CMS assigned an absolute edit to most new CPT codes

Why This Topic Matters

Understanding this update helps practices anticipate claim denials or payment disruptions for newly released CPT codes and stay aligned with CMS edit files as they are implemented. It is especially relevant for organizations that bill services in the specialties and service categories covered by the update.

Article Sections

1. Overview of the CMS update

   Introduces the CMS edit update, its timing, and the general scope of the reviewed new codes across multiple CPT chapters.

2. MAI 2 codes

   Summarizes the group of newly reviewed codes assigned one adjudication indicator and presents the associated code list.

3. MAI 3 codes

   Summarizes the group of newly reviewed codes assigned the other adjudication indicator and presents the associated code list.

4. Operational considerations for practices

   Discusses the relevance of the update for claims workflow, payer monitoring, and review of plan-specific implementation timing.

5. Resources

   Lists CMS reference materials related to the edit file and the underlying program guidance.

6. Adjudication indicators and medically unlikely edits, effective April 1

   Provides the article’s code-by-code breakdown table organized by adjudication indicator and associated edit values.