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ADVOCACY NEWS


New Taxonomy Code

January 10, 2019

Stakeholders in the medical community, hospitals, state governments, and payers alike have all recognized the American Board of Medical Specialties (ABMS) board certification under the American Board of Preventive Medicine (ABPM) as a qualification that signifies expertise in the diagnosis and treatment of addiction and related health conditions. Patient access to physicians with expertise in addiction medicine is crucial at a time when our nation is experiencing an opioid overdose crisis. Therefore, it is critically important for patients, insurers, government officials, and others to be able to identify physicians with the training, experience, and expertise to provide addiction services. Given the recognition of addiction medicine as a medical subspecialty by ABMS, with an established curriculum and training standards and a new certification pathway, the American Society of Addiction Medicine (ASAM) believed it was timely and appropriate to request a new taxonomy code that would capture the distinctive nature of this area of specialty practice.


Following our application, the National Uniform Claim Committee (NUCC), which oversees the taxonomy code, accepted our application, and beginning April 1, 2019, Addiction Medicine specialists will have a new taxonomy code to choose from when listing their specialty on National Provider Identification (NPI) applications and insurer claim remittance forms.


Physicians who meet the following description can choose to use the code: “A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.”


Dr. Kelly J. Clark, MD, MBA, DFASAM, DFAPA, president of ASAM had this to say about the announcement:

“We are very pleased to announce that our application for a new taxonomy code to identify Addiction Medicine physicians was approved by the National Uniform Claim Committee and had the support of both the American Board of Medical Specialties and the American Board of Preventive Medicine. Addiction Medicine is a legitimate medical specialty, and patients should be able to be confident their health plans will cover treatment by these physicians. These doctors will now be appropriately recognized, and insurers will have a new resource to process billing credentials, health insurance claims, and determine network adequacy. We look forward to working with our federal, state, and private sector partners to educate more people about this new code and its importance in advancing the field of Addiction Medicine.”

For more information, please read these FAQs.


Background

Prior to 2016, Addiction Medicine was only recognized as a “certified” medical specialty under the American Board of Addiction Medicine (ABAM). As this was not an ABMS-recognized medical board, this certification was not recognized by many payers and other officials. In 2016, ABMS recognized Addiction Medicine as a medical sub-specialty under the ABPM with three paths to board certification in Addiction Medicine, including Accreditation Council for Graduate Medical Education (ACGME)-recognized residencies in Addiction Medicine as a subspecialty of Preventive Medicine. While the existing taxonomy provides Addiction Medicine codes in Anesthesiology, Family Medicine, Internal Medicine, and Psychiatry/Neurology (reflecting existing subspecialty practices inside these disciplines), the existing codes overlook those providers practicing outside these specialties. These respective medical boards do not have ACGME-recognized residencies or fellowships, or ABMS recognized board certification exams, specific for Addiction Medicine. As a result, physicians board-certified in Addiction Medicine by ABMS under ABPM are not currently recognized in the taxonomy code, despite the fact that (1) they have earned credentials that designate them as highly trained and experienced specialists available to provide quality treatment to patients diagnosed with an addiction; (2) they have undergone a rigorous certification process, and (3) they devote a significant portion of their clinical activity providing treatment to patients with an addiction.


Resources

FAQs

National Uniform Claim Committee

CMS