AMA – Practice Management Alerts

Payers not accepting 2013 CPT codes? Report them.

The rejection of a valid Current Procedural Terminology (CPT®) code is a violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Included within the Healthcare Common Procedure Coding System (HCPCS) code set, CPT is one of the medical data code sets adopted under HIPAA. Additionally, HIPAA-covered entities—including payers—are required to use the current applicable medical data code set valid at the time the health care is furnished. The introduction of the CPT book provides instruction for use of the CPT codes and states that Jan. 1 is the effective date for use of the updated CPT code set.

We encourage you to report HIPAA violations. Simply file a complaint through the Centers for Medicare and Medicaid Services website and/or through the online AMA Health Plan Complaint Form at www.ama-assn.org/go/clickandcomplain. AMA members and their practice staff can visit www.ama-assn.org/go/templateletters to download sample appeal letters and customize them for use in their practices.

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