As of January 1, psychologists nation-wide have a new practice issue with which to contend. After conducting its routine five-year review, the Centers for Medicare and Medicaid Services (CMS) have made some changes to current procedural terminology (CPT) psychotherapy codes. Appropriate use of these new codes will mean the difference between reimbursement for services billed and denials.
According to the American Psychological Association Practice Organization (APAPO), many diagnostic and therapeutic services bear new code numbers and the existing numbers for these services will no longer be used, although the basic services will remain the same. Specifically, three new psychotherapy codes will be implemented: 90832 for 30-minute sessions, rather than 20-30 minutes; 90834 for 45-minute sessions, instead of 45-50 minutes; and 90837 for 60-minute sessions, in lieu of 75-80 minutes. All codes apply to meetings with patients and/or family members. The billing provider is allowed to select the code closest to the actual time of the patient session.
Additionally, the APAPO reports that outpatient and inpatient psychotherapy will use the same code sets; psychoanalysis, family psychotherapy, group and multifamily group psychotherapy codes and descriptions will undergo no change.
For complicated care delivery concurrent with diagnostic evaluation, psychotherapy and group therapy, code 90785 will be added to the basic service code. For instance, challenges in communicating with family members or children incapable of verbal communication may require this add-on code.
Psychologists with prescribing privileges will use add-on code 90863 for pharmacologic management in addition to psychotherapeutic care and/or evaluation and management (E/M).
Two new add-on codes will be used for crisis psychotherapy sessions that involve urgent assessment and history. Code 90839 applies to 60-minute sessions; Code 90840 will be used for every additional 30 minutes of crisis-related psychotherapy.
To inform its members of the changes, some state associations held training sessions during December. Additionally, the APA disseminated print materials and offered detailed information on its Web site.
Randy Phelps, Ph.D., APAPO’s deputy executive director, says, “The APA Practice Organization has developed several membership resources and guides on the new CPT codes. These resources include an easy-to-use chart comparing the old codes and new codes and a practical question-and-answer guide to help psychologists prepare for the changes in 2013. And, the APAPO has been providing updates to members through email alerts, a bi-weekly electronic newsletter, special issues of the Good Practice magazine and a special insert into the APA Monitor Magazine.”
Elena Eisman, Ed.D, executive director of the Massachusetts Psychological Association, notes that the new codes are not merely different numbers, but they conceptualize differently the way psychologists practice today. She indicates that in order to avoid denials, the new codes should be used when billing Medicare, Medicaid and private insurers for services provided on or after January 1, 2013. “If you bill for December services in January, you should use the old codes,” she adds.
By Phyllis Hanlon