The American Hospital Association (AHA) is urging the Centers for Medicare & Medicaid Services (CMS) to eliminate certain “temporary CPT codes” to standardize coding and documentation requirements for outpatient billing.
Hospitals primarily use Healthcare Common Procedure Coding System (HCPCS) Level II codes to bill for products, supplies, and services not covered under Current Procedural Terminology (CPT) codes, according to CMS. These include ambulance services, medical equipment, prosthetics, orthotics, and supplies not typically used in a physician’s office.
In an Aug. 12 letter to CMS Administrator Seema Verma, the AHA highlighted concerns about the “temporary CPT codes” within HCPCS Level II, specifically Q codes and G codes, which add complexity and administrative burden to the coding process.
“CMS states that temporary CPT codes address immediate operational needs of specific insurance sectors that existing national codes do not cover. However, some ‘temporary’ codes have remained in use for years, creating inconsistencies that require different code assignments for the same service when billing Medicare versus commercial insurance,” the AHA wrote.
The letter cited screening colonoscopies as an example, where Medicare requires HCPCS Level II codes while commercial payers use CPT codes, leading to discrepancies in billing.
To resolve this issue, the AHA urged CMS to reduce or eliminate the use of “temporary” Q and G codes and align billing requirements with CPT codes. This would ensure consistency across all payers, allowing providers to use a single national CPT code for the same service.
The AHA’s letter was submitted in response to the federal government’s request for feedback on reducing administrative burdens in healthcare.