2013 CPT Code Revisions: The mental health community is abuzz about the 2013 Current Procedural Terminology (CPT) code changes. Don’t worry; CPT codes are still boring! This article will explain the changes, and what you need to know to prepare for them.
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Starting January 1, 2013, a number of CPT codes for psychiatry and psychotherapy services will be revised. For instance, if you bill a “90806” to a third party payer after December 31st, the claim will be denied. And if you talk about having a “90806 appointment” with colleagues in 2013, they will roll their eyes at you because “Gosh Judy, you’re so last year!”
CPT codes are set by the American Medical Association (AMA), and are revised on an annual basis. This year, the revisions are substantial. Fortunately for counselors, many of the changes concern psychiatry, and not psychotherapy.
Major Psychiatric Revisions
The CPT revisions that effect psychiatrists are more complicated than those that effect counselors and psychologists. For those who run group practices, here are five major psychiatric CPT revisions:
- Evaluation and management (E&M) plus psychotherapy codes will be retired (including “90805” and “90807”)
- Codes for psychotherapy and E&M services are now differentiated
- The code “90801” will be replaced by “90792” for “a diagnostic evaluation with medical services”
- Pharmacologic management codes will be retired (providers are to use an E&M code)
- 2013 introduces “add-on” codes for psychiatry, which are services in addition to a primary service (not a stand-alone service)[i]
…and several other changes.
Major Psychotherapy Revisions
The CPT code revisions that effect counselors are simple and straightforward. Here is a list of psychotherapy CPT codes that will be retired, and their 2013 comparables:
- 90801 –> 90791 (diagnostic evaluation without medical services)
- 90804 –> 90832 (was 20-30 minutes psychotherapy, now 30 minutes)
- 90806 –> 90834 (was 45-50 minutes psychotherapy, now 45 minutes)
- 90808 –> 90837 (was 75-80 minutes psychotherapy, now 60 minutes)
Family therapy codes (90847 and 90846) will remain unchanged, as will codes for psychological testing.
A Note on Service Duration Changes:
As seen above, unlike existing codes that provide a service time range (i.e., 45-50 minutes), 2013 code descriptions list fixed times (i.e., 45 minutes). However, according to the 2013 CPT manual, providers still have flexibility. Respectively, 16-37 minutes for code “90832,” 38-52 minutes for code “90834,” and 53 minutes or more for code “90837.” When reporting a service, a provider should choose the code closest to the actual duration.[ii]
Will Reimbursement Rates Change?
It is unlikely that the 2013 CPT code revisions will affect reimbursement rates for counselors. That said, several large third party payers (including Medicare and Medicaid) are expected to announce their 2013 service rates in November.
Preparation
An experienced medical biller should be able to adjust to the 2013 CPT codes without much difficulty. Similarly, quality practice management software companies are already prepared for the code revisions, and are ready to apply them on 1/1/13. For most psychologists, social workers, and professional counselors, adopting the new CPT codes will be a simple administrative change that won’t affect their clinical workflows.
Need more? Continue reading about CPT Code Add-Ons For 2013
Author:
Dr. Anthony Centore is CEO of Thriveworks, is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at https://twx.atlantacounseling.com/counseling-private-practice-book/
Looking for help starting or growing a private practice? We can help! Learn more at https://twx.atlantacounseling.com/private-practice
[i] Source: National Council for Community Behavioral Healthcare at www.TheNationalCouncil.org
[ii] www.apapracticecentral.org/update/2012/09-27/psychotherapy-codes.aspx. The 2013 AMA CPT Professional Edition Manual can be purchased on Amazon.com: www.amazon.com/Professional-Edition-Current-Procedural-Terminology/dp/1603596844
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Anthony Centore
I’m in Illinois and have not seen a rate change for bcbs. For a 45 min session the reimbursement rate is 88.20. This is the same rate as last year. Humana lowered their Rates last year to 43 for a standard 45 min session so I did not renew my contract with them. Cigna and Aetna have remained the same at 60. I’m out of network with united and usually get reimbursed around 70 something. I don’t know if illinois is different right now or if I’m not getting the updated reimbursement rates yet? I bill electronically and get my eob payments in about 3 weeks from bcbs and have been paid for 2013 sessions. As for a 60 min code…. Well alot of instance companies want you to get pre auth for it or you need to appeal the claim after it gets rejected submit your case notes to prove why that length of a session was medically necessary to justify that length of treatment. Family sessions are still being paid out as a 90847 with a higher rate of reimbursement vs a individual session through bcbs but Cigna and Aetna pay less for a family… Why? There’s no consistency with reimbursement claims when clearly a family session is more work! Seems only bcbs recognizes this. Also with the inter comp add on code I’ve been getting denied on that code from bcbs for several patients saying that their claim does not cover that code. So it seems that it depends on each individuals policy. When you call to verify benefits ask if the policy covers codes xx, xx, xx etc and see if pre auth is necessary for a 60 min session. What use to be a 90808…. Also I’ve experienced a rejected on a crisis code so I needed to submit notes to prove it was a crisis. Just a scam to get out of paying a higher reimbursement claim in my opinion.
Does anyone have info on a lpc being paid lower than a Lcpc for 2013? Or insurance companies now my allowing a lpc to get reimbursement from ? What insurance companies while billing under a group?
I can tell you from receiving my first out of network claim payment,one of the REAL Large carriers-NE is paying $40 less for the 90837 (and this is used in a private practice)than for the 90808. This is going to be a drastic assault on my relationship with my analyst (whom I meet with multiple times a week). Somebody needs to do something fast.
Karyn, Thanks for sharing! Which carrier are you referring to?
But the Rates DID get reduced and in MA, BCBS is ONLY reimbursing 90834 (formerly know as the 90806 — 50 min session f/u), at $50.51 (NOT the former $70.10/ 50 minute session). They are also DENYING 90837 codes — outright for private practitioners here. ( I am a LMHC ).I am in a small, private practice that is approx. 30-40% BCBS — this change represents a HUGE cut in revenue for me. What should I do? Any suggestions? I have several colleagues in the same situation altho it seems (some) other states are not having the same issue. Thanks for ANY help you can offer. ~ Best, Lynda
PS: no other rates or reimbursement seem to have been reduced EXCEPT the BCBS – why?
Yikes! I know that Harvard Pilgrim in MA also dropped their rates…