CPT Codes for Prior Authorization: Reporting Prior Authorization–Related Activities Within E/M Services (99203, 99204, 99205, 99213, 99214, 99215, 99358, 99452, 99080)
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Prior authorization (PA) is an administrative process that requires physicians or other qualified health care professionals (QHPs) to obtain approval from a health insurance carrier before a service, supply, or medication will be authorized if provided to a patient. The process may include extensive review and discussion leading to physician attestation to affirm the appropriate care path, all of which can involve a significant amount of time and work for the physician or other QHP. This article provides information on how PA-related work performed by physicians or other QHPs is recognized within evaluation and management (E/M) office or other outpatient codes and other codes in the Current Procedural Terminology (CPT®) code set. Continue Reading
