On Jan. 1, 2018, a few coding changes, directly affecting psychologists went into effect. New codes for cognitive services are now available, as well as updated codes and billing requirements for telehealth services.
Cognitive Function Intervention — CPT code 97127/HCPCS code G0515
In January 2018, Current Procedural Terminology (CPT®) code 97127 took effect. Code 97127 is described as Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact.
Code 97127 replaces now-deleted CPT code 97532 for Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes. It is important to note that the new code is untimed (i.e. no longer includes "each 15 minutes" in the code descriptor); therefore, it can only be reported once a day, regardless of the amount of time spent to perform the required elements.
The Centers for Medicare and Medicaid Services (CMS) will not recognize the new CPT code 97127 for Medicare payment. Instead, CMS created Healthcare Common Procedure Coding System (HCPCS) code G0515 for Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes, to report cognitive treatment services. G0515 has the same descriptor as former CPT code 97532, and the payment rate is very similar. Additionally, in contrast to 97127 which can only be billed once per day, G0515 remains a timed code (i.e. "each 15 minutes"), and can be billed multiple times on the same day based upon the length of time required to complete the service.
Psychologists who provide cognitive treatment services to Medicare patients, should report code G0515 in the same manner that 97532 was reported. However, psychologists that provide cognitive treatment services to patients with a non-Medicare payer (e.g. private insurance, Medicaid or Medicare Advantage), should verify whether the payer will accept CPT code 97127 or HCPCS code G0515 on the claim form.
Telehealth Updates for 2018
Telehealth in Medicare allows psychologists to bill for services furnished to a Medicare beneficiary via a telecommunications system. Telehealth is only available for Part B services furnished to beneficiaries enrolled in fee-for-service Medicare and is subject to state law.
In their continued effort to modernize Medicare payments, promote patient-centered innovations and strengthen access to care, especially for those living in rural areas, CMS is transforming Medicare telehealth services by paying for more services and making it easier for providers to bill for these services.
For Calendar Year 2018 (CY2018), CMS has added the following psychology-specific services to the Medicare telehealth list:
- CPT codes 90839 and 90840: Psychotherapy for crisis (first 60 minutes) and Psychotherapy for crisis (each additional 30 minutes).
- CPT code 90785: Interactive complexity.
- CPT codes 96160 and 96161: Administration of patient-focused health risk assessment instrument and Administration of caregiver-focused health risk assessment instrument.
The addition of the Psychotherapy for crisis codes to the telehealth list came with CMS stating that payment for these services via telehealth is explicitly conditioned upon the remotely located practitioner having the ability to mobilize resources (i.e. communicate with and inform staff) at the originating site to diffuse the crisis and restore safety, when applicable.
Also, effective for CY2018, CMS has eliminated the requirement to report modifier GT (telehealth service provided via interactive audio and video telecommunications systems) on professional claims for telehealth services. Instead, psychologists should use the telehealth Place of Service (POS) Code 02, which became effective in 2017, and which certifies that the service meets the telehealth requirements. By eliminating the GT modifier reporting requirement, CMS is hoping to make it easier to bill for these services by reducing administrative burden for practitioners.
For more information, watch the February 2018 webinar, Getting Reimbursed: Using Telehealth and the New Cognitive Functioning G Code.
Additional Resources
- MLN Matters MM10303 "2018 Annual Update to the Therapy Code List" (PDF, 224KB)
- MLN Matters Number MM10393 "Summary of Policies in the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List" (PDF, 295KB)
- Telehealth Services Fact Sheet (ICN 901705) — February 2018 (PDF, 596KB)
- MLN Matters Number MM10152 "Elimination of the GT Modifier for Telehealth Services" (PDF, 185KB)