Payers Not Accepting 2013 CPT Codes? That’s a HIPAA violation.

by Rebecca Farley on January 28, 2013

Are the payers you work with creating new definitions for the 2013 CPT codes? Or not accepting claims submissions with 2013 CPT codes? Both are HIPAA violations.

The AMA recently released two Practice Management Alerts (on January 7th and January 8th) encouraging providers to report HIPAA violations.

While payers can make benefit and reimbursement decisions, they must ”use the current applicable medical data code set valid at the time the health care is furnished.” This includes not making changes that are contrary to the guidelines provided in the CPT code set, even if they are using 2013 codes.

The AMA recommends filing a complaint through the Centers for Medicare and Medicaid Services website and/or through the AMA’s Health Plan Complaint Form. AMA members and their practice staff can also download sample appeal letters and customize them for use in their practices.

Are you up to speed on CPT code changes for 2013? Check out our CPT resource page:


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