New CPT codes accepted by AMA

 The National Psychologist  January/February 2001  Vol. 10  No. 1, p. 15

By Paula Hartman-Stein, Ph.D.


Question: Is it true that there are new clinical (CPT) codes available for psychologists to bill under the Medicare system?


Answer: Six new codes have been proposed by APA and accepted by the American Medical Association that reflect psychological and behavioral interventions with medical and surgical populations, rather than limiting these services to patients with psychiatric diagnoses. From mid November to mid December, 2000, the APA membership had an opportunity to participate in a survey of the “work values” of these health and behavior assessment and intervention codes.


Work value includes the time it takes to perform the service, mental effort and judgment, technical skill, physical effort, and stress to the practitioner involving the risk of complications and estimated risk of a malpractice suit with a poor outcome.


According to James Georgoulakis, Ph.D., the American Psychological Association’s representative to the AMA Relative Update Committee (RUC), said the fact the service has a CPT code does not mean reimbursement automatically follows.  He noted that there are CPT codes in preventive medicine that have no reimbursement.


Georgoulakis is scheduled to present the survey data at a February meeting of the RUC.

Several outcomes are possible, according to Georgoulakis. The committee could approve the recommended value for the code, reduce the recommended value for the code, or ask the APA to re-survey. If accepted, the new codes would go into effect for psychologists no earlier than 2002.


Question: “There seems to be a lot of rhetoric and debate about mental health parity in private sector insurance plans. Is anything happening regarding parity of payment for psychological services with medical services under the Medicare system?”


Answer: There are two Congressional bills that have been proposed and/or discussed in 2000. Rep. Jim Greenwood, (R- Pa) and Rep. Peter Deutsch, (D-F) were the bill’s co-sponsors. According to Joseph Casciani, Ph.D., from California, the bill, projected to cost $20 million,  was blocked when the Chair of the Ways and Means Healthcare committee, Rep. Bill Thomas asked for more hard data on older adults not having access to mental health services due to the fees. The Ways and Means Committee is asking HCFA to commission a study on this, says Casciani.


Another bill sponsored by Rep. Roukema (R-NJ) increased the Medicare fees from 50 to 80% of allowable fees. This bill is projected to cost billions. With Medicare reform on the Bush agenda, these issues need to be watched carefully in 2001.


Question: “Will the Office of Inspector General continue its close scrutiny of psychological services provided to patients in nursing homes?”


Answer: According to the webpage of the OIG outlining their plans for 2001, more audits will be conducted in 2001 of psychological services to patients in nursing facilities. Sorry, no let up in sight regarding these efforts.


Question: “How does the 2001 ‘pay raise’ for psychological services compare to that of other disciplines in the Medicare system?”


Answer: Medicare payment rates to physicians increased by 4.5% overall in 2001. Psychiatry and Psychology rates averaged a 5% increase. In 2001 Medicare will pay approximately $40 billion for physician services, up from $37 billion in 2000. The new payment system for physician practice expenses is based on resources involved in providing care, rather than on historical charges. HCFA is currently implementing resource-based values for the expenses associated with physicians’ practices, according to a press release from HCFA in November 2000.


Question: “Can psychologists have any impact on local Medicare review policies?”


Answer: A recent situation in Connecticut would indicate the answer is a definite “Yes.” According to Mark Kirschner, Ph.D., a representative for the Connecticut Psychological Association on the local carrier advisory committee, a proposed policy change in 1999 would have required that psychologists send patients who have one of a list of specified 7 disorders for medication evaluation before treating them. Ongoing discussions resulted in a change in the wording of the final policy adopted in November 2000, requiring that the provider “must consider a referral to a physician/psychiatrist for consultation for evaluation to determine whether the patient needs medication in addition to therapy.”


Paula Hartman-Stein, Ph.D., a clinical psychologist in

 Kent, Ohio, can be reached through her web page, 

 Main Page