CPT Code Master File
CPT (Current Procedural Terminology) codes are standardized procedure codes maintained by the American Medical Association that describe medical services and procedures. In a clinical laboratory, they serve as the universal language for identifying and billing laboratory tests.
How labs use CPT codes
- Ordering to resulting: Map each test (or test component) in the LIS to its appropriate CPT code(s).
- Claim creation: Transmit CPT codes with units and modifiers on claims, paired with ICD‑10‑CM diagnoses that justify medical necessity.
- Panel and reflex logic: Apply panel billing rules and reflex algorithms so claims reflect what was actually performed and what policy allows.
📘 Instructions
- Complete all required fields
- Price: The default charge amount for each procedure. This value may be overridden by payer contracts, price schedules, or billing rules.
- POS and TOS: Place of Service and Type of Service are typically configured at the Bill Type level. When exceptions apply, set POS (and TOS, if needed) at the CPT-code level to override the default for specific procedures.
For additional information speak to one of our support specialists.
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