Shopping for Affordable Healthcare: What’s a CPT Code? Why Does the CPT Code Matter?

Here at MyHealthCafe.com, we’re big advocates for shopping around for the most affordable healthcare, and today’s tip is yet another tool that you can use to help you compare pricing between different medical providers.

Now of course, if you’re in the middle of medical emergency, we absolutely do not suggest that you stop to shop around for which emergency room can take care of you most affordably. But if you have the luxury of little time before you need your procedure or treatment, we suggest that you at least ask around with a few different doctors and/or hospitals to find out whether you can find more affordable medical care. This is especially important if you’re uninsured or only have high-deductible health insurance, since you’ll be paying for all or most of your healthcare yourself instead of having health insurance pay for most of it.

But how will you know if you’re comparing the same procedures while you’re shopping around? Is a “hip replacement” always a hip replacement when some doctors or hospitals may bundle services under one price tag and others may charge separately for individual services in a procedure?
That’s where the “Current Procedural Terminology Code” (usually called the “CPT Code”) comes in. The CPT code is an alphanumeric code, usually five digits, which is used to refer to medical services and procedures. If you are on Medicare, the codes may be referred to as HCPCS codes, but from the patient perspective, they are essentially the same.

A CPT code is assigned every medical service and procedure performed, and because CPT codes are used by healthcare providers to bill insurers, they are uniform. A service which has a CPT code of 99213 will be the same for every single medical provider across the country, so if you’re shopping around for the more affordable price and are able to refer to a CPT code for what you need, you will be able to do a real apples to apples comparison. (The 99213 CPT code refers to a general check-up, by the way.)

So if a doctor or other medical provider recommends a service or procedure for you, and you’d like to shop around, make sure that you get the CPT code(s) for whatever he or she is recommending. If you cannot get the CPT code(s) from your doctor or hospital, you may also be able to look it up at the American Medical Association website, using their CPT Code Catalog. However you get it, though, using the CPT code can make shopping around that much easier!

Have you been shopping around for affordable medical care lately? Tell us about it!

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