It’s funny how you stumble on things, right? Lot’s of times you just think: hmmmm… that’s interesting. Other times, you think: wow, I’m going to try to remember that. Well (a while ago) when I stumbled up upon what I’m about to share with you, all I could think was: holy crap — wasn’t anybody going to tell me about this?
Anyway, I thought that you might live in the same cave I apparently do — so I decided to write this post to give you a heads up about something that could affect your bottom line.
Apparently, January 1st 2013, the CMS (Centers for Medicare and Medicaid Services) is going to revise the list of CPT codes that we use to bill insurance and describe the “type of service” we provide our clients on a given day. You might think that this will only affect you if you are a provider for Medicare of Medicaid — but that would be wrong!
You see, CPT codes are CPT codes. They are what we use when we bill insurance companies; they are what we put on our “Super Bills” so clients can submit for reimbursement.
This is information you need. Submitting claims with the wrong CPT codes can cause rejections and a delay in your reimbursement.
Although the specific information I’m about to share with you is subject to change, here’s an overview of what I’ve heard to date. I’m thinking (hoping) that as we come closer to Jan 1, 2013, we will all hear a lot more about this news.
Psychiatric Diagnostic Evaluation Current: 90801 Proposed: 90791
Outpatient Psychotherapy (45-50 min) Current: 90806 Proposed: 90834 (45 min)
Outpatient Psychotherapy (75-80 min) Current: 90808 Proposed: 90837 (60 min)
Group Psychotherapy Current: 90857 Proposed: 90853
In addition, there are (at least) a couple of new codes: the Crisis Code (90839 for 60 minutes and 90840 for additional 30 minutes); and the Interactive Complexity add-on code (90785) for use when the delivery is more complex.
Here are a few things to keep in mind as you read this post:
- The proposed changes are not limited to these specific service codes
- This information is subject to change as CMS chisels out the details
- You should get the specifics about how this affects you, directly from the insurance companies for which your are a provider (hopefully they will let you know more as we get closer to the first of the year)
- You can purchase a 2013 CPT manual from the AMA at: https://catalog.ama-assn.org/Catalog/home.jsp
Be informed — Take action — GET PAID!