reduce claim rejections
  
• ✅ You stay compliant with insurance and regulatory requirements
  
• ✅ You give patients clearer bills
  

And for concierge or hybrid practices, CPT codes are still useful. Even if you’re not billing insurance, you might need them for:

• Creating superbills
  
• Structuring service packages
  
• Tracking visits or services internally
  
• Supporting patients with out-of-network reimbursements
  

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CPT vs. ICD-10: Know the Difference

This part trips people up. CPT tells what was done. ICD-10 tells why it was done.

Think of it like this:

• CPT: “We did a flu shot.”
  
• ICD-10: “Because the patient needed a vaccine.”
  

Both codes go on a claim and must match up logically. If they don’t, you risk delays or denials.

Who Updates These Codes?

The AMA’s CPT Editorial Panel reviews and updates the CPT code set every year. They add, change, or remove codes to reflect new technologies, updated guidelines, and evolving patient care models.

Recent updates have included:

• Expanded telehealth codes
  
• New codes for remote monitoring
  
• Adjustments for prolonged care visits
  

Using outdated codes is one of the most common reasons claims get denied.

Common CPT Codes You’ll Actually Use

Here’s a quick cheat sheet of frequently used codes in outpatient and concierge settings:

These codes are gold when you’re building service menus, planning hybrid billing, or supporting your patients with detailed records.

Mistakes to Watch Out For

Even the best providers make coding mistakes. Here are a few we see often:

• ❌ Using outdated codes
  
• ❌ Forgetting modifiers (like -25 or -59)
  
• ❌ Billing for individual procedures that should be bundled
  
• ❌ Mismatching CPT and ICD-10 codes
  
• ❌ Overcoding (billing at a higher level than was performed)
  

These can lead to delays, underpayments, or even audits. And yes, even concierge providers can be affected—especially when patients use FSA/HSA funds or request claim support.

📎 How We Help Prevent These Errors

Real Talk: This Doesn’t Have to Be So Complicated

CPT codes are nobody’s favorite part of medicine. But the good news? You don’t need to memorize the entire codebook—you just need to understand how these codes work in your world.

At Concierge Practice Solutions, we help providers every day—especially those who feel overwhelmed by billing and just want it to work smoothly. Whether you’re new to private practice or, on the other hand, trying to clean up a messy RCM process, getting your coding right is a smart and essential place to start.

Need help decoding your CPT chaos?
👉 Reach out to our team today. We’re happy to take a look and get things on track.

What This All Means for You

At the end of the day, CPT codes bring clarity, create consistency, and help you get paid for the work you do.
Whether you’re billing insurance, supporting cash-pay patients, or offering a mix of services, having the right codes in place keeps everything running smoother.

So, if you’ve been winging it with old cheat sheets or generic software suggestions, now is the perfect time to revisit your process—and we’re here to help.