CPT Codes Explained: A Broker’s Guide to Speaking the Language

Why CPT Codes Matter for Disability Brokers

You don’t need to be a medical expert to sell disability insurance to doctors—but you do need to speak their language.

Here’s the disconnect most brokers miss: traditional LTD policies define disability by job title. A surgeon is disabled when they can no longer work as a surgeon. But doctors think about the specific procedures they perform. An orthopedic surgeon who loses fine motor control can still conduct patient consultations and review imaging. Are they disabled? Their income says yes—they’ve lost the ability to perform joint replacements that generate most of their earnings. Their generic LTD policy says no—they can still “work as an orthopedic surgeon.”

CPT codes give you the competitive advantage here.

CPT codes—Current Procedural Terminology—are the standardized codes doctors use to bill every procedure they perform. MGIS uses these codes to define disability based on what doctors actually do, not just their job title. When you understand CPT codes, you identify coverage gaps your competitors miss, ask smarter questions that build instant credibility, and explain why MGIS protects doctor income better than traditional LTD.

This is your 10-minute crash course. Let’s get you dangerous.

What Are CPT Codes? (In Plain English)

The Simple Answer

CPT stands for Current Procedural Terminology. Think of CPT codes as the universal language doctors use to describe what they do. Every procedure—from a routine office visit to complex heart surgery—has a specific five-digit code. The American Medical Association maintains this system, and every doctor in the country uses it for insurance claims, billing, and documenting services.

Why They Exist

CPT codes create standardization across healthcare. Without them, one doctor might describe a procedure one way while another uses completely different terminology. Insurance companies wouldn’t know what they’re paying for. Hospitals couldn’t track services accurately. CPT codes solve this by giving every medical service a precise, consistent label everyone recognizes.

What They Look Like

CPT codes are five-digit numbers. Code 99213 represents a standard office visit with an established patient. Code 29881 represents a knee arthroscopy. Code 27447 represents a total knee replacement. Each code captures not just the procedure performed, but often the complexity and time involved.

The MGIS Connection

CPT codes become powerful for disability conversations here. MGIS defines disability based on the actual procedures each doctor regularly performed for twelve months before disability. We determine this using CPT codes—not vague job descriptions or specialty titles. If a surgeon can no longer perform the specific procedures that generate most of their income, MGIS recognizes that as a disability. Traditional LTD policies miss this because they focus on whether doctors can perform “any” duties of their occupation. MGIS coverage is more precise and more protective.

There’s a distinct difference between the MGIS approach to the definition of disability (using actual procedures) and typical group coverage (using either ABMS or DOT). There are only 30 Department of Labor (DOL) Medical “Sub-Specialties”, 190 American Board of Medical Specialties (ABMS) Medical “Sub-Specialties”– and 10,000 procedural codes.

Superior to Specialty and Sub-Specialty

The doctor’s actual procedures and duties at the practice – based on CPT codes, job description, medical malpractice insurance coverage, etc. – allow for the definition of occupation to be specific to what each doctor or dentist does at their specific practice.

The 5 CPT Code Categories Every Broker Should Recognize

You don’t need to memorize thousands of codes. Understanding these five functional categories will help you spot coverage gaps and ask better questions.

Category 1: Evaluation & Management (E&M) Codes (99201-99215)

E&M codes cover office visits, consultations, and hospital rounds. These are lower physical demand activities—talking with patients, reviewing charts, making diagnoses.

Here’s why this matters: if a surgeon loses the ability to operate but can still see patients in clinic, they’ve shifted entirely to E&M work. Their income drops dramatically. A surgeon performing joint replacements earns $300,000 to $600,000 annually. That same surgeon limited to office consultations? More like $150,000 to $200,000. E&M codes help you identify partial disability scenarios where doctors can still work but have lost their highest-earning procedures.

Category 2: Surgical Procedures (10000-69990)

What happens when a hand surgeon develops essential tremor at age 52?

She can still conduct patient consultations, review imaging, and supervise physician assistants. But she can no longer perform the microsurgery that generates 70% of her income. Code 27447 represents a total knee replacement. Code 43280 represents a laparoscopic gallbladder removal. These procedures typically generate the highest income and require the most specialized skills—and create the highest disability risk.

Loss of ability to perform surgical codes means major income loss. A hand tremor, back injury, or visual impairment can end a surgical career while leaving other medical work possible. This is where MGIS’s CPT-based definition of disability becomes most valuable.

Category 3: Radiology & Imaging (70000-79999)

Radiology codes cover X-rays, MRIs, CT scans, and ultrasounds. A radiologist’s entire practice revolves around reading and interpreting these images.

Conditions affecting vision, fine motor skills, or cognitive function can eliminate the ability to perform these procedures safely and accurately. Consider a 48-year-old radiologist who develops macular degeneration. She faces total disability—she can’t reliably read imaging studies. Yet she could theoretically still conduct patient consultations. Traditional LTD policies might argue she’s not disabled. MGIS recognizes she’s lost the procedures that define her practice.

Category 4: Anesthesia (00100-01999)

Anesthesia codes represent services during surgical procedures. Anesthesiologists bill based on time and complexity.

If an anesthesiologist develops a condition that prevents them from handling high-complexity cases—cardiac surgery, neurosurgery, trauma—their income drops significantly. They might still administer anesthesia for routine procedures, but they’ve lost access to their highest-earning work.

Category 5: Medicine & Special Services (90000-99199)

This broad category captures non-surgical specialists’ primary income sources. Code 93015 represents a cardiovascular stress test. Code 96372 represents an injection administration. Cardiologists, dermatologists, and other specialists bill these codes for their core procedures.

This category shows the breadth of medical work beyond surgery. A cardiologist who can no longer perform stress tests or cardiac catheterizations has lost essential income-generating procedures, even if they can still see patients for follow-up visits.

How to Find and Interpret CPT Codes

Where to Look

Ask the doctor group directly: “Can you share the top 10-15 CPT codes your doctors bill most frequently?” Most practice administrators can pull this information. If they provide sample billing reports during discovery, review those for patterns.

The AMA offers a CPT code lookup tool online. Full access requires purchase, but basic lookups are available for quick reference. You don’t need to do this research alone, though. MGIS helps identify relevant codes during underwriting. We’ll work with you to understand what procedures matter most for each client.

What to Look For

Focus on four key factors:

• Frequency: Which codes do they bill most often?
• Complexity: Are these high-skill, high-earning procedures?
• Physical demands: Do these codes require fine motor skills, standing endurance, or strength?
• Specialization: Can only certain doctors within the practice perform these procedures?

Red Flags That Signal Coverage Gaps

Watch for practices that perform highly specialized procedures with a narrow CPT code range. These doctors face significant income loss if they lose the ability to perform just a few key procedures. A high percentage of income from surgical codes creates vulnerability. Procedures requiring specific physical abilities—hand dexterity for microsurgery, standing endurance for long operations—represent clear disability risks. Also note when doctors bill codes outside their listed specialty, which may indicate they’ve already adapted due to limitations.

Broker Tip: You don’t need to memorize thousands of codes. Focus on understanding the top 5-10 procedures each doctor performs regularly. That’s where MGIS’s CPT-based Definition of Disability becomes your strongest selling point.

Where CPT Codes Show Up in the Sales and Claims Process

During the Sales Conversation

Open with this question: “Walk me through the most common procedures your doctors perform. What codes represent your highest-earning services?” This demonstrates you understand their business beyond their specialty name. You’re not treating all orthopedic surgeons or cardiologists the same. You’re recognizing that what they actually do matters.

This question helps you identify doctors whose income depends on specific, vulnerable procedures. It sets up the MGIS differentiator naturally. You’re not forcing a product pitch—you’re having a conversation about how they work.

Highlighting the Coverage Gap

CPT codes make your case concrete here. Traditional LTD scenario: “Your current policy considers an orthopedic surgeon disabled only if they can’t perform ANY duties of an orthopedic surgeon.” MGIS scenario: “If your surgeon can no longer perform total joint replacements—CPT code 27447—due to tremors but can still do office visits, MGIS would consider that a disability because they’ve lost the ability to perform their regular procedures.”

The CPT code makes this real. You’re not speaking in hypotheticals. You’re talking about specific billable procedures that generate specific income.

During Claims

The MGIS claims team reviews the insured’s historical CPT codes and compares what they were performing versus what they can perform now. No subjective debates about job titles or vague duties. The documentation provides a clear basis for determining disability and benefit levels.

The Competitive Advantage

Most brokers skip this level of detail. Most LTD carriers don’t use CPT codes in their Definition of Disability. This knowledge positions you as the expert who truly understands doctor clients. You’re speaking their language. You’re identifying risks others miss. You’re offering protection that matches how doctors work and earn.

Your Next Steps: Putting This Knowledge to Work

Start Simple

In your next meeting with a doctor group, ask about their top billing codes. Listen for procedure names, then follow up: “What’s the CPT code for that?” Use this as a bridge to discussing how MGIS evaluates disability differently. You don’t need to be the expert on every code. You just need to show you understand that codes matter.

The Question That Opens Doors

Try this: “How does your current LTD policy account for the specific procedures you perform? Does it recognize that losing the ability to do certain CPT codes—even if you can still work in some capacity—represents a real disability?”

Most groups have never been asked this question. It reframes the entire conversation about disability coverage.

Connect With MGIS

We’ll help you identify the CPT codes most relevant to your doctor clients. Our team can walk you through how our CPT-based Definition of Disability works in practice. Together, we’ll show doctors why this approach protects their income better than traditional LTD. You bring the relationship. We’ll bring the expertise. Let’s get started.