Key Takeaways
- The AMA is developing SNOMED CT-to-CPT terminology mappings to support interoperable, FHIR-based electronic prior authorization workflows
- The initiative is intended to reduce physician administrative burden, improve interoperability, and help accelerate prior authorization decisions before the Jan. 1, 2027, CMS compliance deadline
- The AMA is inviting health plans, EHR developers, health IT vendors, and other stakeholders to participate in testing, implementation, and validation activities
The American Medical Association (AMA) announced a new interoperability initiative aimed at supporting electronic prior authorization by developing and deploying mappings between SNOMED CT and CPT terminology.
According to the AMA, the effort is intended to reduce administrative burden for physicians while supporting broader industry efforts to modernize prior authorization and improve interoperability across the healthcare system. The initiative aligns with the Centers for Medicare & Medicaid Services' (CMS) Health Tech Ecosystem strategy and comes as healthcare organizations prepare for FHIR-based electronic prior authorization requirements scheduled to take effect Jan. 1, 2027.
Prior authorization has long been cited by physicians as a source of administrative complexity that can delay medically necessary care. By linking clinical terminology used in patient records with administrative procedure coding, the AMA said the mapping initiative is designed to enable more automated, real-time prior authorization workflows.
"Modernizing prior authorization requires more than electronic bridges between software applications," AMA President Willie Underwood III, MD, MSc, MPH, said in a statement. "It requires trusted, interoperable terminology assets that can support real-world clinical and administrative workflows. By helping bridge SNOMED CT clinical concepts and CPT procedural coding for prior authorization use cases, the AMA aims to support a more seamless, standards-based ecosystem for physicians, hospitals, payers, and patients."
According to the AMA, the terminology mappings will provide a foundation for scalable automation by improving interoperability between clinical documentation and administrative processes. The organization said the approach is intended to streamline workflows, enhance data exchange, and support faster, more consistent prior authorization decisions.
The initiative will initially focus on prior authorization scenarios with the greatest potential to reduce administrative burden and improve timely access to care. The work is being developed in alignment with emerging FHIR implementation approaches, Da Vinci implementation guides, and CMS interoperability priorities.
The AMA is seeking collaboration from stakeholders across the healthcare technology ecosystem, including health plans, electronic health record developers, clearinghouses, prior authorization vendors, standards development organizations, and implementation communities.
Participating organizations will be invited to engage in collaborative testing, attend technical and educational sessions, provide implementation feedback, validate operational use cases and data flows, and help ensure the mappings reflect real-world prior authorization workflows across specialties and care settings.
The association said it plans to work with health plans, EHR vendors, health IT developers, and other stakeholders to test and refine the terminology mappings before broader implementation. The objective is to create a practical, scalable solution that enables physicians to spend less time on administrative tasks while supporting more efficient prior authorization decisions ahead of the 2027 compliance deadline.
Over the coming months, the AMA plans to convene technical working sessions, pilot projects, educational forums, and collaborative testing activities to advance development and prepare the solution for broader adoption.
Organizations interested in participating in testing or implementation activities can contact the AMA at cptproducts@z.ama-assn.org
