AMA billing codes are a new target for DC. Fighting medical fraud

WASHINGTON — For decades, politicians have blamed some of the health care system’s problems on the nation’s largest physician lobby. Now, Republicans are facing new attacks as they paint health insurance cuts as anti-fraud policies.

The law requires physicians to bill Medicare and Medicaid fees for services using Current Procedural Terminology (CPT) codes owned by the American Medical Association. The code describes the services the patient received.

Leading House Republicans are requesting a meeting with Centers for Medicare and Medicaid Services officials to discuss oversight of the CPT coding system as part of the committee’s investigation into fraud, waste, and abuse. In a letter, Representative James Comer of Kentucky suggested that the “complexity” of medical coding “may be contributing to inappropriate billing and rising costs” and “creates an environment where inaccurate billing thrives.”

STAT+ exclusive story