CPT® codes play a pivotal role in the transition to value-based care

In order for value-based healthcare to succeed, it is imperative that physician practices effectively articulate the medical services and procedures they provide. This underscores the vital role of the Current Procedural Terminology (CPT®) code set in driving the shift towards value-based care.

According to the chair of the AMA/Specialty Society Relative Value Scale Update Committee (RUC), value-based care hinges on a standardized terminology with a long-established track record, enabling quality comparisons and ensuring continuous, demonstrable enhancements over time.

Value-based care aligns payment with the actual outcomes and quality of services, ensuring equity and cost-effectiveness. With evolving payment models demanding greater accountability and risk-sharing from physicians, the significance of the CPT code set is amplified, emphasized by an MD, chair of AMA/RUC, a distinguished diagnostic and interventional radiologist based in San Antonio. He underscores the continued importance of accurately describing physician actions.

The former co-chair of the AMA Digital Medicine Payment Advisory Group, also Chair of the AMA/(RUC) community, highlighted the pivotal role of the CPT Editorial Panel in streamlining care, particularly in moving away from fragmented fee-for-service payment. This includes the establishment of care management codes for post-encounter services like developing care plans and collaborating with other professionals for execution.

During a recent AMA webinar, the Chair of the AMA/(RUC) emphasized how the CPT code set forms the bedrock of innovative care models and payment reforms aimed at delivering high-quality and equitable patient care. Beyond billing, it also furnishes essential data for designing cutting-edge healthcare delivery models, enabling assessment of resultant savings and quality enhancements.

In the face of emerging value-based care models, the transparent, evidence-driven process of the CPT Editorial Panel in creating new codes offers solutions tailored to the requirements of physicians, healthcare professionals, systems, policymakers, and payers.

Encouraging Value-Based Care by CMS

During the webinar, the AMA’s director of editorial and regulatory services emphasized the Center for Medicare and Medicaid Innovation’s ambitious target: ensuring 100% of traditional Medicare beneficiaries receive value-based care through an Accountable Care Organization (ACO) by 2030. While interpretations of value-based care may vary, Hochstetler underscored the core principle of ‘patient-centered care.’

Hochstetler outlined key components of the AMA’s framework for high-value care, which encompass:
• A clear, shared vision placing the patient at the core.
• Leadership that fosters training with a focus on teamwork.
• A robust IT infrastructure.
• Wide-ranging access to care, particularly for the most vulnerable patients and those in marginalized communities.
• Payment models designed to eliminate incentives for volume-based care.

Assistance in Implementing Value-Based Care through CPT

The AMA has created a guide to propel the adoption of value-based care through alternative payment models (PDF). Additionally, the AMA, in collaboration with the health insurer trade group AHIP and the National Association of ACOs, has introduced a playbook aimed at enhancing the implementation of value-based care frameworks in the private sector. This initiative holds the potential to significantly improve the quality and equity of care while facilitating participation through the voluntary alignment of data-sharing practices.

For comprehensive resources on CPT coding, the AMA offers the CPT 2024 Professional Edition codebook and other CPT materials, available through the AMA Storefront on Amazon. This inclusive book comprises over 11,100 codes within the CPT code set, and notably, it also features consumer-friendly Spanish-language code descriptors for the first time. Additionally, an additional resource titled ‘CPT Changes 2024: An Insider’s View’ is accessible to aid in the seamless transition to the newly modified CPT code set on an annual basis.

To further support learning, a dedicated CPT education section has been established on the AMA Ed Hub™ online learning platform. This section includes a series of learning modules covering the fundamentals of CPT coding.

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