Proposed Rule Offers Better Medicare Reimbursement for Psychologists
The Centers for Medicare and Medicaid Services’ 2020 physician fee schedule proposed rule increases values and improves the coding structure for Health and Behavior Services.
Practicing psychologists who help Medicare patients cope with or manage a physical health condition should see an increase in their 2020 payments for these services when billing health and behavior assessment and intervention (H&B) CPT codes.
In a proposal released July 29, the Centers for Medicare and Medicaid Services (CMS) indicated that the agency has accepted recommendations presented by APA Services to increase the relative value units (RVUs) for H&B services. The proposal would raise reimbursement rates for H&B services to a level that is comparable to payments for psychotherapy services.
This rate increase and other proposed payment policy and billing changes for health care services are included in the agency’s 2020 Medicare Physician Fee Schedule proposed rule.
In addition to increased values for H&B services, CMS has proposed:
- Replacing the existing CPT® codes (96150-96155) for H&B services with new codes and updated descriptors.
- Using a single, nontimed code to report H&B assessment (similar to CPT code 90791; Psychiatric diagnostic evaluation).
- Making structural changes to codes that describe the primary or base service, and add-on codes to describe additional work and time beyond the primary/base service.
- Increasing the units of time for reporting the base codes from 15 minutes to 30 minutes.
CMS will announce final changes to 2020 values and CPT codes when it releases the physician fee schedule final rule in November. Implementation of the new codes and values will begin Jan. 1, 2020.
“We are so pleased with the proposed changes to H&B codes,” says APA Chief of Practice Jared Skillings, PhD. “The proposal not only represents success in our ramped-up advocacy for reimbursement, but it also signals that CMS recognizes the value of psychologists’ expertise with patients who have a medical condition.”
These changes will expand access to psychological care for patients with a medical condition without a psychological diagnosis.
Psychologists working in hospital-based consultation services and integrated primary care, among others, will be able to more accurately document and be fairly reimbursed for their work.
Additionally, psychologists in private practice will now have more opportunities to provide and be reimbursed for working with patients with physical health conditions.
CMS has not reviewed the H&B code set since 2002, when they were first established to reimburse psychologists for providing psychological services that help patients manage physical health problems. In 2017, CMS tasked the American Medical Association’s (AMA) CPT® Editorial Panel and Resource Based Relative Value Update Committee with reviewing and revising the codes. APA representatives and staff have been working with the AMA committees to advocate for fair and accurate updates to these codes.
Resources, Next Steps and How to Get Involved
As part of the rulemaking process, APA will complete its analysis of the proposed rule and submit a comment letter to CMS addressing the agency’s changes to the H&B codes and other relevant issues. Comments to CMS on the proposed rule are due Sept. 27.
Email us if you have questions about the proposed rule and its implications.
Read PracticeUpdate to stay informed about changes to billing and reimbursement.
Visit APA Services’ Reimbursement webpage for more information and resources on Medicare, codes and billing.
In the table below you will find the proposed coding changes and updated work RVUs for the family of H&B codes.
Proposed Revisions to Health Behavior Assessment and Intervention Services for 2020
| CPT® Code | Code Descriptor | Proposed wRVU |
Assessment Services |
||
| 961X0 | Health behavior assessment, including re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) | 2.10 |
Intervention Services |
||
Individual Intervention |
||
| 961X1 | Health behavior intervention, individual, face-to-face; initial 30 minutes | 1.45 |
| +961X2 | Health behavior intervention, individual, face-to-face; each additional 15 minutes (list separately in addition to code for primary service) | 0.50 |
Group Intervention |
||
| 961X3 | Health behavior intervention, group (two or more patients), face-to-face; initial 30 minutes | 0.21 |
| +961X4 | Health behavior intervention, group (two or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) | 0.10 |
Family Intervention (with patient present) |
||
| 961X5 | Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes | 1.55 |
| +961X6 | Health behavior intervention, family (with the patient present), face-to-face each additional 15 minutes (list separately in addition to code for primary service) | 0.55 |
Family Intervention (without patient present) |
||
| 961X7 | Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes | 1.50 |
| +961X8 | Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) | 0.54 |
+ indicates Add-on Code