Standardized medical procedure codes support healthcare insurance Gulf

The scale of health care demand in the Gulf Region has increased drastically over the last decade. Annual health insurance claims in the Emirate of Abu Dhabi show that utilization of health care services increased 99.3% between 2011 and 2020—and this was before the COVID-19 pandemic accelerated demand even further.

To successfully manage this continuing rise in demand, governments across the region are seeking to implement innovative, resilient and sustainable practices in public health and medicine. To achieve this, several governments have deployed standardized Current Procedural Terminology (CPT^®) content from the American Medical Association (AMA) in order to unlock greater efficiencies for local health care insurance programs.

In 2022, the Capital Market Authority (CMA) in the Sultanate of Oman selected the CPT code set to support the newly launched electronic platform that automates the administration of Dhamani, a new mandatory national health insurance system. Similarly, the Department of Health – Abu Dhabi (DOH-AD) and Dubai Health Authority (DHA) in the United Arab Emirates have been using standardized CPT codes since 2011 to help streamline communications and reporting analytics within their entire heath care ecosystems. CPT serves as a common language that uses consistent and standardized procedural codes to enable communication between patients, health care providers, and private and public insurers to support each country’s reimbursement network and its government regulatory role.

Furthermore, the use of standardized CPT codes in the Gulf Region has enabled increased automation and efficiency through integrated digital systems such as eClaimLink established by Dubai Health Authority, Shafafiya by the Department of Health – Abu Dhabi and the Dhamani platform supporting the population of the Sultanate of Oman. Insurers, health authorities and medical practitioners in this region have a structured reimbursement system that enables the pre-approval of treatment more efficiently for patients  — encouraging greater access to treatment as demand for more care continues to grow.

The implementation of integrated systems and CPT codes enable health ministries to manage and monitor the localized payment rates for each medical procedure regardless of the care setting. Most CPT procedural codes are linked to Relative Value Unit (RVU) data, which offers an objective measurement of the resources required to perform a medical procedure. Based on the principle that payments for physician services should correlate directly with the resource costs for providing those services, the RVUs for CPT codes are updated regularly to support the modernization of medicine. The RVUs linked to CPT procedures enable health care professionals to combine the time, intensity and cost of care into single relative ranking scale for payment. These relative values are then converted locally by health ministries to support their goals of sustainably managing health care costs. To understand more about how RVUs deliver value to health systems, please watch this short two-minute video.

Governments across the Gulf Region rely on a globally recognized, evidence-based CPT code set that keeps pace with modern medicine. The CPT code set continues to serve the evolving needs of data-driven health systems of the Gulf Region that aim to innovate while controlling costs, improving quality and increasing access to care. CPT content helps maintain the affordability of healthcare services as governments expand and adopt innovative practices in public health and medicine, supporting them in their vision of building sustainable, resilient health care systems. The implementation of CPT code sets has supported the Department of Health – Abu Dhabi in driving innovative health care solutions such as supporting the Malaffi platform with the delivery of COVID-19 testing and vaccine codes to enable medical and governmental agility during Abu Dhabi’s COVID-19 pandemic response.

About the American Medical Association

The American Medical Association (AMA) is the physicians’ powerful ally in patient care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises, and driving the future of medicine to tackle the biggest challenges in health care.

Current Procedural Terminology

The Current Procedural Terminology (CPT®) code set streamlines communication across health care settings and informs the advanced analytics on medical procedures and services. Governments, health care providers, tech vendors and payers utilize the CPT code set within their health management systems.  CPT coding is trusted to support payment processes and inform public health planning and research. As a standardized, comprehensive language, it reduces reporting challenges so providers can unlock administrative efficiencies and productivity while centering care around their patients.   

Learn how CPT content can support your initiatives. The CPT code set is the language of medicine today and the code to its future.