番茄社区

Physicians who use the electronic medical record (EMR) will have to pay separately for CPT code licensing fees next year -- and there has been confusion over the price.

CPT codes are owned and managed by the American Medical Association, and licensing fees are typically wrapped up into the cost of the EMR itself, so physicians rarely see them.

But for reasons that neither the AMA nor Practice Fusion (through its parent company Allscripts) would discuss with 番茄社区, the EMR vendor is passing on the cost to the user for 2021.

AMA says the cost to license its CPT codes is $17 per user per year, but some physicians told 番茄社区 they were initially asked to pay $300, despite being in solo practice.

Jonathan Malek, chief technology officer at Practice Fusion, that the AMA "owns the copyright on CPT codes." A company spokesperson similarly told 番茄社区 that the AMA "holds the copyrights to CPT codes and thus governs their use. As a result, questions about charges for the use of CPT codes should be addressed to the AMA or an authorized distributor."

The AMA selected Optum360, which is owned by UnitedHealth Group, as the vendor for the licensing fees for Practice Fusion users. Optum360 referred requests for comment to the AMA.

In a statement to 番茄社区, the AMA said that the "CPT royalty for ambulatory EHR users remains the same as last year for Practice Fusion customers. A solo physician practice would pay $68 or less for a CPT license in their Practice Fusion system."

That $68 refers to a typical solo practice office with one physician and three support staff, but the cost would be less if the practice does not have three support staff.

Jean Antonucci, MD, a family physician in Farmington, Maine, told 番茄社区 that she received an alert in her Practice Fusion EMR that she would need to purchase a CPT license for 2021. That alert routed her to Optum360, where she says she was quoted a fee of $300 despite being in solo practice. She did not purchase the license.

Antonucci says she already pays $99 per month for her Practice Fusion EMR.

Similarly, who use the Practice Fusion EMR said they were asked to pay $300 for access to the 2021 CPT codes, though the exact number of providers in their practice could not be determined. At $17 per license, a practice would need to purchase about 18 licenses to reach a total of $300.

Physicians have said the cost should not be passed on at this time, as small practices have been particularly hard-hit economically by the pandemic.

The AMA does not divulge exactly how much it earns from CPT licensing fees, although they are believed to be substantial. A put the figure at $71 million; its listed $148 million in "royalties," which is believed to represent CPT code revenues.

The 2021 CPT code set has more than 200 code changes, including the evaluation and management code changes that go into effect on Jan. 1, a source told 番茄社区. Practice Fusion has posted a on its website, which indicates that current customers can continue to use the 2020 codes "in perpetuity whether or not they choose to purchase a license for 2021 or beyond." But new codes or modifiers introduced next year will not be included.

Practice Fusion has been in hot water with the Department of Justice over allegations that it was involved in a kickback scheme to increase opioid prescriptions. In January, it paid $145 million to settle those claims, and last month it was revealed that those allegations were tied to Purdue's extended-release opioids.

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