305.990 Fair Compensation for Prior Authorization and Appeal of Service Denials
MSSNY advocates and requests that upon adoption of CPT codes by the AMA CPT Panel at the May 2024 meeting for payor authorization services and appeals of denied services, the AMA immediately starts advocacy on federal and state levels for legislative mandates for coverage of CPT Codes for work involved for payor authorization and appeals of wrongful denials of services (visits, tests, procedures, medications, devices, and claims), whether pre- or post-service denials; and further that model legislature satisfies the requirements enumerated in RUTLEDGE, ATTORNEY GENERAL OF ARKANSAS v. PHARMACEUTICAL CARE MANAGEMENT ASSOCIATION.
MSSNY requests that our AMA report at the 2025 Meeting on the progress of implementation of this resolution. (HOD 2024 – Emergency resolution A)
