Why have the CPT codes changed?
Changes to CPT code sets are made by AMA under contract with the Centers for Medicare and Medicaid Services (CMS) on an annual basis; decisions made this year will have a significant impact on psychiatry and psychotherapy services.
Who is affected by these CPT code changes?
Code changes affects all provider types (psychiatrists, psychologists, clinical social workers, etc.) that provide CPT professional services in all states.
When do these CPT code changes go into effect?
The AMA & CMS do not allow for a transition period. Providers must bill with new CPT codes for dates of service on or after January 1 or the claim will deny. This includes electronic claims. Any claim submitted for dates of service on or after January 1, 2013 that includes the old CPT codes will be denied.
Will I be able to begin using the new codes prior to January 1, 2013?
No. Claims for services rendered prior to January 1, 2013, should be submitted using the old codes. Use of new codes for services rendered prior to January 1 will result in claims denials.
If I am sending in a claim in 2013, but the date of service is in 2012, do I use the new or old CPT codes?
Which set of CPT codes you use for a charge is based on when the service occurs, not when you bill for it. If the appointment happened in 2012, you would use the 2012 codes. If the appointment happened in 2013, you would use the 2013 codes.
Until we are sure that the insurance company will honor the new codes shall we use both the new and old codes at the same time?
No, payers should reject all 2012 CPT codes for services that take place during 2013. They are required to honor the 2013 codes beginning January 1st, 2013.
We have been informed the changes for psychiatrist billing have been delayed. Is this not the case?
There will be no delay of the 2013 CPT code changes, to our understanding. Any payers that delay implementation will be violating HIPAA.
How do we find out if we are eligible to bill the E&M codes?
Medicare outlines the license levels eligible to bill E/M codes.
Here is a link:
Is there a seperate E/M book availiable or is it included in the CPT book
Our favorite for behavioral health is the Procedure Coding Handbook for Psychiatrists, 4th Edition, by Schmidt, Yowell, and Jaffe.
Where can we find Medicare's reimbursement rates for the new codes?
You can check with your Medicare Administrative Contractor. If you don’t know who your MAC is you can check cms website.
Below are two links:
Do We Still Use POS code with new codes?
Yes, all CPT codes will continue to be billed with a POS code.
What about Skype or other forms of video sessions?
Telepsychiatry is a hot topic and coverage of it is completely payer dependent.
What is the code for phone sessions?
The telecommunication codes are 98966-98969, and 99441-99444.
Will all of this have an effect on the CMS 1500 forms?
No, the CMS 1500 form is not changing.
Is it correct that an E/M code with the new add-on psychotherapy codes (90833, 90836 and 90838) can only be billed by Doctors of Medicine (MDs), Doctors of Osteopathy (DOs), qualified Clinical Nurse Specialists (CNSs), Nurse Practitioners and Physician Assistants?
Yes, that’s correct. Yes, please remember that the new add-on psychotherapy codes (90833, 90836 and 90838) can only billed in addition to the appropriate E/M codes (992xx or 993xx).
Please confirm that Psychiatrists, Clinical Psychologists, qualified Clinical Nurse Specialists (CNSs), Physician Assistants (PAs) and Clinical Social Workers may bill codes 90791, 90792, 90832, 90834 and 90853, therefore they are not allowed to bill an E/M code?
Psychiatrists, CNSs and PAs may bill 90791 (if no medical services provided, which would be rare). They may bill 90792 when medical services provided. They also could bill 9920x, the appropriate E/M code for initial service. Also, they may bill 90832, 90834, and 90837 and 90853 if no medical service provided (e.g., only psychotherapy services without any E/M services).
If they use these codes, they cannot bill an E/M code at the same time. If they do provide E/M plus psychotherapy, they bill the appropriate E/M codes with appropriate add on code (90833, 90836, and 90838).
Can non-medical disciplines (e.g., Clinical Psychologists, Clinical Social Workers, master’s level therapists, etc.) bill 90792? Can they bill E/M codes?
Non-medical disciplines may bill only 90791 for initial evaluation. They may bill 90832, 90834 and 90807, 90853 for psychotherapy. They cannot bill most E/M codes.
Where can I find out more information about the new CPT codes?
The AMA administers CPT codes and owns the official descriptions; for more information about CPT codes, please consult the AMA website at: http://www.ama-assn.org/ama/pub/category/3113.html
Providers can purchase a copy of the 2013 CPT code book from https://catalog.ama-assn.org/Catalog/home.jsp or 1-800-621-8335.
Providers can also purchase a downloadable copy of 2013 CPT codes: https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod2040075
Additional resources on the CPT code changes can be found by contacting your professional organization (e.g. the American Psychiatric Association, the American Psychological Association, the American Academy of Child and Adolescent Psychiatry, the National Association of Social Work, etc.)