The American Medical Association released the CPT 2024 code set this month. The headline numbers: 349 editorial changes, made up of 230 new codes, 49 deletions and 70 revisions. Most take effect January 1, 2024. A handful of vaccine codes, including the new RSV immunization codes, were released early so that the products could be billed as they reached the market this fall.
Every September, the release lands on a coder's desk, gets a quick read, and then waits until the week between Christmas and New Year, when the practice management vendor pushes an update and everyone discovers that a code the practice bills 200 times a month has been deleted. We would rather do the work in October. Here is the plan we use.
Key takeaways
- CPT 2024 brings 230 new codes, 49 deletions and 70 revisions, effective January 1, 2024. Only the codes your practice bills matter; start from your own utilization report.
- The RSV immunization codes were released ahead of the main set. Confirm they are in your charge master and that each payer has a fee and coverage position before the first dose.
- Revised descriptors are the change everyone skips because the number did not change. Read every one on your list.
- End-date deleted codes as of December 31, 2023; never remove them, because 2023 claims, corrections and appeals still need them.
What is in the 2024 update
| Change type | Count | Examples relevant to office practices |
|---|---|---|
| New codes | 230 | RSV immunization codes 90380, 90381, 90678, 90679 and 90683; caregiver training services 97550, 97551 and 97552 |
| Deleted codes | 49 | Codes replaced by new or consolidated descriptors; check your top 100 against the deletion list |
| Revised codes | 70 | Descriptor and guideline revisions that change when a code applies without changing its number |
The AMA also released Spanish-language consumer descriptors for the full code set this year, which matters for practices that produce patient statements or estimates in Spanish. And the evaluation and management guidelines picked up further clarifications, continuing the clean-up that began with the 2021 office visit overhaul and the 2023 changes to the remaining E/M families. Coders who bill E/M should read the guideline revisions even where no code number changed.
The RSV codes are already in play
The five RSV codes describe specific products. Two are for the monoclonal antibody nirsevimab for infants: 90380 for the 0.5 mL dose and 90381 for the 1 mL dose. Three describe adult vaccines: 90678 and 90679 for the two products approved this year, distinguished by manufacturer formulation, and 90683 for an mRNA product that is still awaiting FDA approval and was published early so the code exists when the product arrives. These were released ahead of the main set and the first two adult codes are in use this season.
If your practice administers RSV products this fall, confirm three things now: the codes are in your charge master, the administration codes are paired correctly, and each payer's coverage and fee for the new codes is known before the first dose. New vaccine codes are a classic source of first-quarter denials because the payer's system was updated later than the practice's. Nirsevimab adds a fourth question for pediatric practices: whether a given payer wants the product billed with the new CPT code or, for Vaccines for Children stock, handled through the program's rules, and what the administration code should be.
Caregiver training: new codes, and CMS has proposed to pay for them
Codes 97550, 97551 and 97552 describe training a patient's caregiver without the patient present, under a therapy plan of care: 97550 for the initial 30 minutes, 97551 for each additional 15 minutes, and 97552 for group training. The CY 2024 Physician Fee Schedule proposed rule in July proposed to make these payable under Medicare, which would be a change; Medicare has historically not paid for services when the patient is absent. Physical, occupational and speech therapy practices should watch the final rule in November. If finalized, the documentation will need the patient's consent to caregiver training and the specific time spent.
A review sequence that fits in October
- Pull your code utilization. Export every CPT code billed in the last twelve months with counts and charges. This is the list that matters; the other 10,000 codes in the book do not.
- Cross-check against the deletions. Any deleted code on your list needs a replacement mapped before January. The AMA's summary of changes shows where each deleted code went.
- Read every revised descriptor on your list. A revision can narrow or broaden what the code covers. This is the part everyone skips, because the code number did not change.
- Scan the new codes by section. Only the sections your practice bills in. A dermatology practice does not need to read the cardiology additions.
- Update the charge master and templates. New codes added with a January 1 start, deleted codes given an end date (not removed, because 2023 dates of service still need them), order sets and superbills revised.
- Load fees. New codes have no contracted rate until payers publish one. Set a placeholder based on similar codes and flag them for review when the Medicare final rule and payer updates arrive.
How the review looks in a real practice
A worked example, with the numbers a typical single-specialty practice produces. A family medicine group with six clinicians exported its utilization and found 212 distinct CPT codes billed in the prior twelve months, of which 48 accounted for 95% of charges. Cross-checked against the 2024 changes, the list produced the following.
| Finding | Count | Action | Owner and deadline |
|---|---|---|---|
| Deleted codes on the list | 2 | Map each to its replacement; end-date December 31, 2023 | Coder, by October 31 |
| Revised descriptors on the list | 6 | Read each revision; note any documentation change for providers | Coder, by November 15 |
| New codes the practice will use | 5 (the RSV codes) | Add to charge master and immunization templates; confirm payer fees | Billing lead, immediately |
| Superbill and order set lines affected | 9 | Revise templates with January 1 versions ready to switch | EHR administrator, by December 15 |
| Provider-facing changes | 1 page | One-page summary for the December provider meeting | Billing lead, by December 1 |
The whole review took the coder about six hours spread over two weeks. The alternative, discovering the two deleted codes on January 3 when the first rejections came back, would have cost more than that in rework alone.
Do not remove deleted codes
One mistake worth its own heading. In January, a deleted code must still exist in the system for claims with 2023 dates of service, corrected claims and appeals. Removing it breaks those claims. End-date the code as of December 31, 2023 and let the system enforce the date. Some practice management systems handle this automatically with the annual update; some do not, and a code that vanishes from the pick list on January 2 causes a very long day for the billing team.
The same logic applies to fee schedules. A 2023 rate row with an end date of December 31 sits alongside the 2024 row with a January 1 start, and the system chooses by date of service. Overwriting the 2023 rate makes every 2023 claim that pays in January look like a variance.
Training: what providers need versus what coders need
Coders need the full change summary for their specialty and time to read the revised guidelines. Providers need a one-page list: the codes they personally bill that are new, deleted or revised, with a sentence on each. A 45-minute provider meeting in early December with that page is far more effective than a link to the AMA summary. Where documentation requirements change, show the provider the old note and what the new note needs.
Practices that run their own coding training internally should schedule the CPT 2024 session for the first two weeks of December, after the Medicare final rule is out, so the fee and coverage information is final. And remember that October 1 is three weeks away: the FY 2024 ICD-10-CM codes take effect that day for all dates of service from then on. If your team has capacity for one project in September, make it the diagnosis code update, and start the CPT review in October.
Questions we hear
Do we need to buy the CPT book every year?
Each practice needs licensed access to the current code set for the codes it bills, whether through the book, the AMA data file, or an encoder or practice management system that licenses it. What we would not do is rely on an outdated book plus memory.
Our vendor says the January update is automatic. Are we done?
The vendor updates the code table. It does not update your superbills, your order sets, your fee schedules or your providers. Those are the practice's job.
When will payers accept the new codes?
Most payers load the new set for January 1 dates of service, but some lag by weeks. Watch first-pass rejections in January for "invalid procedure code" on new codes and hold those claims briefly rather than changing the code to something inaccurate.
What to do this month
- Export twelve months of CPT utilization with counts and charges, and mark the codes that make up 95% of revenue.
- If you administer RSV products, add the new codes to the charge master today and ask each major payer for its fee and coverage position in writing.
- Finish the ICD-10-CM FY 2024 update before October 1, then start the CPT cross-check in the first week of October.
- Book the coder's review time and the December provider meeting on the calendar now, so neither depends on a quiet week that will not come.
- Ask your practice management vendor for the date of the CPT 2024 update and whether it end-dates deleted codes automatically.
