New current procedural terminology (CPT) codes went into effect January 1 of this year, marking the first overhaul of the codes used to describe psychotherapy treatment since 1998. The only codes that were revised were the psychotherapy family of codes – codes used to describe testing, health, and behavior remain unchanged.
Reports of the new codes causing major glitches for many providers have started to surface. Many third-party payers, including Medicare and Medicaid, were not updated to recognize the new claim codes, causing delays for payment and denials for service. Though steps are being taken steps to rectify these issues, many providers have not received payment for the work they have done this year.
The American Psychological Association’s coding Web site has had more than 300,000 hits in the past month and has published an extensive list of questions on how to handle this transition and what to do if you are being denied payment. For more information on the new codes, APA has published a special issue.
What has your experience been with the new CPT codes?
The CPT code numbers that mental health professionals use for billing psychotherapy services to insurance carriers will change on January 1, 2013. In addition to the code changes, Medicare reimbursement rates will also be revised. The AMA will publish the new codes and rates later this fall.
The American Psychological Association’s Practice Central Web site outlines some of the anticipated changes, which include:
1. Outpatient and inpatient psychotherapy codes will be replaced by a single set of codes that can be used in both settings.
2. The new psychotherapy codes will have specified times rather than ranges:
- 30 minutes, not 20-30 minutes
- 45 minutes, not 45-50 minutes
- 60 minutes, not 75-80 minutes
3. The single psychiatric diagnostic evaluation code will be replaced by two codes: one for a diagnostic evaluation and the other for a diagnostic evaluation with medical services.
What practical steps do you need to take now in order to prepare for these changes? According to the American Psychiatric Association, the pharmacologic management code will no longer exist, so it is important for practitioners to start familiarizing themselves with the medical evaluation and management (E/M) codes for medication management. Practitioners should also review any contracts they have with insurers to make sure that the contracts don’t limit them to specific codes in the psychiatry section that may be replaced as of January 1. HIPPA requires that insurers use current CPT codes, so these companies should be updating contracts in the coming months.
For the latest information about these changes and how they may affect your practice, visit the American Psychological Association’s Practice Central Web site or call its Practitioner Helpline at 1.800.374.2723.