How CPT code set’s public process helps health innovation thrive

Often called “the language of medicine,” the Current Procedural Terminology (CPT^®) code set is the foundation for how the provision of care is described and reported across the health care ecosystem. Representatives from medical specialty societies, health insurers, medical coders and government agencies are meeting this week in Chicago to facilitate the path between medical innovation, payment and physician adoption.

These experts are coming together to attend a meeting of the CPT Editorial Panel, during which applications for updates to the CPT code set will be deliberated. The public agenda (PDF) highlights the nearly 100 code change applications that were received for the Panel meeting, including the code(s) affected and a brief description of the request. 

The CPT Editorial Panel is an independent body of 21 volunteer physicians and other qualified health care professionals appointed by the AMA Board of Trustees. Operating autonomously and prioritizing openness and transparency, the Panel collects broad input from stakeholders across the health care community to ensure CPT content reflects the coding and data-driven demands of a modern health care system. 

The CPT Editorial Panel is supported by more than 200 advisers who are nominated by specialty societies. The Centers for Medicare & Medicaid Services (CMS) has an advisory role on the Panel, and representatives from the Food and Drug Administration and the Centers for Disease Control and Prevention were recently invited to the table in nonvoting seats.

The AMA plays a pivotal role as a convener, ensuring that diverse perspectives inform the development of the code set. CPT codes are defined through a process that plays out at three hybrid meetings every year. Over 1,000 people attend the meetings on average, in-person and online.

The CPT process is open and transparent. Anyone can attend a CPT Editorial Panel meeting and anyone can submit a code-change application.

Providing needed evidence

Once a code-change application is received, the CPT Editorial Panel members review all applications against certain criteria, such as having sufficient published literature to document the value and the medical appropriateness of whatever the procedure is that is being discussed. 

Having that sufficient level of evidence is critical because that is what helps to drive physician adoption. For physicians, a key consideration is whether an innovation will benefit patients, and that is where the evidence comes into play.

The evidence also matters to payers who independently review the clinical evidence for each procedure or service that may receive coverage. This is why CPT codes, especially Category I codes, are often considered the first step on the path to payment and patient access.

“They look to the Panel to do that first level of filtering,” said Barbara Levy, MD, vice chair of the CPT Editorial Panel.  “And just because you get a code does not mean that either CMS or private payers will necessarily pay for the procedure. It’s the first step. It’s not the only step.”

Category III CPT codes, on the other hand, require less evidence for adoption and are generally used to track the use of new services or procedures.

“They’re extremely helpful for new companies to be able to look at that adoption and to say: Here’s the evidence that lots of people are using this, and here’s the patient population who feels this is really helpful,” Dr. Levy said. “The codes provide the structure to be able to follow adoption of new technology over time.”

In addition to facilitating innovation of digital health tools, CPT codes are foundational to value-based care models because they account for the medical services and procedures that physicians and qualified health professionals deliver to patients. By capturing and communicating data associated with cost and quality measures, digitally enabled care and emerging technologies, and coordination of patient care, the CPT code set supports new and novel care delivery models. 

Following the September meeting, the CPT Editorial Panel’s next meeting will be Feb. 5–7, 2026, in Palm Springs, California. 

To stay current with the CPT code set, register to attend a CPT Editorial Panel meeting and view actions that the CPT Editorial Panel has taken on code applications on the AMA website.