Important Issues

On Wednesday, the American Medical Association and four state medical societies filed a brief in the court case Peters v. Aetna claiming certain insurance companies misuse Current Professional Terminology (CPT) codes to pass on administrative charges as medical care.

The case is before the 4th U.S. District Court of Appeals in Virginia.The case is on appeal from the U.S. District Court for the Western District of North Carolina.

The brief argues that Aetna used CPT code 97039 to charge patient Sandra Peters an administrative fee as part of a chiropractic visit. The AMA brief argues that:

CPT does not have a "catch-all" or "miscellaneous" code that can serve as a label for whatever the defendants elect to charge a member and their plan. The defendants searched for a CPT code that would be difficult for a layman to understand in order to "bury" (their words) their administrative fees so they could assert an unjustified, uncontracted charge against Ms. peters and her employer-funded health insurance plan.

The AMA is the author and copyright holder of the CPT and the codes are maintained and updated by a panel of 17 medical and allied health professionals (including the insurance industry). The brief also argues that documents sealed in the case need to be unsealed and for the case to go before a jury.