Understanding CPT Codes: A Primer for Digital Health Startups
Cameron Jacox is the founder of Rocket Digital Health, the foremost digital health scale consultancy. Go-to-market is hard in healthcare, and we believe that you don’t need to reinvent the wheel to bring your brilliant invention to market. Having helped scale 13 digital health startups, including for 4 years as Chief Growth Officer at Lark Health from Series A to Unicorn status, Cameron & his team work with select startups to bring growth strategy to bear to beat their growth goals and catch their stride.
CPT codes, or Current Procedural Terminology codes, are a standardized system of codes that are used to describe medical procedures and services. They are used by healthcare providers and payers to accurately document and bill for medical services. Understanding CPT codes is important for digital health startups that are developing products or services that are used in the healthcare industry, as they can help ensure accurate billing and reimbursement.
What are CPT codes?
CPT codes are a standardized system of codes that are used to describe medical procedures and services. They were developed by the American Medical Association (AMA) and are updated annually to reflect changes in medical technology and practice. CPT codes are used by healthcare providers and payers to accurately document and bill for medical services.
How are CPT codes used?
CPT codes are used by healthcare providers to accurately document and bill for medical procedures and services. They are typically used in conjunction with diagnostic codes, such as ICD-10 codes, which are used to describe the diagnosis or condition being treated. CPT codes are used by payers, such as insurance companies, to determine the amount of reimbursement that is due to a healthcare provider for a specific service.
What types of codes are included in the CPT code system?
The CPT code system includes a variety of codes that are used to describe different types of medical procedures and services. These codes are organized into different categories, including evaluation and management codes, surgical codes, anesthesia codes, and radiology codes.
How can digital health startups use CPT codes?
Digital health startups that are developing products or services that are used in the healthcare industry should be familiar with CPT codes and how they are used. Understanding CPT codes can help ensure that the products or services developed by a startup are accurately documented and billed for, which can be important for securing reimbursement from payers.
As medical technology and practice continue to evolve, it is important for CPT codes to be updated to accurately reflect these changes. The AMA is responsible for updating the CPT code system on an annual basis, and new codes are added to reflect advances in medical technology and practice.
One way that CPT codes are being applied to new technologies is through the use of Category III codes. Category III codes are temporary codes that are used to describe emerging technologies and procedures that do not yet have a permanent code assigned to them. These codes are used on a trial basis and are reviewed by the AMA on an annual basis to determine whether they should be made permanent or removed from the CPT code system.
Another way that CPT codes are being applied to new technologies is through the use of modifier codes. Modifier codes are used to indicate that a procedure or service was modified in some way, such as by using a new or experimental technology. Modifier codes can be added to existing CPT codes to describe the use of new technologies and help ensure accurate billing and reimbursement.
In order to bill CPT codes for telehealth services, for example, certain criteria must be met. These criteria vary depending on the specific code being billed and the payer, but may include requirements such as the use of real-time audio and video technology, the presence of a qualified healthcare provider, and the provision of services within the scope of the provider's practice.
It is important for telehealth providers to be familiar with the specific requirements for billing CPT codes for telehealth services and to ensure that these requirements are met in order to secure reimbursement from payers.