As you may be aware, the American Medical Association (AMA) recently released a set of temporary Current Procedural Terminology (CPT®) health insurance billing codes for ABA evaluation and treatment services that went into effect July 1, 2014. Although this is a major step forward for our field and CalABA supports efforts to improve health insurance billing procedures, the rollout of these new codes will likely pose challenges for practitioners and health insurance carriers alike.

CalABA is actively engaged in discussions with insurance regulators and health plans in California and beyond about implementation of the temporary codes. We will keep our membership apprised of the results of these discussions. In the interim, we offer some preliminary answers to questions our members have been asking.

Q. Why are the codes considered temporary?
A. According to the AMA, "CPT Category III codes are a set of temporary codes that allow data collection for emerging technology, services, and procedures. These codes are intended to be used for data collection to substantiate widespread usage..."

Q. Should I start using the new billing codes right away?
A. It is essential to understand that the use of billing codes is a contractual matter. Providers should only use billing codes for which they have written approval from the health plans with which you are contracted as a provider.

Q. Will all of my contracts be switching over to the new codes?
A. We anticipate that some carriers will elect to adopt the new temporary CPT codes while others will not. Check with each health plan with which you are contracted on the billing codes you are to use.

Q. Why will some carriers use the new codes and some continue to use current codes?
A. Carriers will select a code set that serves their various needs based on many variables.

Q. How will I know if I need to switch to the new codes?
A. Carriers with which you are in-network should notify you directly and likely will require you to sign an addendum to your existing contract or a new contract specifying the new billing codes you are to use.

As always, read your contracts carefully. Please reach out to CalABA at [email protected] if questions or concerns arise.