Mr. Chairman and members of this Committee, I appreciate the invitation and opportunity to appear before you today to discuss the coding of Complementary and Alternative Medicine Services (CAM) from a Health Plan's perspective.
American Specialty Health (ASH) operates in California and nationally from its corporate headquarters in San Diego, California. ASH is a full service specialty benefits company for complementary health care and lifestyle management. ASH administers benefit plan programs for chiropractic, acupuncture, massage therapy, naturopathy and/or nutrition services in California and nationwide to health plans, insurance carriers, employer groups and trust funds. Outside California ASH affiliates currently cover over five million members.
Its affiliate American Specialty Health Plans® of California, Inc. (ASHP) is a licensed specialty health plan for chiropractic and acupuncture services, currently covering over four million Californians. ASH affiliates currently work with many health plans such as Blue Cross Blue Shield, Kaiser, HealthNet, PacifiCare and others.
ASH's services include utilization management, quality management, member and provider services, claims processing and provider credentialing. American Specialty Health Plans and American Specialty Health Networks (another ASH affiliate) are accredited by the American Accreditation HealthCare Commission/URAC for the quality of its health care operations.
Affiliates of ASH currently hold individual contracts with over 20,000 providers: 13,000 chiropractors, 2500 acupuncturists, 4300 massage therapists, 240 naturopathic physicians and 700 registered dietitians. Providers are reimbursed on a fee-for-service basis based on a contractually agreed upon fee schedule. Medically necessary services rendered are billed using the American Medical Association’s (AMA) Current Procedure Terminology (CPT) to describe the service(s) performed. All services are coded using CPT. The most common CPT codes currently used by ASH providers include Evaluation and Management (E/M) codes, specialty procedure codes (delineated under the “Medicine” section in the AMA CPT Manual), such as Chiropractic Manipulative Treatment (CMT) and Acupuncture codes, Physical Medicine and Rehabilitation codes, Radiology, Pathology and Laboratory codes. Providers are required to use the CPT codes available that most closely describe the services they provide. For example, acupuncturists are most likely to use E/M codes and/or acupuncture codes to describe their services, while doctors of chiropractic are most likely to use CMT, E/M, Physical Medicine and Rehabilitation codes, and Radiology codes.
ASH requires our CAM providers to use the AMA CPT coding system to describe their services because in our opinion they best describe the services provided and allow ASH to use a common language when working with our health plan clients. ASH has 15 years of experience with the use of CPT codes to describe CAM services. For instance, during the 12-month period from 07-01-01 to 06-30-02, ASH CAM providers were reimbursed for 2.86 million CPT coded services representing a total of approximately 1.2 million claims.
CAM needs a coding system that is understood by health plan clients and providers. CPT codes meet this requirement because of their accuracy and longstanding use in the provider and health plan communities. Using CPT allows the rapid processing of large volume of codes using a common language understood by all the parties involved in the health care services delivery community. Given that there are very few complaints, the ASH CAM provider community appears satisfied that it is able to code its services properly in the ASH system. They are able to appropriately code the services provided and, since they are using CPT, they are also meeting the needs of secondary payers without any difficulties.
As stated earlier, ASH has alliances with many health plans. Most of these health plans, among other delegated functions, delegate clinical management and claims administration to ASH. Data interoperability, data uniformity and data integrity between payers is of paramount importance. Use of the already established AMA CPT system makes this possible. There are currently CAM specific codes to describe CMT, acupuncture and massage services. In the opinion of ASH, the coding needs of insurers are best met through the existing AMA CPT coding system. If deemed necessary, additional CAM codes can be added to CPT via the existing AMA CPT system. CAM providers representing the CAM professions should be allowed to participate as members of the AMA’s CPT Health Care Professionals Advisory Committee to ensure that appropriate CAM coding expertise is included. Adding codes for procedures used by CAM practitioners through the established scientific route within the CPT system has assisted and will continue to assist in the effort to bring data uniformity and consistency into the reimbursement of all health care services.
Thank you for the invitation to testify before this committee.