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New CPT codes
set for psychological testing
(August/September
2005 Issue)
By Elinor Nelson
This fall, the American Medical Association (AMA) will present
new Current Procedural Terminology (CPT) codes (to be used beginning
Jan. 2006) for psychological testing, neuropsychological testing
and neurobehavioral status exams. The hope is that the new CPT codes
will pave the way for fairer reimbursement rates for psychologists
who perform these services.
"The issue isn't the new codes," explains Russ Newman, Ph.D.,
J.D., the American Psychological Association's executive director
for professional practice. "That's just the method to fix the problems
surrounding payment for psychological testing."
A multi-step process determines payment. It is guided by CPT codes
(issued by the AMA), reimbursement rates set by the Center for Medicare
and Medicaid Services (CMS) and reimbursement rates set by independent
insurance companies. The APA has been working on this issue for
10 years, Newman says.
While the services are billed using CPT codes, the codes' lack
of specificity has been one of the sticking points in improving
the compensation due psychologists. Newman outlines the payment
process, starting with practitioners submitting bills assigning
the proper CPT codes to the services. CMS designates what Medicare
and Medicaid will pay for each service billed by CPT codes and while
independent insurance companies may set their own reimbursements,
they often take the lead from the CMS rates.
CMS uses a formula that includes the practice expense (what it
costs to provide the service), the malpractice expense (the insurance
premium) and the work value. It is the work value that has gotten
in the way of psychologists' compensation, because work value is
defined, Newman says, by the time and effort of the physician performing
the service. If there's no physician, there's no work value and
the reimbursement includes only the practice and malpractice expenses.
"Over time," Newman explains, "we worked with the AMA CPT people
regarding what should be the work value for psychologists for testing,
looking at the actual time and effort necessary to provide the service
in question." The APA conducted surveys among psychologists to determine
the expenses of performing the service. This process led to the
development of "new codes which more precisely articulate who in
fact is performing the service," whether a psychologist, technician
or computer is performing the psychological test.
"We needed to change the codes," concludes Newman, "not because
these are new activities, but because the old codes were stumbling
blocks for [fair reimbursement]. The existing codes were the final
obstacle and now I think the problem will go away. I hope and anticipate
that Medicare will assign a work value for the service."
According to Newman, these CPT codes have been the only ones where
the work value has been zero - because only psychologists perform
the testing and bill under these codes. With other codes that psychologists
bill under (such as psychotherapy), there may be an overlap with
physicians who also provide the service.
The codes that will be affected are 96100, which covers psychological
testing and 96117, which covers neuropsychological testing. Both
will be deleted and each will be replaced by three new codes, which
will dictate whether a psychologist, technician or computer administers
the test, although for each new code, it is the psychologist who
will interpret and report the findings of the test. Code 96115,
which deals with neurobehavioral status exams, will also be deleted,
but it will be replaced by only one new code that will cover the
administration, interpretation and report all being performed by
a psychologist.
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