New medical billing codes for psychological and neuropsychological testing services that took effect Jan. 1 were supposed to improve accuracy in filing claims and even increase reimbursement rates, according to the American Psychological Association (APA).
But the Current Procedural Terminology or CPT codes used when billing Medicare and all insurance carriers led to sleepless nights for many testing psychologists worried about keeping their practices afloat.
That’s because new codes were finalized by the Centers for Medicare and Medicaid Services in November 2018, leaving insurance plans without enough time to complete the IT configuration process required.
Providers accustomed to being paid relatively quickly by health plans found themselves waiting weeks for reimbursement or prior authorization approval or even having their claims denied. There were angst-ridden posts on a Facebook group page for testing psychologists with some even suggesting they were experiencing their own version of a shutdown.
“I did have to borrow some money in January,” said Claudia Rutherford, Ph.D., director of Pioneer Valley Psychological Assessment in South Deerfield, Massachusetts, when interviewed on March 4.
Rutherford has three other psychologists working associates with her practice. They had enough private pay and legal work to keep them busy over the winter, but she was worried.
“Long term, we’re not sure what we’re going to do,” she said.
The new CPT codes were more complicated than the old codes because they were broken down into multiple codes. But they were not overly complicated for providers to learn how to apply them to their billing, said Margaret Lanca, Ph.D., president of the Massachusetts Psychological Association and director of adult neuropsychology and psychological testing and training for Cambridge Health Alliance.
“What we’ve seen is a lot of confusion on the part of insurance companies in applying these codes,” Lanca said, “and this is causing some real chaos among providers.”
Rutherford was still waiting for payment for six of seven claims she submitted for reimbursement. The claim she was paid for appeared to show a small increase in the hourly rate, but she couldn’t be sure.
She had no fee schedule from the health plan, Massachusetts Behavioral Health Partnership (MBHP), which manages behavioral health care for more than 500,000 MassHealth Members.
“Every time I’ve emailed this insurer and ask when we’re getting a fee schedule, they either don’t answer me or finally I got someone to write me back and they said ‘soon.’ And that was 3 weeks ago,” Rutherford said.
It took about six weeks to receive the payment whereas under the old codes, Rutherford said she would receive payment in a week to 10 days.
Psychologists Receive Fee Schedule
About a dozen of the 400 testing psychologists in MBHP’s network had received a fee schedule by the first week of March, said Terri Hubbard, MS, LMHC, RN, vice president of operations and contract compliance. Those who had received them had called to ask for them, she added.
Hubbard said claims submitted in the first two weeks of January were held as pending until the completion of IT configuration. All claims had been paid or were in process of being paid by March.
Providers were used to being paid by MBHP very quickly, Hubbard acknowledged. She said four to six months is ideally needed for a new code rollout.
“This was a complicated one,” she added. “There is a lot of operational work that happens behind the scenes at an insurance company whenever codes are changed. It’s a domino effect.”
A Breakdown of New Codes
The changes retired codes 96101-96103, 96116 and 96118-96120. New codes for test administration and scoring overlap while testing evaluation is service specific.
The single code of 96101, is now billed using four codes. Two are for psychological evaluation services with 96130 for the first hour of evaluation and 96131 for each additional hour needed to complete the service. The other two are 96136 for the first 30 minutes of test administration and scoring by a psychologist and 96137 for each additional 30 minutes.
Code 96102 for psychological testing per hour by a technician was replaced by two codes: 96138 for the first 30 minutes of testing by a technician and 96139 for additional 30 minutes.
Neuropsychological testing codes 96118 and 96119 were replaced by multiple codes providing more detail about whether a psychologist or a technician performed the service and for what duration.
Health New England, which covers 160,000 members in western Massachusetts, revised the first fee schedule it released for Jan. 1 after a neuropsychologist who sits on the company’s behavioral health advisory committee pointed out they were incorrect, said Robert Azeez, behavioral health manager. The correct fee schedule was released at the beginning of February.
Azeez said 44 claims were submitted between Jan. 1 and early March, when all had either been paid or were in process. “None of our providers got paid incorrectly,” he said.
Health New England has more than 150 different commercial plans, requiring its configuration team to go through every single one to input the changes.
“So, if you’re talking about 150 plans, different benefit packages, that could take six, seven hours to configure each one,” Azeez said. “Think about the manual labor that goes into just doing one code change and here we’re talking about a crosswalk of multiple sets of different codes that were rolled out.”
In a perfect world, Azeez said the CPT changes would have been finalized last June. “They weren’t rolled out until the end of November and they were starting Jan. 1 so that’s a very, very short window,” he said.
APA had organized webinars in July, October and December of last year along with a detailed series of documents about the new codes that replaced the codes eliminated after Dec. 31, 2018. The outreach efforts included a webinar for insurers.
By March, the confusion and chaos seemed to be fading as insurers reconfigure their IT systems, according to Jared L. Skillings, Ph.D, APA chief of professional practice.
“They’ve all pretty much turned the corner pretty well from what we’re hearing,” Skilling said.
APA announced last July that testing psychologists would likely receive an estimated six percent increase in reimbursement. The coming weeks will reveal the accuracy of that estimate.
“The feedback that we’re getting is that the rates are at least as good as they were before and, in some cases, even better,” Skilling said.