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Code Change Requests

Coding Cycle

Code changes for all medical specialties take effect on January 1 annually as a result of the CPT Editorial Panel process. The American Medical Association (AMA) is responsible for Current Procedural Terminology (CPT) and has convened the CPT Editorial Panel to develop and maintain the nomenclature healthcare providers use to report medical procedures and services. The CPT Editorial Panel meets three times a year to evaluate code change proposals for new and emerging technology and is responsible for reorganizing and maintaining the code set. After codes are created or modified by the CPT Editorial Panel, they go before the Relative Value Update Committee (RUC), also convened by the AMA, to be valued. For more information on the RUC process and how to efficiently complete a RUC survey if you are randomly selected to do so, this 13-minute video prepared by the AMA is a good resource.

The CPT Editorial Panel and the RUC processes are cyclical; code changes approved by the CPT Editorial Panel at the February 2017 meeting, the May 2017 meeting, and the October 2017 meeting take effect on January 1, 2019. The Centers for Medicare and Medicaid Services (CMS) takes the RUC recommendations under consideration when assigning final values to codes and updates its payment policies annually via the Physician Fee Schedule rulemaking.

ISASS joined the AMA’s House of Delegates in June 2014. With a seat in the House of Delegates came the opportunity to participate as advisors to the CPT Editorial Panel and the RUC beginning in calendar year 2015. ISASS strives to represent our membership in all three of these forums.

Requesting Code Change Support or Sponsorship from ISASS

  1. Review information regarding the CPT Editorial Panel process and the RUC process
  2. Draft a code change proposal for review by ISASS. Please include the following information in your proposal:
    • Contact information of requestor
    • Type of support requested
    • Type of code change requested
    • Rationale for request
    • Procedure and technology description
    • Volume/utilization of procedure or technology
    • Published clinical evidence supporting the request
  3. Submit your code change proposal to ISASS at codingassistance@isass.org
  4. The ISASS CPT Review Subcommittee will review the request and will contact the requestor with a final determination.

 

If you have further questions, please email codingassistance@isass.org.

 

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