Helping News March 2013 Issue 56
On January 1, 2013, The AMA (American Medical Association), as implemented by insurance companies, has modified procedure codes for counseling. Many insurers are now disallowing one hour sessions without "special approval/ authorization."
For 2013 there have been major changes to the codes in the Psychotherapy section of the AMA’s Current Procedural Terminology, the codes that must be used for billing and documentation for all insurers. These changes apply to any services provided beginning January 1, 2013.
· A distinction has been made between an initial evaluation with medical services done by a physician (90792) and an initial evaluation done by a non-physician (90791).
· The psychotherapy codes have been modified: There are now just three timed codes to be used for psychotherapy in all settings (90832- 30 minutes; 90834-45 minutes; 90837- 60 minutes) instead of a distinction made by setting and whether E/M services were provided.
Since the new psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For 38 to 45 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.
In other words, the AMA has determined that the "standard" session now begins at the 38 minute mark! 53 minutes, or longer, is considered by many insurances, an "extended session." Insurers have adjusted fees as well, leaving many mental health practitioners with the burden of trying to do much more in less time, and with less reimbursment. The AMA, and insurers are calling it a "simplification," yet for mental health therapists and their clients it's anything but simple.
The Clinical Counseling Group, among several other practices, has discovered through client surveys, that most prefer the longer sessions for effectiveness. This preference was not considered, while the AMA, and insurance companies made their "simplified" adjustments.
More information coming...