Several Current Procedural Terminology (CPT®) coding changes went into effect for 2015. This article addresses key changes of note for psychologists who bill Medicare for reimbursement.
New submodifiers for Modifier 59: Do they affect your testing codes?
Beginning Jan. 1, 2015, the Centers for Medicare and Medicaid Services (CMS) instituted a new subset of code modifiers. Modifiers allow a psychologist to indicate to a payer that there is something unusual about the way in which a particular service was provided.
The new submodifiers are: XE (separate encounter), XP (separate practitioner), XS (separate structure) and XU (unusual non-overlapping service). The new modifiers are for use only in the Medicare program.
According to CMS, the correct use of modifier 59 is:
“Modifier 59 is used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially. There is an appropriate use for modifier 59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 minutes, per hour). If two timed services are provided in time periods that are separate and distinct and not interspersed with each other (i.e., one service is completed before the subsequent service begins), modifier 59 may be used to identify the services.”
The new submodifiers should not be used with the psychological and neuropsychological testing code combinations 96101 with 96102, or 96118 with 96119. For psychological and neuropsychological testing, modifier 59 (separate and distinct service) remains the most appropriate choice when billing the testing code combinations 96101 with 96102, or 96118 with 96119.
Here are the modifiers, with brief explanations of why they are not appropriate for the psychological and neuropsychological testing codes:
- XE (separate encounter) applies when distinct services are provided during different encounters on the same date. In technician-administered testing, the additional time for integration of data from external sources is not a patient encounter.
- XP (separate practitioner) applies when different practitioners deliver the same service during an encounter. In 96102 and 96119, the technician is not the practitioner; the psychologist/neuropsychologist is the practitioner and the one whose name is on the claim.
- XS (separate structure) applies to procedures on different anatomic structures. This is not applicable to psychology/neuropsychology.
- XU (unusual non-overlapping service) applies when a service is distinct because it does not overlap — in an expected way — with the usual components of the main service.
Official CPT coding instruction (in the parenthetical statement that follows each of these code pairs) states that it is permissible to report 96101 with 96102, or 96118 with 96119. Providers should be careful to append modifier 59 to one of the reported codes. Coding guidance for Modifier 59 and its submodifiers (PDF, 131KB) is available from CMS. In this online document, CMS provides a number of examples of correct and incorrect uses of 59, and then follows with examples for the new X [EPSU] modifiers.
Developmental screenings and brief behavioral assessments: CPT changes
CPT code 96110: Developmental screening
CPT code 96110, developmental screening, was revised to provide a clearer description of this particular service and to distinguish it from the new brief behavioral assessment code and the adjacent psychological and neuropsychological testing codes in the “Central Nervous System Assessments/Tests” section of the 2015 CPT code manual.
The 2015 descriptor for CPT code 96110 now reads: “Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument.” The italicized passage shows the newly revised language. The phrase “interpretation and report” (present until the end of 2014) was deleted, since the code’s payment value had never included the psychologist’s or physician’s professional work.
CPT 96110 should be used to report screening for healthy, physical development (speech and language development, physical growth).
CPT code 96127: Brief behavioral assessment
Code 96127: Brief emotional/behavioral assessment (for example, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument, is new for 2015.
This code should be used to report a brief assessment for ADHD, depression, suicidal risk, anxiety, substance abuse, eating disorders, etc. This code was created in response to the Affordable Care Act’s federal mandate to include mental health services as part of the essential benefits that must be included in all insurance plans offered in individual and small group markets. The mandate covers services such as depression screening for adults and adolescents, alcohol misuse in adults, alcohol and drug use in adolescents, and behavioral assessments in children and adolescents.
Distinguishing between screening and assessment for mental and behavioral health problems: A statement from an American Psychological Association Practice Organization work group on screening and psychological assessment. American Psychological Association Practice Organization. Washington, D.C.
Promoting Optimal Development: Screening for Behavioral and Emotional Problems. Carol Weitzman, MD, FAAP, Lynn Wegner, MD, FAAP, Pediatrics, Volume 135, number 2, February 2015.
2015 CPT. American Medical Association. Chicago.
2015 CPT Changes: An Insider’s View. American Medical Association. Chicago.
If you have questions about these changes, or other coding/payment issues, please send an email to the APA Office of Health Care Financing.
Current Procedural Terminology (CPT®) copyright 2014 American Medical Association. All rights reserved.