CPTII

CPT II codes, officially known as Category II CPT codes, are a subset of the CPT coding system created by the American Medical Association. They are supplementary tracking codes designed to capture performance data for quality measurement and improvement. Category II codes are five-character alphanumeric codes that accompany Category I CPT codes on professional claims. They are used to document that a measurable element of care was addressed during a patient encounter, such as a preventive service delivered, a screening test performed, counseling provided, or a follow-up plan arranged.

The primary purpose of CPT II codes is to facilitate data collection for quality reporting rather than to generate separate reimbursements. Using a Category II code does not typically create separate payment, but it can support payer-based quality reporting programs, incentives, or performance measures. These codes help standardize the documentation of whether evidence-based practices were followed and outcomes or processes were recorded.

CPT II codes are maintained and updated periodically by the American Medical Association. They may be used by payers to assess quality, monitor performance, and support public health reporting. Code usage can vary by payer and program, and some programs may require or specifically accept certain Category II codes for reporting.

In practice, Category II codes may be appended to the same claim line as the corresponding Category I CPT code or reported on a separate line, in accordance with payer rules. They are not intended to replace Category I codes but to augment them with structured quality data. Limitations include that not all measures have Category II codes, and acceptance can differ among payers and programs.