New 2027 CPT codes released as AMA faces mounting criticism

The American Medical Association has released the Current Procedural Terminology code set for 2027 amid criticism that it has created a monopoly over the coding and billing tool.

The latest code set, set to take effect on Jan. 1, has 453 editorial changes, including 299 new codes, 74 revisions and 80 deletions.

The CPT code set provides a standardized system of five-digit medical codes and related descriptions for reporting medical, surgical and diagnostic services and procedures. The AMA releases updates each year based on recommendations from the CPT Editorial Panel, consisting of clinical expert volunteers appointed by the group's board of trustees.

The new codes for 2027 notably update billing and coding for several areas, including ventricular assist device procedures, hernia repair, prostate biopsy, biofeedback, radiology and sleep medicine.

The latest CPT code set also replaces the global maternity care bundled with a new code framework to reflect contemporary obstetric care from antepartum to postpartum, the AMA said in the announcement yesterday evening.

Additionally, the AMA added 10 new codes to better describe AI-related services that support or assist healthcare providers. The latest additions bring the total number of AI-related CPT codes to 43.

CPT codes are accepted by public and private payers and used by virtually every U.S. provider and healthcare facility.

With such widespread use, legal and patient advocacy groups, such as PatientsRightsAdvocate.org, have filed lawsuits against the AMA seeking to invalidate their copyrights on the code set. They argue that the set's incorporation by reference in federal regulations and state laws means the codes should belong in the public domain for free access.

The CMS has also recently sought public feedback on using an alternative to the CPT system. The agency questioned the nearly six-decade-long reliance on the AMA's recommendations, given that the group is a private entity with financial stakes in coding and payment valuations.

Critics have raised concerns about high licensing costs and administrative complexity that could be driving up federal healthcare spending. The code set has expanded to over 7,800 codes, creating an environment ripe for billing inaccuracies and potential fraud, waste and abuse, they argue.

The AMA defended the code set in the latest announcement, saying it provides a pathway for incorporating new medical services and procedures into the healthcare system while serving as "the backbone of health data interoperability."

"The continued evolution of the CPT code set demonstrates why a trusted, physician-led coding system is essential," said AMA President Dr. Willie Underwood III. "As new technologies and clinical approaches emerge, the nation's health system needs a reliable way to describe the care physicians provide."

The AMA is "uniquely positioned," Underwood continued, to oversee the code set as it is the largest physician association in the country.

Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health IT since 2016.