Funding and Reimbursement for Integrated Behavioral Health
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Reimbursement

Help meet P4P requirements (specific measures/overall quality)

Coding at a higher level (depth/documentation)

CPT 96101/96103

CPT 96110

E&M Code 99358(Christopher Ryan uses this exclusively)

Prolonged evaluations and management services – Before and/or after direct (face-to-face) patient care (eg. Review of extensive records and tests, communication with other professionals and/or the patient/family; first hour (List separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient Evaluation and Management service)

Christopher Ryan uses this exclusively

Medicare/Medicaid will not accept

CPT 90801-90899 Psychiatric codes

Can not be billed same day as H&B codes (NCCI ruling)

CPT 96150-96155 H&B codes (Health & Behavior codes started Jan 2002)

Apply to psychological services that address behavioral, social, and psychophysiological conditions in the treatment or management of patients diagnosed with physical health problems

Documentation must show evidence of coordination of care with the patient's primary medical care providers or medical provider responsible for the medical management of the physical illness that the psychological assessment/intervention was meant to address.

Applies to psychologists, nurses, licensed clinical social workers, and other non-physician health care clinicians whose scope of practice permits can bill the codes. Physicians performing similar services should use Evaluation and Management codes

A lot of examples around nursing home settings

Payment Breakdown

CPT Code Service Est Payment 15 min: 1 unit 1 hr: 4 units
       
96150 Assessment: initial $26 * $106 *
96151 Re-assessment $26 * $103 *
96152 Intervention: individual $25 $98
96153 Intervention: group (per person) $5 ** $22 **
96154 Intervention: family w/ patient $24 $96
96155 Intervention: family w/o patient $23 $93

NOTE: Although Medicare has assigned a payment rate, the program is not presently covering services billed under 96155.

* Multiple-unit differences compared to 1-unit amounts are due to rounding.
** Total group fee equals amount times number of persons in the group.

 

CPT 99401-99409 SBI codes (Screening & Brief Intervention codes)

FYI: Health psychologists now may have some alternatives to the H&B codes, although it is not entirely clear how all of this will shake out. .

New CPT codes for 2008 include the Screening and Brief Intervention (SBI) codes for substance abuse

The two new SBI codes :

CPT 99408 15-30 min
Medicare equivalent = G0396   [ASSESSMENT and Brief Intervention – Medicare does not pay for screening those with no known Dx]

CPT 99409 30+ min
Medicare equivalent = G0397

The fees: for 15-30 minutes, Medicare will pay about $22, unadjusted for geographic location, and private payers who cover the services could pay even more; for more than 31 or more minutes, Medicare will pay $55. Codes 99408 and 99409 should be used to report a structured screening session, using "specific, evidence-based verbal, written, or electronic screening questionnaires," and a brief intervention that goes beyond a general recommendation to stop the behavior.

    See:
    http://www.medpagetoday.com/PublicHealthPolicy/PracticeManagement/tb/6972
    http://mentalhealth.samhsa.gov/publications/allpubs/sma04-3906/xv.asp


Also parallel ones for tobacco cessation

CPT 99406 15-30 min

CPT 99407 30+ min

    See: http://www.medpagetoday.com/PrimaryCare/Smoking/tb/7007



Also, related preventative behavioral services codes:


Preventive Medicine, Individual Counseling, and/or Risk Factor Reduction Intervention Provided to an Individual as a separate procedure to address such issues as family problems, diet and exercise, substance abuse, sexual practices, injury prevention, dental health, and
diagnostic and laboratory test results available at the time of the encounter.

CPT Cod
e    Approximate Duration of Procedure
99401    15 minutes
99402    30 minutes
99403    45 minutes
99404    60 minutes

See: http://www.ama-assn.org/ama1/pub/upload/mm/433/appendixa.pdf

Billing for Preventive Behavioral Services (psychologists will likely be able to use these with some insurers):

http://mentalhealth.samhsa.gov/publications/allpubs/sma04-3906/xv.asp



Also, when I attended the CAPP committee (APA’s committee for the advancement of professional psychology, it was stated that in negotiations with medicare, Medicare for the first time expressed a willingness to allow psychologists to use E&M (physician ) codes. I will post more about this later.

Does anybody have access to a CPT 2008 yet to see what the actual CPT descriptions and intro text is? I have not seen that yet.

 

 

Payer

Code

Description

Fee Schedule

Commercial Insurance

CPT 99408 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes

$33.41

CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes

$65.51

Medicare

G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes

$29.42

G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes

$57.69

Medicaid

H0049 Alcohol and/or drug screening

$24.00

H0050 Alcohol and/or drug service, brief intervention, per 15 minutes

$48.00

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