305.991 CPT Codes for Preauthorization Denials and Fair Compensation
MSSNY will advocate that the AMA include fair compensation based on CPT codes for appeal of wrongfully denied services in any Model Legislation and as a basis for all advocacy, including those for prior authorization reforms and that CPT codes must fully reflect the aggregated time and effort expanded by physician practices.
MSSNY will urge the AMA to have the AMA CPT Editorial Panel establish a CPT code which would account for administrative work involved in prior authorizations and that reflects the actual time expended by physician practices advocating on behalf of patients and complying with insurer requirements.
MSSNY will urge the AMA to have the AMA CPT Editorial Panel establish a CPT code which would account for administrative work that reflects the actual time expended by physician practices and their billing vendors in successfully appealing wrongful pre- and post-service denials. (HOD 2021-254 and 255
