05/14/2024

A CPT Code for Prior Authorization? Here's How it Could Happen

One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now.

Alex Shteynshlyuger, M.D., initially submitted a proposal for the American Medical Association (AMA) panel in Chicago this week that has since been rescinded. Shteynshlyuger, the director of urology with New York Urology Specialists, told Fierce Healthcare that he believes the plan he brought forward is the only way to realign the incentives of prior auth services that are unbalanced in favor of insurers.

“Prior auth is one of the biggest issues of concern for physicians nationwide,” he said. “It’s also a big concern for patients. It frustrates everyone.”

Under this CPT code plan, prior auth services would be a time-based, Category 1 code. He believes prior auth services are shown to be medically necessary and show clinical benefit, meeting the requirements of a Category 1 code. His plan is similar to a policy proposal by Harvard economist David Cutler several years ago.

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