New health care codes released mid-year in unprecedented move

New health care codes released mid-year in unprecedented move
National Psychologist, Vol. 23, No. 5, p. 7

By Paula E. Hartman-Stein, Ph.D.
Washington, D.C. – The American Medical Association CPT committee recently released a new set of medical codes for Applied Behavioral Analysis (ABA). In an interview at the American Psychological Convention, Antonio Puente, Ph.D., professor of psychology at the University of North Carolina and voting member of the AMA CPT committee, said in his 25 year involvement with the coding system, it is unprecedented to see new ones released in the middle of the year.
“Psychologists can use some of the ABA codes, as several are meant for doctoral level providers and some are technical codes,” said Puente. He said the bulk of ABA that applies to doctoral level providers will most likely be for supervision, and the actual service delivery may be technical activity, similar to psychological testing done by technicians.
The ABA codes are under Category III, which are for emerging technologies. Puente said, “Most likely certain carriers may not reimburse them. I’d be surprised if Medicare carriers reimburse them because there are questions about the codes that are unresolved. Conceivably providers could bill for 60 to 80 hours a week worth of services.”
He said another question has to do with the requirements for the provision of these services. He said it is likely the states will define the qualifications of the provisions. “You are now going to place on the Medicaid system a challenging situation, an unlimited number of hours by an undefined professional in a heavily taxed system.”
According to Puente, the intent of the ABA codes is to provide service to autism-related spectrum disorders, but the clinical services could be used with patients with dementia, head injuries or medical conditions that impact behavioral regulation.
“These codes could be so robust they could bust the bank. To make sure the bank is not busted we need collaboration with multiple groups and the sooner the better,” he said.
Puente thinks the future of health care is a state issue. He said there are major challenges ahead for all of health care, especially psychologists, and the ABA codes may be an example of what is to come.
“The question to be resolved is how do we work in a system that is already broken financially? This could be tantamount to chaos,” he said.