Major Changes to CPT Codes for Psychiatry and Psychotherapy in 2013
Effective January 1, 2013, there will be significant changes to Current Procedural Terminology (CPT) codes for psychiatry and psychotherapy services. The CPT code set is defined by the American Medical Association (AMA) and describes procedures and services by physicians and other health care professionals. CPT codes are used as the basis for billing third party payers, and changes to these codes can affect insurers’ coverage and pricing decisions. Changes to CPT code sets are made by AMA on an annual basis, but decisions made this year will have a much higher-than-usual impact on psychiatry and psychotherapy services.
Significant Changes to the 2013 Psychiatry CPT Code Set
Several commonly used psychiatric CPT codes have been deleted or modified. Changes include:
- Removal of evaluation and management (E&M) plus psychotherapy codes from the psychiatry section (90805, 90807)
- Deletion of pharmacologic management (providers to use appropriate E&M code)
- Psychotherapy and E&M services are distinguished from each other (time spent on E&M services is not counted towards psychotherapeutic services, and separate codes can be used in combination with one another)
- Inclusion of add on codes for psychiatry, which are services performed in addition to a primary service or procedure (and never as a stand-alone service)
- Addition of code 90785 for interactive complexity
- New code for psychotherapy for a patient in crisis
While insurers, including Medicare and Medicaid, cannot use codes that were outright deleted by AMA, they can still make pricing and coverage decisions within the remaining (and new or modified) codes.
- Click here for this information in a printable form, including an overview of the CPT Code Change and Adoption Process
Louisana Behavioral Health Partnership Provider Network
A multi-pronged approach has been deployed to assist you through these changes, including:
- A provider notification / contract amendment mailing
- Click here for the LBHP specific Crosswalk from 2012 to 2013 CPT Code Sets
- A Frequently Asked Questions document for our LBHP Partner Providers
- Click here for information on Clinical Advisor configuration and updates related to the 2013 CPT Code Changes
- Type of Service Codes (TOS) relating to new CPT Codes
- Clinical Advisor prompts for Add-On codes, when TOS indicates possible appropriateness
- Spotlight and Provider Focus articles on the provider website
- Message on hardcopy EOBs
Which applicable CPT codes are NOT changing?
- 90845 Psychoanalysis
- 90846 Family therapy-patient no present
- 90847 Family therapy-patient present
- 90849 Multi-family group treatment
- 90853 Group therapy
Will this impact my reimbursement rates?
Magellan has mapped the rate amounts from current codes to the new codes based on the time spent and complexity of the service so that in almost all situations identical amounts will be paid for the same service. See the LBHP specific CPT Code crosswalk. However, there may be changes in how a service now represented by a new CPT code or codes are billed, which could impact the amount you are paid for a particular service.
What are add-on codes? How do I use them?
Add-on codes are codes used in conjunction with another primary code and are indicated by a (+) in CPT publications and our materials. These codes are used as follows:
- Added to 99xxx codes to denote psychotherapy in addition to evaluation and management (E/M) services. If E/M services are provided, timed add-on codes for psychotherapy include:
- +90833 30 minutes
- +90836 45 minutes
- +90838 60 minutes
- Added to denote "interactive psychotherapy" - use of device or interpreter- +90785
- Initial evaluation codes
- To evaluation and management codes with a psychotherapy add-on code (99xxx codes with the appropriate time-related add-on psychotherapy add-on code)
- To psychotherapy codes
- To group psychotherapy codes
- Used with crisis therapy for each 30 minute session beyond the first hour- +90840
The (+) is not used when submitting claims. Please note that since E/M codes are not time-based, but based on medical complexity, the times listed here are only gross estimates.
Magellan Health Services hosted a national webinar on November 9th regarding the 2013 CPT code changes. Below is a webinar recording link and PowerPoint slides. We encourage you to share this information with others in your organization that could benefit from this webinar.
- Click here for the November 9th national webinar recording
- Click here for the PowerPoint slides of the above national presentation (accessing these slides is not necessary to view the webinar recording)
- Visit the CPT Code Change page within the Magellan Provider website under the Getting Paid header and HIPPA subheader for more information.