Preparing for AMA’s CPT® 2025 Updates
The American Medical Association (AMA) is set to release the CPT® 2025 Code Set on January 1, 2025. This release introduces significant changes to the coding landscape for healthcare professionals and organizations alike. With 270 new codes, 38 revisions, and 112 deleted codes, the 2025 updates will impact the way medical services and procedures are documented, billed, and reimbursed.
Staying ahead of these changes is crucial for healthcare providers, coding professionals, and organizations to ensure compliance, maintain billing accuracy, and avoid disruptions in reimbursement. There are necessary steps that need to be taken to ensure your organization is prepared for AMA's release of the CPT 2025 code set including athenaNet tablespace configuration edits along with updates to protocols and training materials.
Breakdown of Changes in CPT 2025
Here’s a quick summary of the key changes in the 2025 code set:
270 New Codes: These reflect emerging technologies, new procedures, and updated medical practices that were not previously captured or have evolved since the last update.
38 Revisions: Existing codes will undergo modifications, such as updated descriptions, new inclusions/exclusions, or changes in coding guidelines.
112 Deletions: Some codes will be retired, either due to obsolete practices, changes in medical technology, or consolidation of codes for simplicity.
These changes are designed to reflect the dynamic nature of healthcare. They will affect specialties ranging from surgery and radiology to dermatology, orthopedics, and behavioral health.
How to Prepare for CPT 2025 Code Set
Update athenaNet Fee Schedule
Add new codes that your organization supports and delete those that are no longer in scope.
Update athenaNet Allowables
Follow up with payers to determine what the expected allowable reimbursement rate will be for new codes. Add those new codes and rates to the Allowable Schedules in athenaNet.
Update athenaNet Custom Rules
Determine if there is any need to add Custom Rules for the new Procedure Codes to ensure they are used appropriately during the initial roll out.
Update athenaNet Claims Worklist
If your Claims Worklists are customized by procedure codes, then you will want to consider how these new codes should filter into your existing worklists or consider building a new worklist to more closely monitor denials for these new codes.
Update athenaNet Order Type & Procedure Template Mapping
Determine if any of the new codes should be mapped using Clinicals Admin > Order Type & Procedure Template Mapping. This will allow the code to automatically trigger on the provider’s billing tab after ordering.
Update any workflow guides or standard operating procedure documents
Implement templates or checklists to ensure all relevant new services and procedures are thoroughly documented and linked to the appropriate CPT code.
Retrain providers and billing staff on new regulations
Communicate changes via email - Make sure that all providers and clinical staff are aware of revised code descriptions to ensure they accurately document the services they provide.
Review changes during Internal Meetings
Host Training Sessions. Record/Distribute Training and require review
Stay Updated on Payer Guidelines
Insurance companies and government programs like Medicare and Medicaid may release their own updates or clarifications on how the new CPT codes should be applied in their systems:
Check for Payer-Specific Guidelines: Each payer may have slightly different rules for applying the new codes. Make sure your coding team is aware of these guidelines.
Monitor Coding Updates: Watch for updates from major insurance companies regarding how they will process CPT 2025 claims, especially if there are any changes in reimbursement rates or coverage policies.
Monitor for Continued Changes
The CPT code set is regularly updated, and there may be additional changes or clarifications even after the initial release of the CPT 2025 codes. Stay Informed: The AMA will provide detailed guidance, including errata or addendums, if necessary. Keep an eye on these updates to ensure your coding practices remain current.
While it can be overwhelming to manage the transition to the CPT 2025 code set, remember that this process is an opportunity to refine your coding practices, streamline workflows, and enhance reimbursement accuracy. By embracing the change and preparing strategically, you’ll set your practice up for success in the coming year.
Behavioral Health E/M Code Updates
