What Is the American Medical Association (AMA)?
The American Medical Association (AMA) is a national organization that represents physicians and develops the Current Procedural Terminology (CPT®) code set used to report medical procedures and services. The AMA reviews and updates CPT® codes annually to reflect changes in healthcare. For medical billing and coding professionals, AMA is essential because CPT® codes help ensure accurate claim submission, clear communication with insurance companies, and proper reimbursement.
Goals of the American Medical Association (AMA)
The AMA works to improve healthcare by supporting physicians, advancing medical practice, and maintaining standardized medical coding used throughout the healthcare industry.
Develop Standardized CPT® Codes
Maintain a consistent coding system that accurately describes medical procedures and services.
Support Accurate Medical Billing
Help healthcare providers and insurance companies communicate using standardized procedure codes.
Improve Healthcare Quality
Support initiatives that improve patient care, medical education, and clinical practice.
Advance Medical Innovation
Update CPT codes to reflect new medical procedures, technologies, and treatment methods.
Promote Consistency Across Healthcare
Provide a standardized language that helps reduce coding errors and improve claim processing.
How the American Medical Association (AMA) Supports Medical Billing
The US healthcare system involves multiple organizations working together to deliver patient care and process healthcare payments. The journey begins when a patient needs medical care and ends when the healthcare provider receives reimbursement and the patient’s financial responsibility is determined.
Patient Receives Medical Services
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Provider Documents the Visit
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Medical Coder Reviews Documentation
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Select Appropriate CPT® Code
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Medical Claim Created
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Claim Submitted to Insurance
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Insurance Reviews CPT® Codes
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Claim Adjudication
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Payment Determination
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Provider Receives Reimbursement
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Account Closed
Key Resources Provided by the AMA
The AMA develops and maintains several resources that help healthcare professionals accurately document, code, and report medical services. These resources improve consistency, support reimbursement, and reduce coding errors.
CPT® Code Set
A standardized code set used to report medical procedures and professional services performed by healthcare providers.
CPT® Professional Edition
The official annual CPT code book containing complete procedure codes, guidelines, modifiers, and coding instructions.
CPT® Code Updates
Every year, the AMA publishes new, revised, and deleted CPT codes to reflect advances in medical practice and technology.
CPT® Coding Guidelines
Official instructions that explain how CPT codes should be selected and reported correctly.
Educational Resources
The AMA provides educational materials, webinars, and coding guidance to help healthcare professionals understand CPT coding changes.
CPT® Editorial Process
The AMA works with physicians, specialty societies, and healthcare experts to review requests for new or revised CPT codes before publication.
Essential AMA Terms
| Term | Simple Definition |
|---|---|
| AMA | American Medical Association, the organization that develops and maintains CPT® codes. |
| CPT® | Current Procedural Terminology used to report medical procedures and services. |
| CPT Code | A five-digit code that describes a medical procedure or professional service. |
| Category I Codes | Standard CPT codes used for widely performed medical procedures and services. |
| Category II Codes | Optional codes used for performance measurement and quality reporting. |
| Category III Codes | Temporary codes for emerging technologies and new medical procedures. |
| Modifier | A two-character code added to a CPT code to provide additional information about the service performed. |
| CPT® Professional | The official CPT code book published annually by the AMA. |
| Code Revision | An update made to an existing CPT code to reflect current medical practice. |
| Code Deletion | Removal of a CPT code that is no longer needed or has been replaced. |
CPT® Code Lifecycle
Every CPT® code follows a structured lifecycle before it is used for medical billing. Understanding this process helps beginners see how new medical procedures become standardized codes that support accurate claim submission and reimbursement.
How CPT® Codes Are Used in Medical Billing
Every medical claim begins with accurate clinical documentation. Medical coders review the provider’s notes and assign the appropriate CPT® codes developed by the American Medical Association (AMA). These standardized codes describe the procedures and services performed, allowing insurance companies to process claims consistently and determine reimbursement.
1. Patient Receives Medical Services
2. Provider Documents the Visit
3.Medical Coder Reviews Documentation
4. CPT® Codes Assigned
5. Medical Claim Created
6. Claim Submitted to Insurance
7. Insurance Company Reviews the Claim
8. Claim Adjudication
9. Payment Determined
10. Provider Receives Reimbursement
11. Account Closed
Keep Learning
Congratulations! You now understand the role of the American Medical Association (AMA) and how it supports medical billing through the development and maintenance of CPT® codes. In the next module, you’ll learn about the American Academy of Professional Coders (AAPC), the organization that provides medical coding certifications, professional training, continuing education, and career development opportunities for medical coders and billers.
Questions, answered
Have questions about the US healthcare system? Find clear, beginner-friendly answers to some of the most common questions to strengthen your understanding before moving on to the next module.
What is the American Medical Association (AMA)?
The American Medical Association (AMA) is a national professional organization that represents physicians and develops and maintains the Current Procedural Terminology (CPT®) code set used for reporting medical procedures and services.
What is the primary role of the AMA in medical billing?
The AMA develops, updates, and publishes CPT® codes, which are used by healthcare providers, medical coders, insurance companies, and government programs to report medical procedures accurately.
Does the AMA create ICD-10-CM diagnosis codes?
No. ICD-10-CM diagnosis codes are maintained by the National Center for Health Statistics (NCHS) under the Centers for Disease Control and Prevention (CDC). The AMA is responsible for CPT® codes, not ICD-10-CM.
How often are CPT® codes updated?
The AMA publishes annual CPT® code updates, which may include new, revised, or deleted codes to reflect changes in medical practice and technology.
Why are CPT® codes important?
CPT® codes provide a standardized way to describe medical procedures and services. They help ensure accurate claim submission, proper reimbursement, and consistent communication between healthcare providers and insurance companies.