New Health & Behavior CPT Billing Codes—An Update

In the previous issue of Bridging the Gap, we introduced new Current Procedural Terminology (CPT) health and behavior assessment and intervention codes and printed highlights from the American Psychological Association (APA) Practice Directorate’s Action Alert about the codes.

The codes are listed in the 2002 Physician Fee Schedule published in the November 1, 2001 Federal Register and were designated as “active” beginning January 1, 2002. Psychologists, nurses, licensed clinical social workers and other healthcare clinicians whose scope of practice permits, can bill using the codes.

The codes are for health and behavior assessment and intervention services and can only be used for patients with a diagnosed physical health problem.

Some healthcare professionals who submitted claims under the new codes have had their claims inappropriately denied. The APA Practice Directorate has worked with the Centers for Medicare and Medicaid Services (CMS) from the outset to address implementation problems, and continue to do so. Now the organizations are also approaching private insurance carriers directly to challenge inappropriate denials.

According to the APA Practice Directorate, as a result of APA/CMS interventions, Trailblazer, the Medicare carrier in Texas, Maryland, Delaware and Virginia; Wisconsin Physician Services, the Medicare carrier in Wisconsin, Illinois, Michigan and Minnesota; and Empire Medicare, serving lower New York State, have all notified the APA that they will pay for services billed under the codes.

Private third-party insurance plans may have different payment policies and should be contacted directly to find out about their reimbursement rates under the codes.

The APA Practice Directorate asks psychologists to notify the APA Government Relations office at 202-336-5889 with any problems experienced when billing under the codes.

To learn more about the codes, FAQs and Medicare coding standards, log on to the APA Practice Directorate’s web site, www.apa.org/practice/cpt_2002.html. You may also contact your local Medicare carrier or your regional CMS office for information. APA conference attendees might want to attend the symposium on implementation and reimbursement for the new CPT codes. It will be held August 25, 8:00 a.m.–9:50 a.m. in Meeting Room S504bc of McCormick Place.

To request a print copy of this article and the complete newsletter, please call 1-888-627-7271 and reference F12F02.

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