Negotiate Rates Now with Private Payers on New CPT Codes for 2013

December 11, 2012

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Neurologists must negotiate rates for all new and revised Current Procedural Terminology (CPT) codes with private payers on an ongoing basis. HIPAA regulations require that all payers—not just Medicare—use ┬áthe AMA's CPT as the "standard" procedural code set, and update their systems according to the release of the new edition of the CPT book every year.

That means, as of January 1, previously reported nerve conduction study and H–reflex codes (95900, 95903, 95904, 95934, 95936) no longer exist in the CPT code set. These “old” codes therefore can NOT be used for any payers for dates of service beginning 01/01/2013.

There may be confusion about when new CPT codes take effect because neurologists are still able to report consultation codes to those private payers that continue to reimburse for the codes. Importantly, private payers still have the option to reimburse for consultation codes because the AMA CPT Editorial Panel did not delete consultation codes out of the code set—the Centers for Medicare and Medicaid Services (CMS) merely made a decision in 2010 that they would no longer reimburse for those codes.

Physicians must negotiate fees or internal credit for the work performed with the private health insurers with whom they contract for all new and revised CPT codes each year. In the negotiations, neurologists should consider whether they receive a certain straight percentage of Medicare, or whether different services receive a varying percentage of the Medicare rates as part of that particular contract.

Negotiations are especially important for neurologists in 2013 as a result of the creation of several new and revised CPT codes that affect nerve conduction studies (95907–95913), intraoperative monitoring services (95940, 95941), chemodenervation for chronic migraine (64615), transitional care management (99495, 99496), and chronic care coordination services (99487, 99488, 99489).

Learn more about how the AAN participates in the CPT process.