Federal regulation adopts the AMA's CPT codes as the standard every physician claim must use

Significant findings

Section 162.1002 of title 45 of the Code of Federal Regulations, "Medical data code sets", is the HIPAA Administrative Simplification rule that names the code sets covered entities must use in standard health care transactions.

Among the code sets it adopts is "Current Procedural Terminology, Fourth Edition (CPT-4), as maintained and distributed by the American Medical Association", in combination with the Healthcare Common Procedure Coding System, for "physician services", "physical and occupational therapy services", "radiologic procedures", "clinical laboratory tests", "other medical diagnostic procedures", "hearing and vision services", and "transportation services including ambulance". The same section adopts the "International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)" for diseases, injuries, impairments, other health problems and their causes, effective October 1, 2015.

Worth asking

The regulation is the government's, not the AMA's, and it adopted a code set that already existed rather than creating one. What it did was make a privately owned, copyrighted code set the compulsory language of every physician claim in the country, including every psychotherapy session and every psychological test billed to an insurer. The previous row shows what that is worth to the owner. The regulation says nothing about what may be charged for it, and neither does this row.