Mental Health CPT Codes for 2013
As of January 1, 2013, Medicare and the federal government have made drastic changes in the reimbursement and coding of psychiatric care. At the same time, they have mandated that private insurance follow the same changes. This hasn’t made the headlines because mental health represents less than 10% of overall healthcare, but please believe me, the changes are major.
Basically, what is new is that medical “evaluation and management,” which has long been part of your internist’s billing is now considered a part of psychiatric care taking place within a session but billed separately. Adding to the complexity, these management services are not tied to time, and vary widely in reimbursement depending on the complexity and seriousness of the situation. What used to be my standard 50 minute therapy session is now split into a variable component of management with the remaining time spent on therapy. For many decades, I have been compensated for the time I spend with my patients. Now, the same face to face time entails widely varying reimbursement depending on just what we do in that time.
At least for the present, I have decided to maintain the same basic fees as before while using the new coding to make sure that you receive the reimbursement that you are entitled to. The end result is that you will see different procedure codes, often two of them, with a fee for each, adding up, in the end, to the old fee. The one change I am making is that when there are phone calls or “Interactive complexity,” meaning exchanges with others besides my patient, I am following the government’s lead in allowing a small charge for that additional work. For that reason, you may find a $10 charge added to some services where third parties were involved.
Here are some typical examples of how the new system works:
1. 53 min. face to face therapy only: 90837 $350. Note: 53 min. counts as a full hour, so I’m spending the extra minutes and coding that way to give you maximum reimbursement.
2. 50 min. face to face with medium complexity medication management or evaluation of a potentially dangerous situation: 99213 $100 for management; 90836 for therapy $250. The total, unchanged from my usual fee scale is still $350, the same as for the past 5 years.
3. 30 min face to face for medication management and review of progress, 99213 $100 for management and 90833 $100 for therapy, with the same total as before, $200.
4. The code for third party contact, whether in the session or outside is 90785 $10.
As always, you should be able to attach my statement to your insurance form for reimbursement.
Jeffery Smith, MD