License For Use Of Physicians’ Current Procedural Terminology, Fourth Edition ("CPT®")
CPT codes, descriptions and other data only are copyright 1995-2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt.
Applicable FARS\DFARS Restrictions Apply to Government Use.
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AMA Disclaimer of Warranties and Liabilities.
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.
The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
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This look-up tool is populated from the Physician and Other Supplier Public Use File (PUF). While the Physician and Other Supplier PUF has a wealth of information on payment and utilization for Medicare Part B services, the dataset has a number of limitations:
- The tool only describes care delivered to Medicare beneficiaries in the fee-for-service program and, as a result, may not represent a provider’s entire practice. Providers may also see patients enrolled in Medicare Advantage, those with Medicaid coverage or private health insurance, or those who are uninsured.
- The tool does not provide any information on the quality of care delivered by providers.
- The information in the tool does not account for differences in the sickness of patients treated by different providers.
- Medicare pays differently when services are provided in a physician’s office versus a facility (e.g., a hospital outpatient department). For services furnished in an office setting, this tool presents the full payment. However, if a service or procedure was furnished in a facility setting, in most cases, this data only includes the payment to the provider and not the payment to the facility.
- In general, when a provider administers drugs to a patient, the provider purchases the drug and Medicare pays the provider 106% of the average sales price (ASP) for the drug.
- The way CMS counts services may differ by HCPCS code. For example, if the Number of Services is 2 this may reflect two separate procedures, two 15 minute increments of a service (e.g., a 30 minute office visit), or the delivery of two units of a drug.