Your Online Resource for CPT Code Information
Specific procedures exist for addressing suggestions to revise CPT, adding or deleting a code, or modifying existing nomenclature.
First, AMA staff reviews all correspondence to evaluate coding suggestions.If AMA staff determines that the Panel has already addressed the question, staff informs the requestor of the Panel’s interpretation. However, if staff determines that the request is a new issue, or significant new information is received on an item that the Panel reviewed previously, the request is referred to appropriate members of the CPT Advisory Committee. If the advisors agree that no new code or revision is needed, AMA staff provides information to the requestor on how to use existing codes to report the procedure.
However, if all advisors concur that a change should be made, or if two or more advisors disagree or give conflicting information, the issue is referred to the CPT Editorial Panel for resolution.
In addition to the Advisory Committee opinions, current medical periodicals and textbooks are used to provide up to date information about the procedure or service. Further data is also obtained about the efficacy and clinical utility of procedures from other sources such as the AMA’s Diagnostic and Therapeutic Technology Assessment Program and various other technology assessment panels.
AMA staff prepares agenda materials for each CPT Editorial Panel meeting. The topics for the agendas are gathered from several sources. Medical specialty societies, individual physicians, hospitals, third-party payers and other interested parties may submit materials for consideration by the Editorial Panel. Panel members receive agenda material at least 30 days in advance of each meeting, allowing them time to review the material and to confer with experts on each subject, as appropriate.
The CPT Editorial Panel meets quarterly, addressing the complex problems associated with new and emerging technologies, as well as the difficulties encountered with outmoded procedures. The Panel addresses nearly 350 major topics a year, which typically involve more than 3,000 votes on individual items.
The Panel actions can result in three outcomes:
A multi-step process naturally means that deadlines are very important. The deadlines for change requests and for Advisory Committee comments are based on a schedule which allows at least three months of preparation and processing time before the issue is ready to be reviewed by the CPT Editorial Panel. The initial step, which includes staff and specialty advisor review, is completed when all appropriate advisors have been contacted and have responded; and that all information requested of a specialty society or an individual requestor has been provided to AMA staff.
Further, the requestor must have completed and submitted a coding change request form. If the advisors’ comments indicate that action by the CPT Editorial Panel is warranted, a second step is then taken by AMA staff to prepare an agenda item that includes a ballot for the request to be acted upon by the CPT Editorial Panel. Once the Panel has taken an action and approved the minutes of the meeting, AMA staff informs the requestor of the outcome. If the requestor wishes to appeal the Panel’s decision, the following appeals process may be followed: AMA staff must receive a written request for reconsideration. The request must contain the reason the requestor believes that the Panel’s actions are incorrect, and should respond to the Panel’s stated rationale for taking the actions that it did. Once this information is received, the issue is referred to the CPT Executive Committee for a decision to reconsider. Unless new information becomes available, when a proposal is rejected for reconsideration, a second request for reconsideration will be entertained not less than one year after the first reconsideration. This request will also respond to the Panel's rationale, and supply those items requested by the panel for inclusion in the reconsideration request.
CPT’s effectiveness depends on constant updating to reflect changes in medical practice. Suggestions of physicians, medical specialty societies, state medical associations, and those who deal regularly with health care information are the only way to ensure that CPT reflects current practice. Accordingly, the AMA welcomes correspondence, inquiries, and suggestions concerning old and new procedures. Coding change request forms are available through the AMA and are required to initiate a review of a proposed coding change by the CPT Advisory Committee. These forms play a vital role in maintaining and increasing the efficiency of the CPT process.
For further information, please visit the AMA website.