How to Use CPT® Codes for Medical Billing

Note: The Medical Billing module must be activated for the CPT codes to be visible.

Just as CDT codes are used for billing dental insurance, Current Procedural Terminology (CPT®) codes are required for billing medical insurance. If your practice uses Sensei Cloud's Medical Billing feature, your Procedure definitions provide a place to enter a corresponding CPT code, enabling these procedures to be included on Medical Billing claims whenever they are completed.

When a CPT code has been added to a procedure code, the CPT code and description can be used to search for a code when scheduling, planning, or posting, in addition to the other associated criteria.

Note: Only CPT-only and CPT cross-coded procedures are billable to medical plans. If a claim contains a combination of billable procedures that are CDT-only and cross-coded with CPT codes, only the cross-coded or CPT-only procedures are included on the medical claim, unless alternate billing is enabled for the procedure code and the insurance plan. See How to Bill a Dental Procedure (CDT) Code on a Medical Claim for more information.

To associate procedures with CPT codes:

1. From the Administration tab, select Procedures & Fees > Procedure List & Fee Schedule.
   The Procedure List and Fee Schedule is displayed listing all the procedures for the Practice, with the Office Code and Description for each, CDT Code and Nomenclature, CPT Code and Description, Treatment Type, as well as the Status, Recare status, T/S/Q, Total Number of Minutes, and the Fees.
   
   - Click the column heads to sort by column.
   - Use the Search field to find a procedure.
   - Filter the list by Treatment Types.
2. Select a code in the list. The Update Procedure window is displayed for the code.
   
3. Use the CPT Code field to search for the appropriate medical cross-code. Note: You can search by code number or description, using a minimum of three characters for the search.
   The CPT Code and full Description are displayed.
4. Make any other necessary changes to the code.
5. Click Update. 

Note: No default medical procedures are provided, but you can add them by creating new procedures, and then linking them to a CPT code instead of a CDT code, and selecting the appropriate Treatment Type. For more information, see How to Create or Edit a Procedure Code.

Supported CPT Codes

For practices using the Medical Billing feature, Sensei Cloud currently supports the use of the Category I subset of AMA CPT codes. 

The 6 main sections of CPT Category I codes are:

• Evaluation & Management Services (99201 – 99499)
• Anesthesia Services (01000 – 01999)
• Surgery (10021 – 69990) – further broken into body area or system within this code range
• Radiology Services (70010 – 79999)
• Pathology and Laboratory Services (80047 – 89398)
• Medical Services and Procedures (90281 – 99607)

Example:

The following chart is an example of the typical mapping of commonly-aligned codes.

Important: You should always consult clinical professionals for advice on the most appropriate CPT codes for mapping.

For more information, see Sensei Cloud Medical Billing.