CPT Code Information Page

Given the growing interest in the CPT Codes, it was decided to provide additional information to KPA members. This page will be updated periodically as more information is received. The following information is the notice released by APA on these new codes.   Click here to download the information presented on this page.

Practice Directorate update on the health and behavior assessment and intervention CPT codes- July 26, 2004

    Effective January 1, 2002, the American Medical Association’s Current Procedural Terminology (CPT) Manual contained six new billing codes designed to capture behavioral services provided to patients to address physical health problems. There is one code for the initial assessment of the patient and another for a reassessment. The four intervention codes are for services with an individual, a group, a family including the patient, and a family without the patient present.

Medicare coverage of the codes

    Throughout 2002, representatives of the State Psychological Associations (SPAs) and the Centers for Medicare and Medicaid Services (CMS) worked along with the APA Practice Organization (APAPO) to ensure that Medicare carriers were reimbursing for services under the codes. The initial problems were resolved and Medicare carriers across the country are now paying for services under the codes. Both inpatients and outpatients are eligible for health and behavior services under Medicare. Psychologists should refer to their local carriers’ policies for any limitations on coverage of services in their area.

Limited coverage under Medicaid

    While not as far along as Medicare, coverage under Medicaid has improved. In the past year, Colorado and Vermont began reimbursing for health and behavior services through their State Medicaid plans. We will continue to work with psychologists and the SPAs to advocate for Medicaid to cover these services.

The private insurance market

    APAPO is working with individual psychologists and the SPAs to raise the coverage issue with carriers in their geographic areas. Psychologists are well positioned to advocate to the carriers because they play an important role as providers of service under the carriers’ policies and can best articulate the needs of their patients. Thanks to the efforts of individual psychologists, the following private carriers are now reimbursing claims in certain geographic areas:

Aetna
Blue Cross / Blue Shield of North Carolina
CareFirst Blue Cross / Blue Shield
Cigna
Fortis
Mid-Atlantic Medical Services, Inc (MAMSI) – the Washington, DC area
Mutual of Omaha
Nationwide Mutual
RISKCO – under the Virginia workers compensation program
WPPA – Wichita, KS

Psychologists with questions about the health and behavior codes may contact the Government Relations office at 202-336-5889.

Click here to download the information presented on this page.