Current Procedural Terminology (CPT) Code Changes

Effective January 1, 2013

The American Medical Association recently released significant changes to the Current Procedural Terminology (CPT) codes for psychotherapy and psychiatry services. These changes become effective beginning with dates of service on or after January 1, 2013.

Prior authorizations

There are no changes to our prior authorization process. If you have already obtained prior authorization using the 2012 CPT codes, you do not need to request a new authorization. After January 1, 2013, you must submit claims using the 2013 CPT codes, even if your prior authorization includes the 2012 CPT codes.

As a reminder, we allow 12 outpatient BH visits per benefit year without prior authorization for some CPT codes (90791, 90832, 90834, 90846, 90847, 90849). These 12 visits are separate from psychiatric medication visits, psychotherapy for crisis, groups, and collateral contacts, which are exempt from prior authorization. If your patient needs more than 12 outpatient BH visits, please use the Behavioral Health Outpatient Psychotherapy Authorization Form to request prior authorization one to three weeks prior to the last covered visit.

Benefits

We have added psychotherapy for crisis to our list of covered services. The rest of our benefits remain the same.

Claims

For the following services rendered on or after January 1, 2013, we will deny claims that do not include the 2013 CPT codes. This is not an exhaustive list of our benefits and only includes covered behavioral health services for which the CPT codes are changing.

 

Covered services

2012 CPT codes

2013 CPT codes

90801: psychiatric diagnostic evaluation

90791: psychiatric diagnostic evaluation (no medical service)

90792: psychiatric diagnostic evaluation (with medical service)

or

99201-99205: E/M codes (new patients)

90804: outpatient psychotherapy, 20-30 minutes

90832: psychotherapy, 20-30 minutes

90805: outpatient psychotherapy with E/M services, 20-30 minutes

99211-99215: E/M codes

and

90833: add-on code (psychotherapy, 30 minutes)

90806: outpatient psychotherapy, 45-50 minutes

90834: psychotherapy, 45 minutes

90807: outpatient psychotherapy with E/M services, 45-50 minutes

99211-99215: E/M codes

and

90836: add-on code (psychotherapy, 45 minutes)

90862: medication management

99201-99205: E/M codes (new patients)

99211-99215: E/M codes (established patients)

No existing code

90839: psychotherapy for crisis (initial 60 minutes)

and

90840: add-on code (30 minutes, up to two allowed per incidence of 90839)

For more information, please contact your professional organization (e.g., American Psychological Association, American Medical Association, National Association of Social Workers).

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