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Creating a new CPT code

  1. Question Creating a new CPT code
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    Hello, All!

    Today I spoke w/ a man who offers a medical "product" for our weight loss clinic. He asked me about billing, and what he needs to do to have his particular product become something that insurance will pay for. I explained to him that all medical goods and services have a CPT association, and if his product is really something that can be considered "medical" his product would need a CPT. He has studies backing the benefits of this product. He asked me how one goes about getting a code created. I was at a loss, but figured his first stop is either the AMA or FDA, to establish his product as something considered medical. I also mentioned the use of unlisted procedure codes, but that's always an iffy situation, especially if his product is not something that is medically necessary and since he has no contracts with any insurance companies.

    How are new CPT created and how does one go about attempting to obtain one?


  2. #2
    Columbia, MO
    The AMA has a process for this and the information is on their website but basically the request needs to come from a physician as I recall.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Sioux Falls South Dakota
    In addition, if this is a "product" rather than a procedure, it could well not qualify for a CPT code. He may want to look into getting a HCPCS code - that is through the federal government: Alpha-Numeric HCPCS Coordinator, Centers for Medicare and Medicaid Services, C5-08-27, 7500 Security Blvd, Baltimore, MD 21244-1850. FDA Approval may need to be obtained, also - I would have him check their website for instructions.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  4. Default
    Thank you both for your insight!!

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