HCFA rejects telehealth payment for psychologists

APA disagrees with HCFA's policy on reimbursement for evaluation and management services.

By Lisa Rabasca
Monitor staff

The Health Care Financ-ing Administration (HCFA) has denied psychologists reimbursement for mental health services delivered by audio-video link--also known as telehealth services--despite legislation that specifically directs HCFA to pay psychologists for these services, according to the APA Practice Directorate. APA is examining how to respond to HCFA's decision and how the issue fits into APA's larger legislative agenda for the 106th Congress.

Last June, HCFA proposed reimbursing psychologists for telehealth services, says David Nickelson, PsyD, special assistant to APA's executive director for practice. In August 1997, the Balanced Budget Act directed HCFA to pay for telehealth services by psychologists, says Nickelson.

The legislation was designed to provide specialty services to rural areas that they otherwise wouldn't have access to, especially mental health services, he says.

However, when HCFA released its final payment schedule last November, it said that psychologists couldn't provide telehealth services because they are considered evaluation and management (E&M) services, which include medical diagnostic evaluations such as drug interactions, multiple medical conditions and interpretations of laboratory or other medical diagnostic studies and observations, according to HCFA.

HCFA contends that only physicians can bill for those services considered to be E&M services, Nickelson says. But the APA Practice Directorate vehemently disagrees with HCFA's presumption that these activities are solely the practice of medicine reserved for physicians.

There are many E&M services that are fully within the scope of a clinical psychologist's license to perform and the Practice Directorate continues to press HCFA to recognize this and revise its restrictive policy.

For example, psychologists often see patients on medication and will recognize behavioral changes linked to medication and contact the prescribing physician, says Laurie Badanes Prather, APA's federal regulatory affairs officer.

Delivery of psychological services via telecommunications is clearly within the practice of psychology and, like the other E&M activities which psychologists provide, should be recognized by HCFA, Prather says. APA intends to pursue a legislative remedy to the E&M problem if HCFA is unwilling to administratively find a solution.

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