APA's Practice Directorate is taking a multifaceted approach to assisting psychologists who use new health and behavior Current Procedure Terminology (CPT) codes to bill for services they provide to help individuals understand behavioral aspects of a physical health problem.
The six CPT codes, which became effective in January, give psychologists a way to bill for behavioral assessments and interventions with patients who have a physical health diagnosis, such as pain management for patients with cancer. Previously, there was no accurate way for mental health practitioners to bill insurers for such services.
"These codes open up a new opportunity for psychology," says John Corrigan, PhD, a rehabilitation psychologist at Ohio State University who uses the codes.
But, as with most organizational change, there have been a few bumps along the way. APA's Practice Directorate is working on several fronts to ensure the codes' proper use. The directorate is:
Answering individual psychologists' questions. Psychologists who have questions are encouraged to contact APA's Government Relations Office at (202) 336-5889.
Collaborating with state psychological associations. For example, after conversations with Alice Randolph, EdD, president-elect of the Ohio Psychological Association, Ohio's Medicare carrier discovered a computer glitch was responsible for denying some psychologists claims. The carrier promised to correct the glitch and advised psychologists to resubmit their claims.
Contacting Medicare carriers to resolve reimbursement issues, such as explaining to insurance carriers that the health and behavior codes are not prevention services that would normally go uncovered.
Working with the Centers for Medicare and Medicaid Services (CMS) to secure consistent coverage of the codes. Following discussions with Practice Directorate staff, CMS resolved an initial coverage problem in Texas and is now taking steps to address a similar problem in Florida.
Corrigan and his colleagues are using the codes to bill both Medicare and private insurers for services such as helping patients with multiple sclerosis understand the condition and the effect it has on functioning. Other psychologists could use the codes when they, for example, assist clients with adherence to medical treatment, health-promoting behaviors or adjustment to physical illnesses.
The more practitioners use the codes for such services, the better chances that the codes' reimbursement values will eventually be raised, says Diane Pedulla, APA's director of regulatory affairs. When the codes are reviewed by the American Medical Association's Relative Value Update Committee in a few years, the committee will look to see which professionals use the codes and how frequently--numbers that could have an impact on the compensation rates for the services as well as determining the extent of APA's role in the review process.