Occasionally individuals or companies who have developed new technologies or procedures may request coding guidance on whether an existing American Medical Association (AMA) Current Procedural Terminology (CPT) code is available to report the procedure, treatment, service, or device or whether the creation of a new CPT code may be necessary. The CRC adheres to the criteria new CPT codes established by the AMA CPT Editorial Panel. United States Food and Drug Administration (FDA) approval is the first criteria for a new Category I CPT code. Visit the AMA CPT webpage for more information about applying for CPT codes.
The AUA adheres to strict confidentiality when considering requests for coding guidance, and CRC members are required to disclose any conflicts of interest. If a conflict is disclosed, members are recused from any discussion or voting on the issue surrounding the disclosure.
Here are the steps to request coding guidance from the Coding & Reimbursement Committee:
- Step 1 – Complete the Coding Guidance Request form for coding advice on whether an established or new CPT code is required to report the procedure, treatment, service or device.
- Step 2 – CRC leadership will review information submitted to determine whether an established code is available or if a new Category I or Category III CPT code is necessary.
- Step 3 – If an existing Category I or Category III CPT code is available, the requestor will be notified via email of the appropriate CPT code. No further action is required.
- Step 4 – If a new or revised CPT Category I or Category III CPT code is required and FDA approval is pending within six months, the requestor may ask for an informal meeting with CRC leadership to discuss additional steps in the CPT approval process. This meeting does not establish final decisions on coding guidance but provides information on the process of the AMA CPT Editorial Panel.
- Step 5 – If FDA approval has been granted or is imminent, the requestor may be invited to the next face-to-face meeting of the CRC (July or November) to present their information, including FDA approval, marketing materials, and literature to the entire CRC membership. Once the presentation has been concluded, the CRC will discuss and vote on whether the criteria have been. AUA Staff will then notify the requestor within two weeks of the CRC meeting of the CRC's determination.
- Step 6 – If the CRC deems that the requestor has met all necessary criteria established through the AMA CPT Editorial Panel, the AUA can work with the requestor to complete the Coding Change Application (CCA) required by the AMA.
- Step 7 – The AUA will assist with submission of the Code Change Proposal to the American Medical Association.
- Step 8 – AUA CPT Advisor may present or assist in presentation of the Code Change Proposal at the next meeting of the AMA CPT Editorial Panel. View the current AMA CPT/RUC Calendar.
For additional information or assistance, contact Stephanie N. Storck, CPC, CCS-P, Director Payment Policy at sstinchcomb@AUAnet.org or 410-689-3786.