Ama Policy

Limitation of Use of Time Component of Current Procedural Terminology (CPT-4) Coding H-70.976

Fee Schedules, Payment Edits

Our AMA (1) adopts as policy that the time element in the new Evaluation and Management codes in the (CPT-4) manual may be used to assist physicians and their staffs in determining appropriate levels of coding;

(2) opposes the use of the time elements to (a) judge how many of any given type of visit may be performed in any one hour; and (b) deny or downgrade services submitted based on a cumulative time;

(3) adopts as policy that there shall be no list of diagnoses used by third party payers to compare against the Evaluation and Management codes in such a fashion as to deny, downgrade, or in any other way seek to limit the submission of any (CPT-4) code visit;

(4) will monitor attempts by the third party payers to institute such time limits and diagnosis limits; and

(5) will work with third party payers to prevent them from attempting to adopt and institute policies that would impose such time and diagnosis criteria.

Policy Timeline

Res. 823, A-92Reaffirmation I-00Reaffirmed: CMS Rep. 6, A-10Reaffirmed: CMS Rep. 01, A-20