Starting this month, psychologists are eligible to be reimbursed by Medicare for services provided under new Current Procedural Terminology (CPT) codes for behavioral assessments and interventions for patients with physical health problems.
The six codes, which cover assessment, individual and group intervention, and family intervention with and without the patient present for patients with a physical health problem, were announced in the Nov. 1 Federal Register by the Centers for Medicare and Medicaid Services (CMS).
"Conceptually, this recognizes that there are psychological services and a psychological component to be identified and valued in the physical-health side of our health-care system," explains Russ Newman, PhD, JD, APA's executive director for practice.
Previously, if you went to see a psychologist for a problem related to your health disorder, says Newman, Medicare required a mental health diagnosis at the time the psychologist provided services, and coverage for the services would have had to come out of the mental health dollars side of the system. That created difficulties in situations where psychologists were providing services to patients with physical health problems.
With the new codes, mental health professionals now have a way to code for psychological services related to physical problems--for example, for services that help a person with diabetes manage his or her diet--and draw reimbursement from physical-health dollars.
The new codes are also significant for psychologists because they will make it possible for health and mental health professionals to better measure the financial benefits of biopsychosocial services. Traditionally, the CPT-coding system has separated physical health from mental health services, leaving no way to account for the savings of, for example, treating a cardiovascular patient's anxiety disorder to avoid future heart attacks. The new codes now provide a way to track such medical cost offsets and show the positive impact of psychological services on physical problems, explains Newman.
APA's Practice Directorate will monitor the implementation of the new codes to ensure that these psychological services are adequately valued by the coding and reimbursement system, and will help practitioners work through any glitches during the codes' implementation. Meanwhile, it is likely that APA will need to press for increased reimbursement values for the six codes. Newer codes generally begin with lower reimbursement values, but those values tend to climb once the code's worth becomes more apparent, Newman says.