Psychotherapy code changes confuse providers, payers

By Paula E. Hartman-Stein, Ph.D.
March 11, 2013

January brought changes in the business of psychotherapy with a new family of Current Procedural Terminology (CPT) codes that are wreaking havoc, and APA underestimated the con-fusion that would ensue. A Sept. 13 email to members said, “The changes are minimal.”

“We have total chaos out there on these codes with both the providers and the payers,” said James Georgoulakis, Ph.D., APA’s representative to the AMA’s Relative Update Committee (RUC). “I think we may have underestimated the problems and the challenges. This is the first revision of the psychotherapy codes in many years. A lot of psychologists do not read the CPT manual and did not even know the codes were being changed.”

He said the American Psychiatric Association told its members there is little information available about how the new codes should be interpreted by Medicare or private insurers and to expect that each company will have its own rules and interpretations. He also noted that the Local Coverage Determinations (LCDs) have not yet been developed.

Antonio Puente, Ph.D., the only psychologist on the voting panel of the AMA’s CPT committee, said he worries that insurance companies do not under-stand the new codes. “Some companies did not load up the codes quickly enough, and there were kickbacks from some of the companies.”

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