April 8, 2013

The American Medical Association (AMA) announced changes to behavioral health CPT codes effective January 1, 2013. These changes impact both payors and health care professionals. All health care professionals currently billing using behavioral CPT codes will be affected by this change; including psychiatrists, clinical social workers, psychologists, etc.

Highlights

• Changes are effective January 1, 2013
• Use of the new CPT codes is mandatory
• Several behavioral health CPT codes have been deleted or modified; major changes include:
  -A new code for psychotherapy when treating a patient in crisis Inclusion of add-on codes for services that are provided in addition to a primary service.
  -These codes cannot be billed alone; they must be in addition to another CPT code.
  -The coding changes will impact the 908xx series of therapy codes, including the replacement of 90862 (Medication Management.)
  - Psychotherapy and Evaluation and Management (E&M) services will now be distinguished from each other.
  -The 9920x and 9921x series of codes may now be used by psychiatrists, nurse practitioners and physician assistants.

APA CPT Code Crosswalk

Frequently Asked Questions

Who is affected by the CPT code changes?

All health care professionals who provide CPT professional services. (Psychiatrists, Psychologists, Social Workers, etc.)

When do these changes go into effect?

All health care professionals must bill with the new CPT codes for all dates of service on or after January 1, 2013.

Should I start billing with the new codes before January 1, 2013?

No. Please submit claims with the current CPT codes for any date of service prior to January 1, 2013.

Will I have to recontract with Cigna Behavioral?

No. You will receive an amendment to your existing contract if necessary.

Will I need to renegotiate my rates with Cigna

No. Any change in rates due to the CPT Code Changes will be sent to you via an official contract amendment.

What are the rates for the new add-on codes?

Please refer to your fee schedule for a full list of CPT Codes and their corresponding reimbursement rates.

Will Cigna be able to process claims for multiple codes on the same date of service?

Yes. Claims processing will be in compliance with the new regulations regarding multiple services on the same date of service. Please itemize your charges by listing a separate fee for each CPT Code/Service provided, as opposed to listing one bundled charge for all services provided.

I currently have an authorization for services billed using an expired CPT code. Do I need to call in to request a new authorization for the new code?

No. There is no need to request updated authorizations. Authorizations that extend into 2013 will continue to be valid when you submit with the updated code.

Will there be any changes regarding when prior authorization is needed for a particular service?

Cigna will follow the same authorization process. If services did not require an authorization in 2012 under the old coding system, they will not require it under the new system.

Where can I find out more information regarding the CPT code changes?

For more information about CPT codes, please consult the American Medical Association’s (AMA’s) or American Psychological Association’s (APA’s)websites.

Can the new "add on codes" be billed alone?

No. The new add-on codes (90833, 90836, 90838, and 90785) are only reimbursable if provided and billed in conjunction with a primary procedure code.