coding debridement with skin graft
Article document IDs begin with the letter "A" (e.g., A12345). If a physician uses a curette to debride slough on the surface of the wound is that classified as subcutaneous or non-surgical? CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! iii. Neither the United States Government nor its employees represent that use of such information, product, or processes An asterisk (*) indicates a All Rights Reserved (or such other date of publication of CPT). In most instances Revenue Codes are purely advisory. 0 To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom What are the 2020 CPT code changes? 0000004501 00000 n The AMA is a third party beneficiary to this Agreement. The views and/or positions presented in the material do not necessarily represent the views of the AHA. Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits Youre right about the skin graft code(s). Distinguish the codes based on body site, as follows: Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. Surgical Preps: When Do You Code Them? - AAPC Knowledge Center PDF Billing and Coding Guidelines for GSURG-052 Application of Question: 4 Quick Tips for Debridement Coding - AAPC Knowledge Center Coding Root Operations with ICD-10-PCS: Understanding Transplantation Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. 0000002478 00000 n Instructions for enabling "JavaScript" can be found here. cm of the total 85.25 sq. cm.). You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Debridement Services (A56617). Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Q4102 . Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (, o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm, o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits, You can still separately code for deep debridement that includes muscle and bone, says, Grasp measurement rules. Q&A: Determine documentation difference between skin graft and - ACDIS Before sharing sensitive information, make sure you're on a federal government site. Sometimes, a large group can make scrolling thru a document unwieldy. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. Add together the surface area of multiple . %%EOF For services related to removal of callus (hyperkeratotic tissue) around an ulcer, paring or cutting of corns, trimming or debridement of nails, please refer to NGS LCD Routine Foot Care and Debridement of Nails (L33636). The care of minor wounds (post-operative, traumatic, or otherwise) is incidental to other covered services. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. 11042 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less + 11045 - each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. Instructions for enabling "JavaScript" can be found here. Article - Billing and Coding: Application of Skin Substitute Grafts for You can collapse such groups by clicking on the group header to make navigation easier. Absence of a Bill Type does not guarantee that the twZ5C2ayV`C~1S6#9mOk)d4sr$#yd:W8 Eu1EgZ \ 0 E endstream endobj 49 0 obj <>stream culture and sensitivity), osteomyelitis (e.g. Code Debridement by Documented Depth and Area When reporting debridement of a bedsore, code selection depends on the depth of debridement and total area debrided: Depth to subcutaneous tissue (to the depth of blood vessels and nerves): 11042 (first 20 sq cm) and +11045 (each additional 20 sq cm, or part thereof) 1 cm and documented 20 sq. /| At a minimum, the Progress Report must document the continuing skilled assessment of wound healing as it has progressed since the evaluation or last Progress Report. This question was answered by Denise Williams, COC, senior vice president of the revenue integrity division and compliance auditor at Revant Solutions in Trussville, Alabama. Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. Non-excisional debridement (e.g., 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) is described as nonsurgical because it does not involve cutting away or excising devitalized tissue. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. Prior treatment by a physician, non-physician practitioner, nurse and/or therapist, Description of wound: length, width, depth, grid drawing and/or photographs, Amount, frequency, color, odor, type of exudate, Evidence of infection, undermining, or tunneling, Comorbidities (e.g., diabetes mellitus, peripheral vascular disease), Skilled plan of treatment, including specific frequency, modalities and procedures, Type of debridement performed, including instrument used, to support the debridement code billed, Changing plan of treatment based on clinical judgment of the patients response or lack of response to treatment. For instance, Versajet debridement is considered to be nonsurgical, mechanical debridement because it does not involve cutting away or excising devitalized tissue. *4 Use CPT code 15340-15341 or CPT code 15360-15366 for the surgical preparation or creation of recipient site for the tissue skin graft. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Question: trailer <<1D25FBD66AB6418699B8EC89A49470A5>]/Prev 196840>> startxref 0 %%EOF 74 0 obj <>stream Distinguish the codes based on body site, as follows: PDF Coding Skin Procedures in the Office Setting - AAPC hbbd``b`J@ H0lV$ W0 y Contractors may specify Bill Types to help providers identify those Bill Types typically Q&A: Triggering PSI 15 with NG tube placement, Q&A: Defining a coders role in clinical validation, Q&A: Determine documentation difference between skin graft and debridement. These codes are primarily used when irrigation and . Applicable FARS\DFARS Restrictions Apply to Government Use. In cases of excessive frequency or prolonged duration of treatment, documentation should include an evaluation for possible infection (e.g. Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. 2021 Evaluation and Management Codes: Is a History Required? The following procedures are considered part of active wound care management, and are not considered as debridement and are not included in the related LCD: Removal of devitalized tissue from wound(s), non - selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care. As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft. Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. An operative note or procedure note for the debridement service. Debridement is considered a separately reportable procedure when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue is removed, or when debridement is carried out separately without an immediate primary closure. %PDF-1.5 % That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. H|Wd5W5Re'c X!XFk4K|?>_/]%zWCBJ7 .`u}}`JWJz=^o\z9e~BT AT9 vqdYkh%BprY-.%V)["[n . I96w4Ak1;*8LMZI;Oe1\s &$W2DQY#"E"2$*85lm"HIl]JW)"4#F3^6F8?1HtaG]xuA*D::!83P|MnKC*{:?qk,nlG,d=atI'0 I2nC No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be hb```b``Qg`e`y @16.5&Gsf cQ"b8)l82+q {5lJ,lhn7: YZGA 3*l910eX,_ ,*KodXD78^mc0[dzMBt CPT code 15002/15005 are only appropriately used in place of service inpatient hospital, . A description of the procedure as excisional pls help me whether to code manually debrided ones. cm involved a skin substitute application, you can report 15271 for the 20 sq. cm of skin substitute application (15271). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 0000018702 00000 n That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. +etUfqVW7]?5P .kJXp. Avoid: Dont report a skin substitute graft when the surgeon applies non-graft wound dressings such as gel, powder, ointment, foam liquid, or injected skin substitutes, according to the guidelines. Skin Substitute, Oasis wound Matrix, per square centimeter A description of the tissue removed (e.g., necrotic, devitalized or non-viable) You're right about the skin graft code (s). R'7bd snYJ@ 9PE@ cL endstream endobj 44 0 obj <>>> endobj 45 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/Tabs/W/Thumb 35 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 46 0 obj [/ICCBased 68 0 R] endobj 47 0 obj <> endobj 48 0 obj <>stream I work in an acute care center with a burn unit and have been striving for accuracy and consistency. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. iC>:D~c~V*H0"Q%L]5CB %PDF-1.7 % Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. RyfJwE@~:_t4lGY@iYTSBd(m6 DZk0XGxmpP+pF+ff,rBQ*A-E;qkdKom`5!0>?|;!Qb5(Hj QPiX)=Zc4cgQ+*lri59? Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. CPT codes 97597 and 97598 are categorized by CMS as sometimes therapy services. Thank you. Integumentary Procedures: 3 Tips Guide Coding for Skin Substitute Grafts, 3 Tips Guide Coding for Skin Substitute Grafts, Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (, 15002 and +15003 for trunk, arms, legs (including wrist or ankle), 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, Non-autologous human skin (dermal or epidermal, cellular and acellular) grafts, including allografts (from a person other than the patient) and homografts (from cadavers), Non-human skin substitute grafts such as xenografts (from another animal such as pig), Biological products that form a sheet scaffolding for skin growth. Auto- is different: If you see the term autograft or tissue cultured autograft, then you are dealing with the harvest and/or application of an autologous skin graft. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Youve learned that you can separately report the site preparation and the skin substitute graft placement procedures, but you may wonder what other services and materials in the op report are separately billable. You can use the Contents side panel to help navigate the various sections. Coding matrix for the new skin substitute graft codes For multiple wounds, sum the surface area of all wounds requiring grafts from the same anatomic site and report the applicable primary code and add-on code in multiples, as appropriate. Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post procedure care and follow-up instructions. Your coder is correct simple debridement is included in the graft codes. No. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential cm; we know that many times the actual size of the skin substitute is larger than the area that was covered. Coding Excisions and Skin Grafts - Elite Learning All rights reserved, Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure., The surgeon debrided the necrotic tissue surrounding the amputation site, harvested skin from the patient's thigh and closed the wound with a split thickness skin graft. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Sign up to get the latest information about your choice of CMS topics in your inbox. Do you code debridement with skin graft? - Wise-Answer Wound Care | CPT Codes for debridement - CodingIntel The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. debridement of a single wound, report depth using the deepest level of tissue removed. cm). Privacy Policy | Terms & Conditions | Contact Us. Remember: Wound surface area is what you should consider when selecting the code, not the size of the graft, cautions Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. Include cleaning: When the surgeon performs a simple cleansing of the wound, that service is included within the skin substitute procedure codes, according to CPT instruction. If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. If billed by a hospital subject to OPPS for an outpatient service, these CPT codes will be paid under the OPPS when the service is not performed by a qualified therapist and it is inappropriate to bill the service under a therapy plan of care. Please do not use this feature to contact CMS. Coding for skin replacement surgery in 2012 | The Bulletin Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. (See "Indications and Limitations of Coverage.") Would also adding Mod 22 help, and for which one 11042 or 11043? HLN>bE+hAi .xiJ2D4>"A_6N@f("nChK!`=x;c` DIS!Sf8_c^x)$ Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. endstream endobj 1254 0 obj <>/Metadata 102 0 R/OCProperties<>/OCGs[1280 0 R]>>/Outlines 119 0 R/PageLayout/SinglePage/Pages 1245 0 R/StructTreeRoot 186 0 R/Type/Catalog>> endobj 1255 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1256 0 obj <>stream Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (Application of skin substitute graft ). v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone). hbbd``b`uw@D`9$-$:@3AJT,$ fdgX*0L@6b``,O M ii. Therefore, the more accurate code is a surgical preparation code (15002 15005) for excision (note the term is not debridement) of the open wound to prepare a viable wound surface for grafting. Please reference the CPT descriptions for application of skin substitutes codes (Attachment C). Q: I have been trying to determine whether a skin graft includes debridement. Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. 0000002591 00000 n Addition to Skin Graft Codes. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC If there is not enough clarity, then a query would be indicated. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Like the site preparation codes, CPT distinguishes these codes by anatomic site and wound surface area, as follows: 0000001292 00000 n "2 2a TDl.Uae9c[yd\asU/(~8}ep 0000015008 00000 n Debridement Prior to Skin Grafting - KarenZupko&Associates, Inc. Terms: Primary intention means that the edges of the wound or graft are closed to allow them to grow together, while secondary intention refers to allowing an open wound to heal from the base up by building new tissue. Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES When the patient has required more debridement services per wound than defined below, the medical record must include documentation reflecting neuropathic, vascular, metabolic, or other comorbid conditions. Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) Copyright 2023, AAPC The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. When can I report a debridement in addition to a graft? The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. For patients with chronic wounds being treated in an outpatient setting, services beyond the fifth surgical debridement, CPT code 11043, 11046 and/or 11044, 11047, per patient, per year, per wound may require a medical review of records demonstrating the medical reasonableness and necessity. Skin Lesion Excision Wait for Pathology? Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC . %PDF-1.5 % |S=LqO=Vz recipient email address(es) you enter. 15002 and +15003 for trunk, arms, legs (including wrist or ankle) *This response is based on the best information available as of 4/11/19. CPT is a trademark of the American Medical Association (AMA). If infection has developed, the patient's response to this infection should be described. Many claims for debridement are essentially dressing changes and are not separately payable. Services exceeding this intensity and duration of treatment will be considered not medically necessary. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. If you would like to extend your session, you may select the Continue Button. The medical record should include the following information: The documentation must include that if indicated, ongoing pressure relief has been prescribed, for example, shoe inserts, modifications, padding, frequent position changes, etc. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Two procedure codes need to be assigned-the excision and the graft closure. Another option is to use the Download button at the top right of the document view pages (for certain document types). endstream endobj startxref HWAnl))1p9CK,q@:(#"ET.OSnt$v\^lt6btT 9A'w>$bg71w= Y)s.girVu^T_N'%u7Ag>f|vsQ lCN}uCjdgIKLYvO0>E,bRpUuCXX_"RkdEN""/@1] $' O*o5-OEJmq@Hc^VVl 0 Reporting of Wound Debridement Procedures Properly Bilateral Carpal Tunnel Procedures Different Days, Multiple Laminectomies to Place a Spinal Cord Stimulator. The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). If any of these elements is missing, documentation does not meet the criteria for excisional debridement. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. Add together the surface area of multiple . CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.. If your session expires, you will lose all items in your basket and any active searches. 43 0 obj <> endobj xref The page could not be loaded. There are lessons to be learned to avoid damaging coding habits. Please visit the. Skin substitute grafts include the following: Avoid: Dont report a skin substitute graft when the surgeon applies non-graft wound dressings such as gel, powder, ointment, foam liquid, or injected skin substitutes, according to the guidelines. Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . Can I report 11042 (debridement skin and subcutaneous tissue, first 20 sq cm) and +11045 (each additional 20 sq cm) for the debridement in addition to the split thickness skin graft code? He is an alumnus of York College of Pennsylvania and Clemson University. 1279 0 obj <>/Filter/FlateDecode/ID[<8B4464A13AA9C745B5A6304A9784D76D>]/Index[1253 57]/Info 1252 0 R/Length 97/Prev 314542/Root 1254 0 R/Size 1310/Type/XRef/W[1 2 1]>>stream Report these procedures, when they represent covered, reasonable and necessary services, using the CPT or HCPCS code that most closely describes the service rendered. article does not apply to that Bill Type. 0000027593 00000 n 0000008214 00000 n You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents.