| 2009 CPT & CDT Codes |
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| Recommendations of the HOSC |
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Recommendations on the placement of new procedures codes from 12-04-08 HOSC meeting (pdf)
HIPAA dictates that the OHP contracted managed care plans and the Division of Medical Assistance Programs (DMAP) accept claims for payment from providers that include new procedure codes beginning on January 1st of each year. As CPT codes are proprietary, Health Services Commission (HSC) staff cannot perform research on the new codes until copies of the new CPT code books are received in early to mid-November. In late 2006 an attempt was made to incorporate changes to the Prioritized List of Health Services involving the new codes effective January 1, 2007. While the Health Outcomes Subcommittee (HOSC) was able to review and make recommendations for HSC adoption during meetings in early December on the majority of the codes, some did require additional information before a decision could be reached and any list changes involving these codes could not go into effect until October 1, 2007. While HSC staff were able to get the official notification of the January 1, 2007 changes out on December 18, 2006, they were found to include many errors because time did not allow for an internal review, revised versions of the list and coding placement files could not be updated and posted on the website prior to implementation, and DMAP (and presumably some plans) was not able to complete the process of loading the changes into their system prior to January 1, 2007.
As a result, HSC staff consulted with the OHP Contractors and DMAP and beginning last year the HSC began reviewing the new procedure codes during meetings in December and January to result in changes to the list that officially goes into effect on April 1st. In order to help guide DMAP and the contracted plans as they enter the new codes into their systems for HIPAA compliance, the PDF file above indicates the recommendations developed by the HOSC at their December 4th meeting for all of the new 2009 CPT (medical) and CDT (dental) codes. These recommendations include the proposed placement of new codes onto the Prioritized List as well as recommendations to DMAP to designate codes not being placed on the list as diagnostic, ancillary, or never covered. The recommendations of the HOSC on these new codes, along with some additional technical corrections and new HCPCS codes yet to be reviewed, will then be taken to the full Commission on the afternoon of January 15th for discussion and approval. An official notification letter detailing the resulting final list changes will be sent to the plans by the end of January and forwarded to actuary for a determination of any potential financial impact.
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