Speaking in “Code”: Why CPT® is a Language Every Entrepreneur Must Learn

by | Oct 6, 2021 | Alliances, Policy

Do you speak fluent CPT®? If not, as a health technology entrepreneur, you likely need to learn more about how a new medical device or procedure fits into the Current Procedural Terminology (CPT) code landscape. That was the topic of a recent American Medical Association webinar hosted by Stanford Byers Center for Biodesign and Fogarty Innovation, and co-sponsored by AdvaMed, Wilson Sonsini Goodrich & Rosati, MedTech Strategist, Silicon Valley Bank and the Medical Device Manufacturers Association (MDMA). 

The goal of the webinar was to help the more than 300 attendees understand how the CPT codes used by physicians, qualified healthcare professionals, health plans, health technology companies and others to describe care also support innovation.

“Making the CPT coding process understandable and transparent is a very important step for early-stage companies, as we all share the mutual goal of getting innovative technologies to patients,” said Andrew Cleeland, CEO of Fogarty Innovation. 

“This is the first of many opportunities for us to collaborate, bringing important content related to processes and policies associated with innovation to all of you so that you can better serve patients,” said Josh Makower, director of Stanford Biodesign.

The presenters included four speakers from the American Medical Association: Laurie McGraw, senior vice president, Health Solutions; Jay Ahlman, vice president, Coding and Reimbursement; Leslie Prellwitz, director, CPT Content Management and Development; and Kenyetta Jackson, Health Equity Manager, Health Solutions.  

The benefits of learning the language of CPT

“We view CPT as the foundational language for innovation, a universal language that’s been around for 50 years,” Laurie said. Change has been rapid, with record levels of investment in digital health, AI and genomics that have reached $20 billion globally. “We want to make sure CPT supports the advancement and adoption of these technologies, and that means we need to listen to the entrepreneurs who are working on these technologies to make sure we understand the challenges and opportunities.”

Likewise, when innovators understand the language and know how to work with it, they are better positioned to understand how their devices fit into patient care. “Physicians want to know that the innovation works and that the technology fits into their existing workstreams,” she said.

“The great thing about CPT codes is that they really are a common language so no matter who you’re talking to, everybody understands,” says Leslie. For example, if a patient gets a hip replacement, they can look at the patient portal to see how much insurance will pay using a code and a description that make sense to the patient, the physician and the payers.

The AMA looks to entrepreneurs to help ensure that codes for new services are being considered to help enhance adoption and keep the health of the nation moving forward, while also addressing the equity gap. For example, more innovation and access are needed in telehealth, given that one out of every four Americans doesn’t have the digital skills or technology needed to engage in video visits.

Today there are nearly 11,000 CPT codes available, and  the CPT code set continues to capture new procedures and terminology through  the rigorous CPT Editorial Panel process.

Weave CPT codes into the development process

While most startups make it a priority to create a strategy for their preferred FDA regulatory pathway, innovators also need to think about the reimbursement pathway, which is often neglected until later in the development process. Instead, early on, innovators should think about their initial requirements and key steps, which might include submitting a comprehensive CPT code change application. During the webinar, the panel suggested checking into the process and timelines on the AMA website. 

Fortunately for innovators, there are a lot of parallels between the information required for FDA and CPT code submissions, which streamlines and speeds the process. 

American Medical Association as collaborator in innovation 

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises, and driving the future of medicine to tackle the biggest challenges in health care.

To this end, the AMA continually aims to streamline and improve the CPT code development process in order to improve the review and approval process while maintaining the same rigor. While the CPT code development process continues to move as medicine does, the speakers stressed it was vital to hear from stakeholders so they can continue to improve the process and stay up to date with the latest advances. 

“The CPT code development process has certain steps. We are talking actively about how to make those steps just a little easier and faster to navigate, and the AMA team has been responsive,” said Josh. “We have made great progress and we look forward to more to come.” 

CPT Code Set Resources

Visit the CPT code set quick reference guide page to learn more about AMA and CPT resources on: 

  • The CPT Editorial Panel Process, including code change application details and the Editorial Panel meetings calendar 
  • CPT News, for the latest in CPT Codes and Content 
  • Innovation and Technology 
  • Medical Practice Management 
  • Health Equity 


Webinar recordinghttps://youtu.be/Vb1FeGRzJbM

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