DEFINITION OF PROCEDURE CODES

Current Dental Terminology (CDT procedure codes)

The American Dental Association's (ADA) Code on Dental Procedures and Nomenclature is contained in the CDT-3 user guide. The maintenance of these codes is the responsibility of the Council on Dental Benefit Programs with consultation from: Blue Cross and Blue Shield Association, the Health Insurance Association of America, the Health Care Financing Association, National Electronic Information Corporation, and the American Dental Association recognized dental specialty organizations. The ADA updates the user guide approximately every five years. CDT codes are five-character, alpha-numeric configurations (e.g., D2110). Contact the American Dental Association to obtain a current copy of the CDT-3 Users Manual.

Current Procedural Terminology (CPT codes)

The American Medical Association's Physicians' Current Procedural Terminology is contained in the CPT user guide. The maintenance of these codes is the responsibility of the American Medical Association with consultation from the AMA CPT Editorial Panel, Advisory Committee, and the AMA CPT Health Care Professionals Advisory Committee. Procedure codes in the CPT user guide are reviewed and revised annually. CPT codes are five-character, all numeric configurations (e.g., 99215). Contact the American Medical Association to obtain a current copy of the CPT Users Manual.
Level II National Codes
(Health Care Financing Administration's Common Procedure Coding System [HCPCS])

The HCPCS Level II National codes are contained in the HCPCS user's guide and are published in the Federal Register. The maintenance of these codes is the responsibility of the Health Care Financing Administration. Procedure codes in the HCPCS user guide are reviewed and revised annually. HCPCS codes are five characters with one alpha and four numeric configuration (e.g., A0042). Contact any publishing company that provides medical coding reference books to obtain a current copy of the HCPCS User Manual.

Level III Medicare Local Codes*

The local Medicare carrier develops local procedure codes which are published in the local Medicare Newsletter. The maintenance of these codes is the responsibility of the local Medicare carrier. Medicare local procedure codes are all five-character configurations with the following alpha/numeric configuration: one alpha, (W, X, Y or Z) with four numeric (e.g., Y5523); and two alphas, (W, X, Y or Z) same character with three numeric (e.g., XX001). Contact your local Medicare carrier to obtain copies of the Medicare Newsletter.

OMAP Unique Procedure Codes*

OMAP's unique procedure codes are listed in the appropriate service guides. The maintenance of these codes is the responsibility of OMAP. These procedure codes are reviewed as needed and are deleted either when a program no longer exists or when other HCPCS codes are created which fully describe the service. Most of the unique codes have been created to meet the needs of specialized services or programs. OMAP's unique procedure codes are all five character configurations with the following alpha/numeric combinations: four numeric/one alpha
(e.g., 7300Y); three numeric, two alpha (e.g., 206EP); two alpha/three numeric (e.g., BA311); or three alpha/two numeric (e.g., VIS01).

* Please note: Due to HIPAA (Health Insurance Portability and Accountability Act) requirements, Medicare Local codes and OMAP Unique codes will be replaced with national standard procedure codes. This process has already begun and will continue until completion of the HIPAA requirements.