Consideration postponed for new billing codes for prior authorization

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Medical experts have put on hold a proposal to create new billing codes for prior authorizations.

The American Medical Association’s CPT (current procedural terminology) Editorial Panel was scheduled to meet May 9 to 11. The agenda included a proposal to create new codes that physicians could use to bill for time spent requesting approval to treat patients.

Alex Shteynshlyuger, MD, said he spoke with the editorial panel briefly on May 9 “and decided to remove the proposal temporarily to address a few concerns that they had.” In an email to Medical Economics, he hinted “there will be a lot of great news as a result of this proposal/meeting,” and that a proposal likely would be resubmitted with a few modifications, but he did not elaborate on details.

Shteynshlyuger and others have argued that insurance companies should compensate physicians and their staff for the time spent compiling patient records for payers to review before authorizing treatments. The process has become burdensome, with physicians, patients and their advocates calling for reforms to streamline interactions that cause harm through delays in treatments.

Along with patients waiting for care or abandoning treatments due to time spent waiting, the work is a net financial loss for physicians and a gain for insurance companies because they don’t have to pay for care, Shteynshlyuger has said.

The problem has reached Congress, where the “Improving Seniors’ Timely Access to Care Act” has strong bipartisan support, along with backing by medical groups. The act has remained pending for years, but has not passed.

Earlier this year, the senators and representatives supporting the act also praised new rules by the U.S. Centers for Medicare & Medicaid Services that aim to speed up PA and promote greater interoperability. Starting in 2026, there will be new requirements for payers to have quicker turnaround on requests for patient care. Medical groups also voiced support for the new rules, although American Academy of Family Physicians President Steven P. Furr, MD, FAAFP, noted U.S. health care would benefit from congressional action to improve the PA process and cut the number of prior authorizations needed.