Every January changes to the CPT (Current Procedural Terminology) directly affect psychologists. CPT is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. These codes can change yearly and are generally done to make the lives of physicians a little easier. This January, new codes influenced telehealth services and cognitive services.
CPT Code Changes
In January 2018, Current Procedural Terminology (CPT) code 97127 took effect. This code is described as therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity and 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), direct (one-on-one) patient contact, which are each 15 minutes. Nevertheless, this new code is untimed and may only be reported once a day, regardless of how long the session may be. However, 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 (“each 15 minutes”), and can be billed multiple times on the same day based upon the length of time required to complete the services.
Psychologists should report G0515 in the same manner that 97532 was reported. However, psychologists that provide cognitive treatment services to patients with a non-Medicare payer (for example, 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 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.
A comprehensive list of codes can be found at the following: https://coder.aapc.com/cpt-codes/