Will there be a new billing code to capture time spent working on Prior Authorizations in 2025?

Unless you’ve been living under a rock, you know just how AWFUL and laborious the prior authorization process can be for medical practices near and far! The time spent obtaining, tracking, managing, and appealing prior authorizations is currently not billable to third-party insurance companies or patients and represents an enormous administrative burden and time-suck to healthcare professionals.


Alternative models to prior authorizations like gold card programs have been largely unsuccessful at achieving their primary objective of decreasing prior authorizations for practices that have met certain metrics. The good news is that we may now get a new mechanism for tracking and quantifying the amount of time and money spent on prior authorization work!


The American Medical Association’s CPT Editorial Panel is scheduled to meet May 9 – 11, 2024 to discuss the 2025 CPT Coding Updates. The agenda includes many items to discuss, but specifically mentions 3 new potential codes (99XX1, 99XX2, 99XX3) that could be reported to capture Physician/QHP/Clinical Staff time related to prior authorization work. This comes on the heels of Medicare’s new rule (CMS-0057-F) streamlining and reforming many prior authorization rules for Medicare Advantage organizations, State Medicaid agencies, and other federal healthcare programs.
Although new codes will not solve the major problems surrounding prior authorizations, it will provide a tracking mechanism and way to quantify the amount of time and money involved in complying with prior authorization requirements. Read more about the potential new Prior Authorization CPT Codes here:


https://www.medicaleconomics.com/view/could-there-be-a-new-cpt-code-coming-for-prior-authorization-work-
https://www.ama-assn.org/system/files/cpt-panel-may-2024-agenda.pdf

Share:

Facebook
Twitter
Email
LinkedIn

Related Posts

Invest in Yourself

Self-development is a life-long journey that involves setting goals, acquiring new skills, curating unique life experiences, and expanding your perception and knowledge base.  Perception =

Read More »