CMS Pub. 100-04, ch. 23, § 20.1

There are over 7,000 service codes, plus titles and modifiers, in the CPT-4 section of HCPCS, which is

copyrighted by the AMA. The AMA and CMS have entered into an agreement that permits the use of

HCPCS codes and describes the manner in which they may be used. See §20.7 below.

• The AMA permits CMS, its agents, and other entities participating in programs administered by

CMS to use CPT-4 codes/modifiers and terminology as part of HCPCS;

• CMS shall adopt and use CPT-4 in connection with HCPCS for the purpose of reporting services

under Medicare and Medicaid;

• CMS agrees to include a statement in HCPCS that participants are authorized to use the copies of

CPT-4 material in HCPCS only for purposes directly related to participating in CMS programs, and

that permission for any other use must be obtained from the AMA;

• HCPCS shall be prepared in format(s) approved in writing by the AMA, which include(s)

appropriate notice(s) to indicate that CPT-4 is copyrighted material of the AMA;

• Both the AMA and CMS will encourage health insurance organizations to adopt CPT-4 for the

reporting of physicians’ services in order to achieve the widest possible acceptance of the system and

the uniformity of services reporting;

• The AMA recognizes that CMS and other users of CPT-4 may not provide payment under their

programs for certain procedures identified in CPT-4. Accordingly, CMS and other health insurance

organizations may independently establish policies and procedures governing the manner in which

the codes are used within their operations; and

• The AMA’s CPT-4 Editorial Panel has the sole responsibility to revise, update, or modify CPT-4

codes.

The AMA updates and republishes CPT-4 annually and provides CMS with the updated data. The CMS

updates the alpha-numeric (Level II) portion of HCPCS and incorporates the updated AMA material to

create the HCPCS code file. The CMS provides the file to A/B MACs (A), (B), (HHH), and DME MACs

and Medicaid State agencies. The file is also available via the CMS website.

It is the MAC’s responsibility to develop payment screens and limits within Federal guidelines and to

implement CMS’ issuances. The coding system is one of the tools used to achieve national consistency in

claims processing.

MACs may edit and abridge CPT-4 terminology within their claims processing area. However, MACs are

not allowed to publish, edit, or abridge versions of CPT-4 for distribution outside of the claims processing

structure. This would violate copyright laws. MACs may furnish providers/suppliers AMA and CMS

Internet addresses, and may issue newsletters with codes and approved narrative descriptions that instruct

physicians, suppliers and providers on the use of certain codes/modifiers when reporting services on claims

forms, e.g., need for documentation of services, handling of unusual circumstances. The CMS

acknowledges that CPT is a trademark of the AMA, and the newsletter must show the following statement in

close proximity to listed codes and descriptors:

"CPT Copyright 2017 American Medical Association. All rights reserved.

CPT® is a registered trademark of the American Medical Association."

(Please note that the use or reprinting of CPT content in any product or publication requires a

license. For more information about the licenses available, see CPT License Information.)

Applicable FARS/DFARS Restrictions Apply to Government Use

Fee schedules, relative value units, conversion factors and/or related components are not

assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The

AMA does not directly or indirectly practice medicine or dispense medical services. The

AMA assumes no liability for data contained or not contained herein.

If only a small portion of the terminology is used, MACs do not need to show the copyright legend. MACs

may also print the code and approved narrative description in development requests relating to individual

cases.

The CMS provides MACs a quarterly update file of HCPCS codes and instructions to retrieve the update via

CMS mainframe telecommunication system.