Ama Policy

Improper Use of AMA-CPT by Carriers/Software Programs H-70.954

Fee Schedules, Payment Edits

Our AMA: (1) continues to seek endorsement of Current Procedural Terminology (CPT) as the national coding standard for physician services; in collaboration with state and specialty societies, will urge the Secretary of HHS and CMS and all other payers to adopt CPT as the single uniform coding standard for physician services in all practice settings; and will oppose the incorrect use of CPT by insurers and others, taking necessary actions to insure compliance with licensing agreements, which include provisions for termination of the agreement;

(2) will work with the American Academy of Pediatrics and other specialty societies to support state and federal legislation requiring insurers to follow the coding as defined in the Current Procedural Terminology Manual and interpreted by the CPT Assistant for all contracts in both the public and private sectors, as long as the CPT process is simple, user friendly, and does not undergo frequent changes; and

(3) seeks legislation and/or regulation to ensure that all insurance companies and group payers recognize all published CPT codes including modifiers.

Policy Timeline

Sub. Res. 801, A-97 Appended: Res. 806, A-98 Appended: Res. 814, I-99 Reaffirmed: BOT Rep. 8, I-00 Reaffirmation I-04 Reaffirmation A-06 Reaffirmation A-07 Reaffirmation A-10 Reaffirmed: CMS Rep. 01, A-20