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APTA partners with the ACA to submit application for a dry needling CPT code

Monday, October 8, 2018   (0 Comments)
Posted by: Matthew Nicholas
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APTA partners with the American Chiropractic Association (ACA) to submit application for a dry needling CPT code

APTA and ACA staff and member experts are presenting the application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public.

We looked into the process of establishing a new CPT code and found out that, once the application for a code has been submitted, the AMA staff refers the application to the CPT Advisory Committee.  If the committee decides a new code is not needed, then the AMA staff informs the requestor on how to use existing codes to report the procedure.  If a change should be made then the issue is referred to the CPT Editorial Panel. 

The CPT Editorial Panel is comprised of 17 members and is responsible for maintaining, revising, updating or modifying the CPT code set.  The panel includes eleven physicians who are nominated by the National Medical Specialty Societies and approved by the AMA Board of Trustees; one physician each nominated from Blue Cross and Blue Shield Association, the America’s Health Insurance Plans, the American Hospital Association, and the Centers for Medicare and Medicaid Services (CMS); one Performance Measures representative is chosen from nominees solicited from Performance Measures development organizations and appointed by the AMA Board of Trustees, and two member of the CPT  Health Care Professionals Advisory Committee.

The CPT Editorial Panel meets quarterly to discuss these items.  The Panel can result in three outcomes:

  1. Add new code or revise existing nomenclature
  2. Postpone/table an item to obtain further information
  3. Reject an item

If an item is rejected, there is an appeals process for reconsideration.

If a new CPT code for dry needling were to be approved by the AMA, the next step is valuation of the code by CMS.

In the meantime, the IPTA continues to recommend that practitioners who seek to bill a third-party payer for dry needling should first check the payer's coverage policy to determine if dry needling is a covered service and if the policy specifies which code is used to report the service.

10/08/2018


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