Legislative Update From SAGES

SAGES LEGISLATIVE ALERT: CPT CODING AND REIMBURSEMENT

The AMA has invited SAGES members to participate in their efforts to address the coding and reimbursement practices of insurers. The rejection of claims or denial of payment for services when CPT modifiers are appended to a CPT code is a continuing problem facing physicians, and most notably, laparoscopic surgeons.

Specifically, the AMA Private Sector Advocacy (PSA) staff would like to know the names of the health insurers (health plans) which reject, deny, or otherwise are not reimbursing you when modifiers are recorded. In addition, AMA PSA staff would like to know the specific CPT modifiers that the health insurer(s) is rejecting and/or denying.

At the moment, no specific documentation about the rejection or denial of the CPT modifiers by each health insurer is needed. However, as the process unfolds, you may be asked to provide specifics including claim forms, EOB or other physician or patient specific information.

All you need to supply are the names of the health insurers, the specific CPT modifiers, and the particular problem (rejection of entire claim, reject of the specific service, lack of payment, partial payment, etc).

If you want to assist us, please download the following form and follow the instructions:

SAGES CPT Modifier Form

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