CMS Seeks Input on Potential Overhaul of CPT Coding System
On July 14, CMS published a Request for Information in the CY 2027 Physician Fee Schedule Proposed Rule seeking feedback on potential reforms to the AMA's Current Procedural Terminology (CPT) coding system. The RFI explores sweeping changes to how medical procedures and services are coded and billed across Medicare and Medicaid. CMS has not specified an effective date; this is an information-gathering exercise ahead of potential future rulemaking. The inquiry could affect how Medicaid fee-for-service and managed care organizations code, reimburse, and track healthcare services, with implications for payment accuracy, prior authorization processes, and claims administration.
Any CMS reform of CPT coding would directly affect Medicaid FFS and MCO payment systems, claims processing, utilization management, and encounter data reporting — state agencies and health plans rely on CPT codes for service definitions, rate-setting, and program integrity.
Managed Care · Finance
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