Denials Reversed: New CPT Health and Behavior Codes
Gain Acceptance
Since six new CPT health and behavior codes (96150–96155) became effective in January, 2002, the American Psychological Association (APA) Practice Directorate has worked with the Centers for Medicare and Medicaid Services (CMS) and its local carriers to correct inappropriate denials of claims using the new codes.
While efforts initially focused on Medicare claims, the Practice Directorate has also helped to obtain reimbursement through private insurance under the Federal Employee Health Benefit Plan (FEHBP).
The following summarizes communications from the APA Practice Directorate, describing recent results the Practice Directorate has met in its effort to correct inappropriate denials. More details about the codes and reimbursement policies can be found in the Practice Directorate’s web pages at www.apa.org/practice/cpt_faq.html.
New York: The medical director of Empire Medical Services, the carrier for lower New York State, has confirmed that the carrier will reimburse under the code. The Practice Directorate continues to address problems with the Medicare carrier for upstate New York.
California: The medical director of the Northern California carrier confirmed that denials solely on the basis that the provider is a psychologist are inappropriate, that he would advise his staff, and that the practice should stop. The carrier for Southern California will accept the claims as long as the codes include the appropriate modifier (AH).
Texas, Maryland, Delaware, Virginia: Trailblazer, the Medicare carrier in Texas, as well as Maryland, Delaware, and Virginia, corrected its November 2001 notice, which said that the new codes would not be covered, and is now paying for services under the codes.
Georgia, Minnesota, Mississippi, Ohio: The carriers claimed computer problems caused initial denials and that the problems have now been corrected.
Maryland: Carefirst Blue Cross Blue Shield, private insurance through FEHBP, reversed a previous denial and reimbursed for behavioral intervention services following involvement by the Practice Directorate.
Florida: The Practice Directorate is continuing discussions with CMS and the local Medicare carrier to resolve reimbursement issues.
Pennsylvania, Washington State: The Practice Directorate is working with the local Medicare carriers to resolve previously denied claims.
The APA Practice Directorate encourages psychologists experiencing difficulties in receiving reimbursement for services billed under the new health and behavioral codes to request assistance by calling the Practice Directorate’s Government Relations Office at (202) 336-5889.
To request a print copy of this article and the complete newsletter, please call 1-888-627-7271 and reference F12W03.
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Winter 2003
