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Psychologists Should Expect More Clarity Under New CPT Health Behavior Codes

January 21, 2020

New Medicare billing codes for services in which psychologists help patients cope with or manage physical health conditions have higher values that will help recognize the pivotal role psychologists have in the delivery of interdisciplinary care.

The American Psychological Association (APA) has been periodically updating members on use of the new codes, which went into effect Jan. 1, and will monitor implementation of the new requirements for payment for health behavior assessment and intervention (HBAI) services.

Stephen Gillaspy, PhD, senior director of the APA's Office of Health Care Financing, tells Addiction Professional that the new Current Procedural Terminology (CPT) codes help to clarify some aspects of billing for HBAI services that has been in effect since the early 2000s. The codes can be used for patients who have both a physical health and mental health diagnosis, but the key is that a psychologist cannot bill for both HBAI and psychotherapy services on the same day, even if they are involved in the treatment of both of an individual patient's areas of concern.

A determination has to be made on “what is the predominant service that day,” Gillaspy says. “At the end of the day, there is only one primary diagnosis.”

The new codes do encourage integrated, same-day service for patients, Gillaspy says, so that a psychologist can bill for a patient's HBAI service on the same day that a physician bills for evaluation and management (E/M) services, for example.

The new codes also can be used in conjunction with traditional psychological testing, Gillaspy says.

Summary of codes

Under the changes, which are included in the Centers for Medicare & Medicaid Services' (CMS's) 2020 Medicare Physician Fee Schedule, health behavior assessment and reassessment services will be reported using CPT code 96156. Unlike the prior assessment code, which was billed in 15-minute increments, the new code is no longer time-based and resembles CPT code 90791 for a psychiatric diagnostic evaluation, Gillaspy says.

Intervention codes now will be billed using a base code for the first 30 minutes of service and a 15-minute add-on code that can be reported in multiple units. The codes formerly were all in 15-minute increments, but the change to a 30-minute base code was made to reflect typical billing patterns seen for health behavior intervention services, Gillaspy says.

There are separate intervention service codes for services provided to an individual patient, a group, or a family with or without the patient present.

HBAI services have become increasingly recognized with the expanded understanding of how psychological factors can affect patients' ability to adjust to and manage serious physical health conditions such as cancer and heart disease.

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