What is CBHPM?
CBHPM is the hierarchical list of medical procedures across all specialties, published by the AMB (Associação Médica Brasileira), with a reference value for each one. The AMB describes it as a minimum acceptable standard for paying medical work [1]. It was created in 2003 and is updated with 54 specialty societies affiliated with the AMB [2].
In hospital billing, CBHPM does two jobs: nomenclature (a code and description for each procedure) and valuation (how much a procedure is worth relative to others and, through the AMB's annual notice, in Brazilian reais). Valuation is what enters contracts with health plans (operadoras), almost always with negotiated adjustments.
In the US: the closest concept is the RBRVS behind the Medicare Physician Fee Schedule, where relative value units set payment. Unlike Medicare, CBHPM is published by a medical association, not the government, and binds no one by itself.
Older contracts may still cite the “AMB table” that preceded CBHPM; this guide covers CBHPM only.
How CBHPM is organized
CBHPM has four chapters, and the first digit of the code shows the chapter. In the 4th edition, chapter 1 covered office and hospital visits; 2, clinical procedures; 3, surgery; and 4, diagnostic and therapeutic procedures [6]. The code has four blocks and a check digit, such as 1.01.01.01-2, the office visit [6].
Each procedure carries a set of attributes that define its value:
| Attribute | What it means | Example |
|---|---|---|
| Porte (tier) | Complexity of the medical act, from 1A to 14C | 8C |
| Fraction of a tier | Part of a tier, for simple acts | 0.1 of 1A |
| UCO (quantity) | Operating cost: equipment, maintenance, premises, support staff | 3.600 UCO |
| Assistant tier | Number of surgical assistants expected | 2 |
| Anesthesia tier | Complexity of the anesthetic act, from 0 to 8 | 5 |
| Film | Radiology film use, in m², when applicable | — |
The examples come from AMB notices issued in 2026: a lumbar spine procedure with tier 8C, assistant tier 2 and anesthesia tier 5, and a lab test with 0.1 of 1A and 3.600 UCO [12].
How do CBHPM tiers work?
The tier (porte) is the procedure's position on a 14-level scale, each level split into A, B and C, for 42 positions in all [2][6]. It is not an amount in reais: it ranks medical acts by technical complexity, time, attention required and level of training [6].
The value of each tier in reais comes from a separate AMB notice. The Oct 18, 2025 notice, the latest published, valid from October 2025 to September 2026, sets the original band at BRL 26.74 for tier 1A, BRL 858.03 for 7A and BRL 6,922.36 for 14C [5]. That notice adds something new: on top of the original value, three higher reference bands (I, II and III), presented as a basis for negotiation, including in bundled, performance-based or value-based payment [5].
The edition (2022, for example) sets codes, tiers and UCO quantities; the value notice sets what each tier and each UCO is worth in a given period. A contract that just says “CBHPM” leaves both open.
Calculation rules, such as assistant, surgical approach, urgency and room percentages, sit in each edition's General Instructions. The 2022 edition's are not open on AMB's page, which sells the edition [1]. The 2012 edition percentages, whose text is on AMB's server, appear in the Physician fee denials guide as that edition's rule: do not treat older-edition percentages as current without checking the edition in the contract.
UCO: the operating cost of the procedure
The UCO (unidade de custo operacional, operating cost unit) pays for the facility used in the procedure, not for the physician's work. Per the CBHPM instructions, it covers equipment depreciation, maintenance, furniture, premises, rent and payroll [6]. That is why it appears mostly in diagnostic and therapeutic services (SADT).
The UCO value is multiplied by the quantity set for the procedure. With the 2025 UCO of BRL 29.80 [5], an exam with 10 UCOs carries BRL 298.00 of operating cost, added to the tier value. Supplies, drugs, contrast media and film are outside the UCO; film is calculated separately, in square meters [6].
The UCO started at BRL 11.50, in the notice of August 1, 2003 [6]. A contract with the UCO fixed at an old value misses the annual update.
See the breakdown as a table
| Component | How it is calculated | Illustrative example |
|---|---|---|
| Porte (tier) | Tier value in the AMB notice × fraction, if any | Tier 7A: BRL 858.03 |
| UCO | Number of UCOs for the procedure × UCO value | 10 × BRL 29.80 = BRL 298.00 |
| Film | Square meters, when used, paid separately | — |
| Reference value | Sum of the components | BRL 1,156.03 |
| Amount billed | Reference adjusted by contract rules (edition, value notice, percentage on tier and UCO, band, add-ons) | Depends on the contract |
What is the anesthesia tier?
The anesthesia tier (porte anestésico) is a separate 0-to-8 scale that measures the complexity of the anesthetic act for each procedure. Tier 0 means no anesthesiologist takes part [6]. Each anesthesia tier maps to a procedure tier on the 1A–14C scale, and that tier sets the anesthesiologist's fee.
The mapping sits in each edition's instructions and has changed over time: in the 4th edition, anesthesia tier 3 mapped to 4C, and tier 8 to 12A [6]. Only the edition adopted in the contract turns an anesthesia tier into a value. The full calculation is in the guide Physician fees on hospital claims.
Is CBHPM mandatory?
No. CBHPM is a reference, and the amount actually paid depends on the contract between provider and health plan. In 2003, CFM (Conselho Federal de Medicina, Federal Council of Medicine) Resolution 1,673/2003 adopted CBHPM as the minimum ethical fee standard in private health insurance [3]. A public civil action in the Federal Court of Espírito Santo, now final, declared that resolution null to the extent it imposed the table as an ethical rule [3]. CFM Resolution 2,293/2021, which repealed rules that had lost their purpose, included 1,673/2003 on its list (art. 3) [4].
In a 2022 note, the AMB maintains that CBHPM remains valid as a fee benchmark but acknowledges it cannot be imposed on health plans [2].
CBHPM, TUSS and the Rol: how they connect
TUSS (Terminologia Unificada da Saúde Suplementar, the unified terminology of Brazil's private health system) table 22, procedures and health events, is based on CBHPM and CBHPO, the dental classification, according to the Organizational Component of the TISS standard set by the ANS (Agência Nacional de Saúde Suplementar, the national regulator of health plans), items 95 to 99 [7]. The same document says every procedure in the ANS Rol (mandatory coverage list) is in table 22 [7]. The AMB states that CBHPM has been a reference for TUSS since 2011 and a criterion for updating the Rol since 2013, and that it sits on the ANS committee that reviews TUSS additions [2].
The legacy shows in the code: the office visit, 1.01.01.01-2 in CBHPM [6], is code 10101012 in table 22, “Consulta em consultório (no horário normal ou preestabelecido)” (office visit, during regular or scheduled hours) [8]. But TUSS has no field for price, tier or UCO [7][8]: the hospital bills with the TUSS code and prices with the contract table. See the guides TUSS code table and ANS procedures list.
| Item | CBHPM | TUSS table 22 |
|---|---|---|
| Publisher | AMB | ANS, within the TISS standard |
| Mandatory use | No; contractual reference | Yes, in data exchange with health plans |
| Tier and UCO | Yes | No |
| Price | Yes, through the annual value notice | No |
| Updates | AMB editions and normative resolutions; value notices | Periodic TISS versions |
How CBHPM appears in the health plan contract
Law 9,656/1998, art. 17-A, added by Law 13,003/2014, requires a written contract between health plan and provider stating the service values and the criteria, form and frequency of adjustment [9]. When CBHPM is the reference, the price clause must say which CBHPM and with what adjustments. The table below lists what is often missing.
| What the clause should set | Example of what to define | Risk if left open |
|---|---|---|
| Edition | CBHPM 2022, with normative resolutions up to a given date | New procedure with no agreed tier; tier disputes |
| Value table | AMB notice for a given period, original band or another | Health plan pays last year's value |
| Adjustment on the table | Percentage above or below tier and UCO, separately | Discount applied to the whole claim |
| UCO value | UCO from the notice or a fixed amount | UCO frozen with no update |
| Exceptions | Procedures with their own price or in a bundle | Double billing or denial of included items |
| Rate adjustment | Index and base date | Yearly dispute with no rule |
On the claim, physician fees billed by the hospital go on the inpatient summary form (TISS, item 62) [7]; see TISS claim forms. Checking tier and role is covered in the guide Physician fee denials.
CBHPM and rate adjustments: what the law and RN 503 say
CBHPM is not an ANS index, but the contract can use it as the adjustment criterion. ANS Normative Resolution (RN) 503/2022 requires clear and objective adjustment criteria, applied yearly on the contract anniversary, with 90 days of free negotiation (art. 12) [10]. The same rule bars adjustments tied to the health plan's loss ratio and clauses that keep or cut the nominal value of the service (art. 5, VII and VIII) [10].
Pegging prices to “the AMB notice in force” is one way to set the criterion: the 2025 notice, dated Oct 18, 2025 (the latest published), runs from October to September [5]. If that date differs from the contract anniversary, the clause must say which prevails. With no agreement in 90 days, when free negotiation is the only form of adjustment, the ANS index applies, based on the IPCA inflation index and the Quality Factor (RN 512/2022) [9][11]. See the guides Payer rate negotiation and RN 503/2022: the payer contract. The stakes are real: at Anahp (National Association of Private Hospitals) member hospitals, other operating revenue, which includes fees and bundles, was 26.13% of gross revenue in 2024 [13]. More figures are in Industry data.
What we see in operations
At Accrua, the CBHPM is read through the contract, not as a standalone schedule. For each health plan, we load the reference edition, the UCO value notice, the adjustment criterion and the tier rules the contract sets. When the contract says “current CBHPM” with no base date, the assessment flags it as a point to clarify.
Before submission, Accrua OS compares the tier, sub-tier and UCO billed with what that health plan's contract defines, and checks the physician fee denial history for that procedure. A mismatch in edition or UCO value becomes an alert before it becomes a denial.
Changing a value or interpreting an ambiguous clause is a person's decision, made with the contract and the schedule and their sources. A contract change, such as fixing the edition and base date at the next adjustment, also goes through a person, and the denial history gathered by health plan supports that conversation.
Where to start
- Map each contract's reference: CBHPM edition, value notice, adjustment on tier and UCO, and exceptions.
- Compare it with the AMB notice in force and compute the gap in UCO and in your most billed tiers.
- Set the edition and values in the billing system by health plan, with effective dates.
- Align the notice date with the contract anniversary at the next renegotiation.
- Check tier and anesthesia tier before submission for the highest-value procedures.