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Latest CPT Coding Changes & Updates in 2021

What is so distinctive about these CPT codes, and why do they play a prominent role in the DME medical billing and coding process? CPT stands for Current Procedural Terminology, which is a specific numeric code that is individually assigned to each and every medical professional’s treatment given to a patient.

These numeric codes are assigned to cover all types of individual treatment for all types of facilities such as dental, surgical, and laboratory.

These CPT codes are commonly used for insurers to assess and announce the sum of compensation that a provider earns for a specific benefit. It will be useful to note that both CPT and HCPCS are health codes that have different roles. In general, DME billing uses CPT codes, while Medicare uses HCPCS codes.

How to interpret the CPT codes?

A CPT code exists as a 5-digit code, usually in integer digits, and may also occur in alpha-numeric values. The CPT code differs based on the explanations for what you are saying. There are various basic CPT codes required for a doctor’s day-to-day tasks, such as general tests.

The American Medical Association holds and still retains the complete copyrights on certain CPT documents. The CPT codes keep revising as new technologies are added, and new regulations often substitute outdated codes.

Depending on the service you offer, the payout value can differ, and even arrangements with insurers and private companies can often affect the value. CPT codes have various definitions to make things easier and understandable, which contain the following:

Category 1 covers equipment and medicines, along with vaccination.

Category 2 comprises success metrics and standard of care.

Category 3 comprises facilities and treatments that incorporate innovations.

Category 4utilizes PLA codes, which come in alpha-numeric and are used for laboratory research.

Using the CPT codes appropriately

CPT codes significantly affect how much a consumer spends on doctors visits, medicines, and other care services. Based on these variables, the AMA specifically generates and practices CPT codes. The CPT coding phase is usually performed by qualified and competent medical billing and coding service providers to ensure that protocols are correctly implemented.

Initial Coding

There are two methods that doctors practice to begin the procedure of medical coding. They input the code manually into an electronic health record (EHR) and type it into the system by marking the code with the aid of the facility’s name.

Verification & Submission

Documents are examined, checked, and finally allocated with the right codes by your doctor. Finally, the company’s accounting section submits a summary of the benefits you have been paying to the provider.

Processing of Claim

CPT codes are relevant for handling the application, as your insurer needs them. Based on the codes, the payout is entirely contingent because, at this point, the insurance can determine how much to compensate the doctor and how much to reimburse the patient.


Insurance providers and federal figures use coding details to forecast potential health insurance expenses or rates on their customers. Furthermore, the increase in medical coding may be monitored by the extensive study.

Where to look for CPT codes

Wherever you need documents when moving to your health history, you will use CPT codes. CPT codes will also be used in the discharge documents issued by your doctor. CPT codes may also be used in your doctor’s medical or service bills to clarify your insurance’s advantages.

Summary of the SARS-CoV-2 related CPT codes

Looking at the overview of the SARS-CoV-2 based CPT codes accepted and released for the 2021 CPT code package.

  • Accepted insertion of code 87635 for disclosing nucleic acid (DNA or RNA) infectious agent detection; extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), intensified probe procedure.


  • Supported revision of code 86318 for reporting immunoassay for contagious antibody and parenting of code 86328; extension of code 86328 for reporting single-step antibody testing for extreme acute respiratory syndrome coronavirus 2; Added infant code 86769 to track multiple-step antibody monitoring for extreme acute respiratory syndrome coronavirus 2; and updated Immunology Recommendations.
  • Authorized addition of PLA code 0202U to the BioFire ® Respiratory Panel 2.1 (RP2.1) test study.


  • Authorized extension of code 87426 to the documentation of infectious agent antigen identification by SARS-CoV and SARS-CoV-2 immunoassay techniques. Besides, two new PLA codes (0223U and 0224U) for SARS-CoV-2 identification were approved.

Codes 86408 to report coronavirus 2 (SARS-CoV-2) to neutralize the antibody panel and 86409 to report coronavirus 2 (SARS-CoV-2) to neutralize the antibody titer were approved.


CPT codes are not difficult, to understand.  The distinction of ICD codes helps aid in the understanding.  . GreenSense Billing is available to help with any scenario of your coding and billing processes.  Contact our team of billing professionals directly to outsource your billing.

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  1. Kathleen Anderson

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    1. Admin

      Thank you for your message we provide multiple services within the billing domain including Workers compensation, PI, Commercial etc. If you are looking for a fulltime dedicated resource we have a standard charge moreover if you are inquiring about the charges per bill it varies depending on the category and the parties you want us to serve the bills for complete details please email our head of marketing Aneeq Servar (