News Alert from the AAOM National CPT Advisory Task Force

July 14, 2005

2005 CPT Code Update: CMS Publishes Higher Values

The Centers for Medicare/Medicaid Services (CMS) has just published a new determination of "customary and reasonable" fees for the acupuncture CPT codes introduced at the beginning of 2005. CMS has increased these fees by an average of 63% for acupuncture and electro-acupuncture.

In January 2005, the American Medical Association (AMA) replaced existing Current Procedural Terminology (CPT) codes for acupuncture and electro-acupuncture with an entirely new set of codes. Subsequently, CMS published relative value unit (RVU) valuations for these new codes. Due to an error in the the RVU calculation, these initial RVUs significantly undervalued acupuncture services. Acupuncturists across the nation were adversely impacted by this CMS error. As a direct result of these published rates, many commercial insurance companies and managed care networks reduced the "customary and reasonable" amounts for the new CPT codes far below what many providers consider minimum payment for these services.

AAOM has been deeply concerned about the implications of these low RVU values for the financial future of its members and the profession. As a result, in March of 2005 AAOM formed the National CPT Task Force inviting representatives from state associations across the nation to participate. We selected two Co-chairs to lead the task force: Shane Burras L.Ac., AIMS Director and Insurance Committee Chair, and Connie Taylor L.Ac., President of CSOMA. The National CPT Task Force works collaboratively to present a united front focused on addressing the deficiencies in the new codes and their valuations , and to ensure that our members have the most up-to-date information available.

CMS Publishes Higher Values: The AAOM National CPT Task Force is pleased to report that effective July 1, 2005--CMS has published corrected relative value unit amounts for the 2005 CPT codes. This information published by CMS will positively affect the financial lives and practices of acupuncturists across the nation. Below is an example of the fee calculation for Los Angeles County. As you can see, this change represents a dramatic increase in the fees.

CPT Codes CMS Fee Schedule

January 2005

CMS Fee Schedule

July 2005

97810

$24.94

$41.38

97811

$22.78

$31.78

97813

$23.52

$44.24

97814

$22.95

$35.93

The National CPT Code Task Force will continue its work by facilitating the dissemination of this new information, by educating commercial and other insurance carriers, and by providing carriers with the data needed to make fair determinations of "reasonable and customary" fees. Insurers have historically utilized the CMS fee schedule as the defacto "minimum wage" indicator for providers across the nation. The Task Force will continue to provide insurers with the information they need to bring their fee schedules into alignment with the new CMS values, but these decisions are ultimately in the hands of individual carriers.

Many thanks go out to the individual participants and associations across the nation who have helped effect this change. This effort serves to illustrate the amazing results that are possible through collaborative efforts to advance the acupuncture and Oriental medical profession. Special thanks should go to the American Association of Oriental Medicine (AAOM) for sponsoring this task force; to the California State Oriental Medical Association (CSOMA) for working diligently alongside AIMS on this project; to Gene Bruno, Will Morris, and Connie Taylor for the leadership they provided in this process; and to Rebekah Christensen, AAOM Executive Director, for her endless support without which this achievement would not have been possible.

If you are interested in the nuts-and-bolts details behind these changes, we have linked this information.

We recommend you forward this email to your OM colleagues and advise them to contact AAOM if they are not currently receiving the AAOM News Alerts. If you are not currently a member, we urge you to consider joining the AAOM and your state associations, as practitioner membership and involvement combines to create the resource base that protects and advances this profession.

Sincerely,

Shane Burras
Co-Chair, AAOM National CPT Task Force