CPT codes: Use them or lose them

Psychologists have long provided services that target medical conditions, from improving heart health by reducing stress to helping patients quit smoking or curb eating behaviors. Historically, though, practitioners have not been reimbursed for such specialized services because insurance billing limited their diagnoses to mental health.

APA and others have sought to change that by promoting the use of health and behavior reimbursement codes--applied through Medicaid, Medicare and private insurance--to increase the recognition of psychologists' role as broader health-care providers. These Current Procedural Terminology (CPT) codes reflect psychological services offered to patients with physical health diagnoses, rather than mental health problems. The codes cover such intervention and assessment services as symptom and stress management, health-promotion behaviors and adherence to medication.

APA's Practice Directorate worked for several years to develop and gain approval for these codes, which were approved by a coding committee organized by the American Medical Association (AMA) and debuted in 2002.

"The codes give us an opportunity to practice more flexibly and to distinguish ourselves as health providers," said Ohio State University's John D. Corrigan, PhD, of APA's Committee for the Advancement of Professional Practice during a symposium at APA's 2004 Annual Convention in Honolulu.

But, Corrigan said, too few practitioners are taking advantage of the codes for fear of not being fully reimbursed for their services. And if that trend continues, the AMA's Resource-Based Relative Value Update Committee could choose to eliminate them in a few years.

"If we don't take this opportunity and use these codes, we will lose them," Corrigan warned. "We're asking you to use them, to advocate for them and to let us know when you need more help."

Getting your due

According to data from August, Medicare reimburses for health and behavior codes in all states, except in Florida. Under Medicaid, only Colorado and Vermont reimburse for the codes. In the private insurance sector, 10 carriers in certain geographic areas recognize the codes, said Diane Pedulla, JD, APA's director of regulatory affairs, who spoke on the status of the codes since their adoption two years ago.

APA, state psychological associations, APA members from 18 states and the Virgin Islands and the Interdivisional Health-care Committee--a group of five APA divisions--have been working to obtain full code reimbursement among private carriers, such as by informing carriers about what the psychological services entail and helping them understand that psychologists don't only treat patients with mental health problems.

"Getting more coverage through private insurance is in everyone's benefit--the patient's benefit, the psychologist's benefit," Pedulla explained. "And, we would argue, it's in the insurance company's benefit because many of these services help delay or forestall the need for more serious or invasive procedures later on."

However, a survey conducted by Alan M. Delamater, PhD, of the University of Miami School of Medicine's pediatric psychology department, found that billing and reimbursement among psychologists who used the codes in institutional settings varied widely--with reimbursements ranging from 3.6 to 64 percent of the charges billed, according to preliminary data. Carriers denied reimbursements mostly due to the "use of medical diagnosis by a psychologist" and lack of preauthorization from carriers--even though, he noted, the codes were designed to be used without authorization being necessary.

On the bright side, Delamater found that insurers were more likely to pay when psychologists proactively communicated about the services and use of the codes. For example, insurers reimbursed most psychologists who called them and detailed the services they were going to offer and to which patients.

Building interdisciplinary teams

One who's had positive reimbursement experiences with the codes is Joseph M. Casciani, PhD, a clinical geropsychologist and president of VeriCare, a mental health-care provider to older adults in skilled and residential settings. Casciani views the codes as a chance to promote greater collaboration among all health-care providers.

"With the health and behavior codes, we want to provide integrative care," Casciani said. "We want to provide collaborations. We want to work right alongside the other caregivers. This is going to put us in a much better place in the future on a level so that there's not that distinction between MDs and PhDs. There's a continuum and a seamless pattern of care."