AAO-HNS is actively engaged in state-level efforts to reform insurer downcoding practices that undermine physician judgment and threaten fair reimbursement for otolaryngology care.
During the 2026 legislative session, the Academy has formally supported downcoding reform legislation across multiple states, submitting letters of support and issuing grassroots action alerts as bills advance. While specific provisions vary by state, these reforms share a common framework: requiring licensed clinician review of downcoding decisions, strengthening transparency and notice requirements, establishing meaningful appeal pathways, and limiting the use of artificial intelligence as the sole basis for payment reductions.
Explore the Academy’s advocacy letters submitted in support of these measures.
- Arizona Advocacy Letter
- Florida Advocacy Letter
- Indiana Advocacy Letter
- New Jersey Advocacy Letter
- New York Advocacy Letter
- Oregon Advocacy Letter
- Tennessee Advocacy Letter
- Virginia Advocacy Letter
Member Resource: Appeal a Downcoding Decision
If you’ve received an automatic downcoding notice from a payer, use the Academy’s template appeal letter to guide your response. Download the resource.
Template_Appeal_Letter-EM_Downcoding
