CPT Codes 2024: A Comprehensive Guide

CPT Codes 2024 is now ready to build a new roadmap for the medical coding industry. This top story of the healthcare IT industry is sparking next-level curiosity among medical coders and healthcare professionals, ending up with a number of questions from both the billers and the practitioners.

Currently, when coders are still determining whether they should resubmit their recently submitted claims by coding new CPT codes 2024 or if they are good to go, the practitioners are also worried about the effectiveness of these recent changes in CPT codes 2024.

Besides these concerns, what matters is whether your practice is prepared to implement CPT codes 2024 or still in the preparatory phase?  Does your medical coding company comply with these medical coding standards of the CPT 2024 code set?

This blog is exclusively written to sort out these concerns and upgrade your medical coding knowledge about the CPT 2024 code set released by AMA. Let’s skim through the most significant and major changes that CPT codes set bring along. Moreover, we will look into the guidelines proposed by the American Medical Association with respect to CPT codes 2024 categories ( I. II. III. ).

Significant Changes in CPT Codes 2024

According to an AMA news release, there are 230 new codes, 49 deletions, and 70 revisions in the 2024 CPT code set. The upcoming 2024 version of medical codes is a significant development in healthcare. It includes Spanish language descriptors for medical procedures and services, benefiting approximately 41 million Spanish-speaking individuals in the United States.

This groundbreaking update will provide patients with clear and concise descriptions of medical procedures and services, thereby eliminating language barriers and enhancing their ability to engage in their own care. Lori Prestesater, AMA senior vice president of health solutions, regards this pivotal step as transformative in creating a more inclusive healthcare environment. 

List of Changes In CPT 2024 Code Set

Here is a detailed list of the CPT codes 2024 that have been changed or deleted according to a recent update:

Changed

Here is a list of CPT Code sets that are replaced with updated CPT Codes 2024:

• 99217-99220: Hospital observation services (replaced by new codes 99315-99318)
• 99241: Office consultation (replaced by new codes 99315-99318)
• 99251: Inpatient consultation (replaced by new codes 99315-99318)

Deleted

Some significant codes deleted in the CPT Codes 2024 updated version:

• 49652-49657: Laparoscopy codes
• 99217-99220: Hospital observation services
• 99241: Office consultation
• 99251: Inpatient consultation
• 99318: Other nursing facility services
• 99324-99328: Custodial care codes for new and established patients in domiciliary, rest home, or home care plan oversight settings
• 99334-99337: Custodial care codes for new and established patients in nursing facilities
• 99339-99340: Domiciliary, rest home, or home care plan oversight
• 99343: Home visits involving new patients
• 99354-99357: Prolonged services add-on codes

PLA CPT Codes 2024 Changes 

According to  AMA, the following are some of the changes to CPT PLA codes for 2024:

New Codes

• 0420U-0438U: A series of new codes for proprietary laboratory analyses (CPT PLA CODES 2024 ) related to illnesses such as cancer, cardiovascular disease, and infectious disease.

Revised Codes

• 0351U: Revision of the code descriptor for Tyrosinemia Follow-Up Panel, Self-Collect, Blood Spot, Mayo Clinic, and Laboratory Developed Test to include more specific information about the test.
• 0356U: Revision of the code descriptor for Nephrology (chronic kidney disease) to include more specific information about the test and to add the term “quantitative” to the Descriptor.

Deleted Codes

• 0066U: PartoSureTM Test, Parsagen Diagnostics, Inc, Parsagen Diagnostics, Inc, a QIAGEN Company.

In addition to these changes, the CPT PLA code set is also being updated to include a new duplicate PLA test symbol and parenthetical note to code 0345U, as well as a correction of the abbreviation CAD to CHD for coronary heart disease in the Descriptor for code 0401U.

These changes should be communicated to providers and updated accordingly.

Additional Changes In CPT 2024 Code Set

• The new hospital observation services codes (99315-99318) are based on the amount of time and resources spent providing care to the patient.
• The new office consultation codes (99315-99318) are based on the complexity of the patient’s case and the amount of time spent with the patient.
• The new inpatient consultation codes (99315-99318) are based on the complexity of the patient’s case and the amount of time spent with the patient.
• The custodial care codes (99324-99337) have been deleted because they are no longer used.
• The home visits involving the new patient code (99343) have been deleted because it is no longer used.
• The prolonged services add-on codes (99354-99357) have been deleted because they are no longer used.

Changes Regarding COVID-19 Immunization Reporting Process

The major changes have been made in recently updated CPT codes 2024 to streamline the COVID-19 immunization reporting process. The three most prominent changes have been made:

1. Consolidating more than 50 previous immunization reporting codes into 17 (91300-91317)
2. The new code (90480) for reporting the administration of any COVID-19 vaccine for any patient. 
3. Replaced all previously approved specific vaccine administration codes.

By simplifying the COVID-19 immunization reporting process, healthcare providers can efficiently track and report vaccine administration, contributing to a seamless and effective immunization program.

Descriptor Revisions About Time: CPT Codes 2024

You’ll be happy to know that the changes made by CPT to the evaluation and management (E/M) codes and guidelines in the past few years are extensive. However, the E/M updates in CPT Codes 2024 are minimal, which may seem insignificant, but they still hold importance. 

Changes W.r.t. Time

According to the CPT Codes 2024 update, it has been announced that it will replace the time ranges for new and established office/outpatient E/M codes with a single total time amount. This total time amount will be the minimum number of minutes currently specified in the range for each code. The new wording in each code’s Descriptor states that this time “must be met or exceeded.”

For example, 99202 Office or another outpatient visit for evaluating and managing a new patient, which requires a medically appropriate history or examination and straightforward medical decision-making, has a current time range of 15-29 minutes. 

Beginning Jan. 1, 2024, the provider must meet or exceed 15 minutes of total service time before you can bill this code by time.

General Criteria for Category I and Category III of CPT Codes 2024

Following are the general criteria for Category I and Category III proposed by the American Medical Associaton according to their latest update guidelines: 

• The Descriptor of the CPT 2024 code set should be understandable , unique, and specific to describe and distinguish the service procedure from existing procedures and services in CPT.
• The structure guidelines, descriptors, and instructions remain compatible with existing editorial panel standards to maintain the CPT 2024 code set.
• Note that the proposed descriptor structure for both services or procedures will be neither a fragmentation of an existing procedure or service nor currently reportable as a complete service by one or more existing codes, excluding unlisted codes. 

Staying up-to-date is pivotal in the constantly evolving world of procedures and services. That’s why new or revised codes are often necessary to ensure accuracy and efficiency. Don’t let outdated codes slow you down – stay proactive and adaptable by implementing the latest codes.

CPT code descriptors are not used to report extraordinary circumstances related to the performance of a procedure or service already described in the CPT code set. A procedure or service must meet specific category criteria to qualify for a CPT code.

Specific Criteria for Category I Codes of CPT Codes 2024 

According to AMA, Category I CPT codes are used to report procedures and services that are

• Performed frequently by many physicians or other healthcare professionals across the United States
• Consistent with current medical practice
• Clinically efficacious and documented in the literature
• Category I CPT codes are not used to report extraordinary circumstances related to the performance of a procedure or service already described in the CPT code set.

To be eligible for a new Category, I CPT code 2024, a procedure or service must satisfy all of the following criteria:

• Devices and drugs necessary to perform the procedure or service must have received FDA clearance or approval when such is required.
• The procedure or service must be performed frequently, consistent with the intended clinical use.
• In order to be considered safe, the procedure or service must comply with current medical standards.
• A procedure or service’s clinical efficacy must be documented in the literature and meet the criteria set forth in the application for a CPT code change.

Specific Criteria for Category III CPT Codes of CPT Codes 2024

According to American Medical Association guidelines, the CPT/HCPAC Advisory Committee and CPT Editorial Panel evaluate applications for Category III codes based on the following criteria:

1. The first and most significant criteria is that the procedure or service should be recently performed or recently performed in humans.

Along with the above-mentioned major criteria, here are some additional criteria. Note that meeting at least one of the following criteria is mandatory.

• Support from at least one CPT or HCPAC Advisor representing practitioners who would use the procedure or service.
• Evidence of the actual or potential clinical efficacy of the procedure or service, supported by peer-reviewed literature available in English for examination by the CPT Editorial Panel.
• At least one Institutional Review Board (IRB)-approved protocol of a study of the procedure or service being performed.
• A description of a current and ongoing United States trial outlining the efficacy of the procedure or service.
• Other evidence of evolving clinical utilization.

Key Takeaways

To get a CPT code for a new procedure or service, you need to show that:

• It is used by doctors and other healthcare professionals.
• There is evidence that it works.
• It is being used in the United States.

Expected Impact After Implementation of CPT Code 2024 

Let us look at the impact of CPT Code implementation on providers and patients.

Impact on Providers

Providers should be aware of the changes to CPT codes 2024 and update their billing systems accordingly. They should also review their billing practices to ensure compliance with the new codes.

Impact on Patients

Patients may be affected by the changes to CPT codes 2024 if their insurance providers change their coverage policies. Patients should contact their insurance providers to learn more about how the changes may affect them.