Last updated: November 2020Date created: November 2018
Practice
CPT and Diagnostic Codes
Current Procedural Terminology (CPT®) codes are used as a common language in the healthcare system. Health care providers, including psychologists, use CPT codes to report the specific procedures and services they provide to their patients. Payers, including Medicare, Medicaid, Tricare, and Commercial Insurers, use CPT codes to determine how procedures and services are reimbursed.
There are thousands of CPT codes in use, but psychologists most commonly provide services and report codes from the following three (3) code sets:
- Health Behavior Assessment and Intervention (CPT codes 96156-96171);
- Psychotherapy Codes (CPT codes 90832-90863); and
- Psychological and Neuropsychological Testing Codes (CPT codes 96105-96146).
However, APA is working to expand access for psychologists to existing codes as well as to develop new codes.
New codes and updates to existing codes occur on a regular basis and require continuous monitoring. Additionally, psychologists need to understand CPT coding for documentation and reimbursement. These resources are here to help psychologists navigate the health care system and provide guidance on the most up-to-date coding, billing, reimbursement and payment information.
The Health and Behavior codes represent psychological services for patients diagnosed with physical health problems.
All mental health professionals delivering psychotherapy services use the same applicable CPT codes when billing clients and filing health insurance claims with third-party payers.
Psychological and Neuropsychological Testing Codes
The toolkit explains the use of the psychological and neuropsychological CPT testing codes and advocating with insurers for reimbursement.
APA is continually advocating for increased access for psychologists to existing CPT codes and working to develop new codes that reflect changes in health care.
Since October 1, 2015, psychologists and other health care professionals have been required to use the ICD-10-CM for diagnostic coding and billing purposes.
This column is geared toward informing practicing psychologists about issues that affect billing and reimbursement rates.
A psychologist’s insurance payment rates are determined by their patient’s health care insurer. Those rates are influenced by Medicare’s Physician Fee Schedule.