AMA CPT Development
CHEST Specialty Assistance Program to Industry on CPT Application Review
The American College of Chest Physician (ACCP) and the American Thoracic Society (ATS) work together at the national level on coding and reimbursement issues through the ACCP Practice Management Committee and the ATS Clinical Practice Committee. Major decisions are reviewed and approved by the ACCP and ATS Board leadership. ACCP and ATS are actively involved in developing American Medical Association (AMA) Current Procedural Terminology (CPT) proposals for new or revised procedure or service codes relevant to pulmonary, critical care and sleep medicine..
The ability to obtain new codes has evolved through early communication with industry and provision of frequent guidance on issues pertinent to reimbursement. Often, these aspects are not inherent in processes involved in FDA approval. Additionally, data necessary for optimizing reimbursement for practitioners may not be considered when developing efficacy and safety studies to support widespread clinical use of new technology. These components of the process are aspects for which the pulmonary societies are able to confer expertise. We actively work with sister societies, such as SCCM, AARC, and NAMDRC on relevant issues.
To facilitate communication with industry, we have outlined required information ACCP and ATS need to assist in the reimbursement process. We recognize that the phase of development of technology will vary and not accommodate the ability to provide all of this information initially. For these projects, we are able to provide guidance as the development matures. However, all should recognize that ultimately this information is needed when attempting to obtain a CPT code and the reimbursement associated with its use. The ACCP and ATS are prepared to assist companies desirous of proceeding along these lines at any step of their development. To prepare our CPT advisors with the necessary defense to support new procedures, the ACCP and ATS work through their committees, networks and institutes to solicit input from individuals that are disconnected from the development process however are considered experts in the area under consideration. Although this critical review of the new technology may appear onerous, the CPT and RUC process will engender this debate and our organization recognizes this exercise facilitates preparing the best proposal. The following reflect our guidelines for assisting with this process. Industry should not contact ACCP CPT and/or RUC advisors or members of the Practice Management Committee directly to lobby for CPT proposals. Initial contact requesting this help should be directed to Diane Krier-Morrow at email@example.com
To view the AMA’s calendar of CPT and RUC meetings and deadlines go to http://www.ama-assn.org/ama1/pub/upload/mm/362/calendar2007-09.pdf
Information Requested from Industry to Facilitate Pulmonary review of CPT Code(s) and Reimbursement
- A brief executive summary or grid of results of 5 U.S. peer-reviewed literature supporting the clinical utility of the device/procedure. Peer-reviewed literature that has passed certain validation is in Index Medicus, indexed as MEDLINE at
http://www.nlm.nih.gov/tsd/serials/lji.html Copies or links to reprints of articles and abstracts should accompany the submission. For less mature technologies, a descriptive narrative explaining the technology and bulleted brief descriptions of physician work and preliminary investigation is adequate.
- A statement regarding which authors in quoted literature have financial ties (stock ownership, consulting fees, research support, honorariums, hedge fund advisory position) with the company. The presence of a financial relationship does not preclude utilization of the data that the investigator is responsible for.
- A review of safety data regarding the device/procedure
- A CPT application should be completed by the requestor as completely as possible (available at http://www.ama-assn.org/ama/pub/category/12889.html) including all literature in support of the application.
- The requestor should provide data regarding physician work for the procedure (pre-, intra- and post-service) and practice expenses (clinical labor by staff type, disposable supplies, and equipment) for both the facility (hospital, ASC) and non-facility (office) settings.
- The requestor must provide the listed catalogue price for any devices and supplies involved in performing the procedure, both in the facility and non-facility settings.
- The requestor must provide the names and contact information of three physicians the company feels can comfortably analyze the procedure/device and who have no financial ties or involvement with research or hedge fund advisory relationship surrounding the company.
- Industry may forward a request to make presentations to representatives of ACCP and ATS at regularly scheduled quarterly committee meetings. Meetings are held in April, August and December each year. The number of presentations will be limited by the volume of material on the committee agenda. Presentations are limited to a maximum of 30 minutes.
For technology/devices that are in the early stages of development, items 4 and 6 may not be applicable.
For questions, contact:
Diane Krier-Morrow, MBA, MPH, CCS-P
American College of Chest Physicians (ACCP) and the American Thoracic Society (ATS)