New health and behavior codes payments temporarily stopped
By Paula E. Hartman-Stein, Ph.D.
Q: Why are practitioners not getting reimbursed for the new Health and Behavior Codes?
A: The carriers initially interpreted the
intent of the codes as preventive in nature. The Centers for Medicare and
Medicaid Services (CMS), formerly known as the Health Care Financing
Administration (HCFA) does not usually pay for services that prevent disease and
maintain health, with a few exceptions such as flu shots. In late December
Antonio Puente, Ph.D., the APA representative to the American Medical
Association’s CPT panel reworked
the language of the preamble to the codes and their descriptors to clarify that
they are not preventive in intent, and that they should be used when working
with patients who have an acute or chronic illness and only when there is an
active disease process.
Puente said he fully expects CMS to pay for the codes. “The question is not if, but when,” he said. He expects payment to begin in the spring or summer.
Q: Are the new codes for the use of psychologists only?
A: Then codes can be used by health care professionals recognized as independent providers under Medicare including psychologists, social workers an psychiatrists.
Q: What is the “work value” of the Health and Behavior codes?
A: The work value, a factor in setting the reimbursement rate, is roughly similar to that of psychotherapy services. These values can improve as providers use the codes, and subsequent survey data of the healthcare professional’s time and effort are evaluated.
Q: Are the Health and Behavior codes billed in the same time increments as psychotherapy?
A: No. They are coded in 15 minute increments, not the typical 20 or 50 minute face to face time requirements used for psychotherapy services. This allows for more flexibility when practitioners are consulting in a primary care or in-patient setting where brief patient interactions are common.
Q: What is the overall significance for psychology of the new codes?
A. They allow psychologists direct access to patients with medical problems, signifying a major paradigm shift. The new codes validate that psychological interventions are useful for management of medical problems, not just psychiatric conditions.
Q: How can psychologists learn more about the new codes?
A: A two hour workshop is scheduled at the APA convention in August 2002.
P.E. (2002) New health and behavior codes payments temporarily stopped. The
National Psychologist, Vol. 11, No. 2, p 8, 9.