Mental health and/or substance use disorders (SUD) affect millions of Americans. According to a 2016 U-M Behavioral Health Workforce Research Center report, nearly 1 in 5 Americans live with a behavioral health condition in a given year. However, there is a workforce shortage of mental health professional across the country. According to the study, there are substantial payment, reimbursement, and billing issues around behavioral health. Ensuring that psychiatrists, clinical psychologists, and licensed clinical social workers receive proper reimbursement for common procedures is critical to enhance access to behavioral health services. Medical billing and coding services allow providers to take advantage of revenue opportunities in behavioral health.
New Codes for Psychiatry Services in 2018
In 2017, the Centers for Medicare and Medicaid Services (CMS) introduced new BHI and Psychiatric Collaborative Care Model (CoCM) codes. Starting Jan 1, 2018, care management for behavioral health conditions will be reported using new CPT codes:
- For care management-focused behavioral health integration (BHI), report 99484 instead of HCPCS code G0507.
- For collaborative care management for behavioral health (CoCM-BHI), CPT codes 99492, 99493, 99494 will replace2017 HCPCS codes G0502, G0503, G0504.
- For cognitive-assessment services, CPT 99483 is to be reported instead of HCPCS G0505.
- Additionally, two new CPT codes have been introduced: 99482 and 99483.
CPT codes commonly used by Behavioral Health Providers
The CPT codes which are commonly used by behavioral health providers and representative of the broadest scopes of practice for these professionals are as follows:
- 90791 Psychiatric diagnosis evaluation without medical servicesThere is no time range for this code. The psychiatric diagnostic evaluation includes a history, mental status, and recommendation. It may include communication with family and other sources but does not include psychotherapeutic services. It can only be reported once per day per patient and may be used for a reassessment or more than once for an initial assessment if more time is needed.
- 90792 Psychiatric diagnosis evaluation with medical services90792 involves medical services and its used is typically restricted to providers with a medical degree. The U-M Behavioral Health Workforce Research Center study found that in some states, non-medical providers report 90792 successfully by providing described services outside of the medical care. In other cases, states defer to 90791 as the primary diagnostic code without medical services.
- 90832 Psychotherapy, 30 minutes (Time range: 16 to 37 minutes)Psychotherapy is a common behavioral health procedure. Code 90832 refers to individual psychotherapy services for the patient and may include an informant. Services include an ongoing assessment and adjustment of treatment interventions. Typically, licensed psychologists and licensed clinical social workers are recognized and eligible to provide this service.
- 90834 – Psychotherapy 45 minutes (time range: 38 to 52 minutes)
- 90837 – Psychotherapy 60 minutes (time range: 53 minutes or more)A 2017 report from the National Association of Social Workers notes that some payers may consider 90834 as the standard psychotherapy session. Therefore providers reporting 90837 would benefit by clearly justifying in the clinical record as to why the longer service was necessary rather than the shorter service.
- 90846/7 Family or couples psychotherapy with/without patientAccording to the U-M Behavioral Health Workforce Research Center report,health insurance companies’ reimbursement policies for 90846/7 differ among states:
- While California, Illinois, South Dakota, and Texas did not reimburse for 90846 at all, South Carolina and Wyoming allowed only clinical psychologists or psychiatrists to be reimbursed.
- A state Medicaid plan not recognizing 90846, may cover the service by a specific local HCPCS code
- While South Dakota and Texas did not recognize 90846, they recognized 90847 for some providers
- 90839 Psychotherapy for crisis 60 minutes (30-74 minutes), and
- +90840 Add-on code for an additional 30 minutes (75 minutes and over). Used in conjunction with 9083990839 and 90840 are used to report psychotherapy for crises. They indicate an urgent and immediate assessment of a patient in high distress, which includes a history of a crisis state, a mental status exam, and a disposition. In addition to psychotherapy, treatment includes:
- Mobilization of resources to defuse the crisis and restore safety
- Provision of psychotherapeutic intervention to minimize emotional trauma
To use 90839 and 90840, the presenting problem should be life threatening or complex.
- 90853 Group psychotherapy (not family)This code does not have any time specification. The add-on code for interactive complexity, 90785, may be used when appropriate with 90835.
90863 Pharmacological management
The U-M Behavioral Health Workforce Research Center report found that 90863 is only used in Louisiana and New Mexico by clinical psychologists who are permitted to prescribe. This code should not be used by psychiatrists or other medical mental health providers.
+90785 Interactive complexity add-on code
Introduced in 2013, CPT add-on code 90785 interactive complexity refers to 4 specific communication factors during a visit that complicate delivery of the primary psychiatric procedure. 90785 can be reported when at least one of the following communication factors is present during the visit:
- The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
- Caregiver emotions or behaviors that interfere with implementation of the treatment plan.
- Evidence or disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.
- Use of play equipment, physical devices, interpreter or translator to overcome barriers to diagnostic or therapeutic interaction with a patient who is not fluent in the same language or who has not developed or lost expressive or receptive language skills to use or understand typical language.
Per CMS, +90785 generally should not be billed solely for the purpose of translation or interpretation services. This code can be reported in conjunction with the following psychiatric “primary procedures”:
- Psychiatric diagnostic evaluation, 90791, 90792
- Psychotherapy, 90832, 90834, 90837
- Psychotherapy add-on codes 90833, 90836, 90838, when reported with E/M
- Group psychotherapy, 90853
When performed with psychotherapy, the interactive complexity component (90785) signifies only the increased work intensity of the psychotherapy service, and does not alter the time for the psychotherapy service.
The U-M Behavioral Health Workforce Research Center report notes that licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists are important contributors to the behavioral health workforce in communities facing behavioral health shortage and access issues. Starting Jan. 1, 2018, multiple changes to the Current Procedural Terminology (CPT) codes related to mental and behavioral health service will take effect. With varying payer reimbursement rules and new codes, partnering with a reliable medical coding and billing company is the best option for providers to report behavioral health services correctly, prevent denials, and maximize reimbursement.