New Psychiatric Services Procedure Codes for 2013 HCPCS Now Available

Transcription

1 New Psychiatric Services Procedure Codes for 2013 HCPCS Now Available Information posted December 21, 2012 The 2013 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions for psychiatric services will be effective for dates of service on or after January 1, 2013, and are now available. All new, revised, and discontinued 2013 HCPCS procedure codes will be effective for dates of service on or after January 1, The 2013 HCPCS discontinued procedure codes will no longer be reimbursed after December 31, Providers must contact the appropriate copyright holder to obtain procedure code descriptions. Important: Texas will follow the American Psychiatric Association coding crosswalk for 2012 Common Procedural Terminology (CPT) procedure codes to 2013 CPT procedure codes with a few exceptions as noted in the table below. Providers must use the comparable procedure codes that replace the discontinued codes that are currently used for rendered services. New and Deleted Procedure Codes The following psychiatric services procedure codes will be discontinued and replaced as indicated: Category 2012 Procdure Codes 2013 Procedure Codes Diagnostic , , Psychotherapy 90804, , Psychotherapy (interactive) Psychotherapy with evaluation and management (E/M) 90808, , , , , 90807, 90809, 90817, 90819, E/M procedure code based on key components plus psychotherapy add-on code 90833, 90836, or (time-based) Psychotherapy with E/M (interactive) 90811, 90813, 90815, 90824, 90827, E/M procedure code plus psychotherapy add-on code 90833, 90836, or 90838

2 Category 2012 Procdure Codes 2013 Procedure Codes Crisis psychotherapy None and are noncovered procedure codes. This service is included in the appropriate therapy procedure code and is not reimbursed separately. Family psychotherapy 90846, 90847, No changes Group psychotherapy Interactive group psychotherapy Pharmacologic management E/M procedure code Interactive complexity add-on procedure code will be informational only and not reimbursed separately from the appropriate psychotherapy procedures code. Reminder: New patient visits are limited to one every three years, per client, per provider. A new patient is one who has not received within the past three years any professional services from the physician or from another physician of the same specialty who belongs to the same group practice. Texas Benefit Changes The following Texas benefit changes support the 2013 HCPCS and CPT updates and will be effective for dates of service on or after January 1, Inpatient Behavioral Health Added Discontinued Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook: for more information. The descriptions of the following procedure codes have been revised: Procedure Codes

3 Procedure Codes Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, for more information. Outpatient Behavioral Health Services Added Discontinued Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information. The descriptions of the following procedure codes have been revised: Procedure Codes Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information. Screening Brief Intervention and Referral to Treatment (SBIRT) Added Discontinued Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information.

4 CSHCN Services Program Benefit Changes The following Children with Special Health Care Needs (CSHCN) Services Program benefit changes have been made to support the 2013 HCPCS and CPT updates and will be effective for dates of service on or after January 1, Behavioral Health Services Added Discontinued Limitations for added procedure codes: Providers may refer to the current CSHCN Services Program Provider Manual, for more information. Providers may refer to the current CSHCN Services Program Provider Manual, section , Procedure Codes Included in the 12-Hour System Limitation, for more information. Reimbursement Rates Effective for dates of service on or after January 1, 2013, Texas and the CSHCN Services Program will implement initial reimbursement rates for some psychiatric services HCPCS procedure codes. The table that begins on the following page shows the reimbursement rates will be effective for dates of service on or after January 1, 2013: For more information, call the TMHP Contact Center at or the TMHP- CSHCN Services Program Contact Center at

5 Type of Service (TOS)* Procedure Code HCPCS - PSYCHIATRIC SERVICES Provider Age Adjusted Type/Specialty Range RVU** Fee Fee RVU** Fee Fee 3, 10,16, 18, 19, 20, Informational Informational 21, 22, 31, 40/51, Not a Benefit Not a Benefit Item Item 31, Not a Benefit Not a Benefit $ $ , Not a Benefit Not a Benefit $ $ Not a Benefit Not a Benefit $ $ Not a Benefit Not a Benefit $ $ All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $50.69 $49.68 Not a Benefit Not a Benefit All Provider Types $ $35.48 $34.77 Not a Benefit Not a Benefit All Provider Types $ $48.28 $47.31 Not a Benefit Not a Benefit All Provider Types $ $33.80 $33.12 Not a Benefit Not a Benefit All Provider Types $ $56.99 $55.85 Not a Benefit Not a Benefit All Provider Types $ $54.28 $53.19 Not a Benefit Not a Benefit All Provider Types $ $69.88 $68.48 Not a Benefit Not a Benefit All Provider Types $ $48.92 $47.94 Not a Benefit Not a Benefit All Provider Types $ $66.55 $65.22 Not a Benefit Not a Benefit All Provider Types $ $46.59 $45.66 Not a Benefit Not a Benefit All Provider Types $ $80.19 $78.59 Not a Benefit Not a Benefit All Provider Types $ $76.37 $74.84 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $71.97 $70.53 Not a Benefit Not a Benefit All Provider Types $ $97.92 $95.96 Not a Benefit Not a Benefit All Provider Types $ $68.54 $67.17 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $53.56 $52.49 Not a Benefit Not a Benefit All Provider Types $ $51.01 $49.99 Not a Benefit Not a Benefit All Provider Types $ $63.58 $62.31 Not a Benefit Not a Benefit All Provider Types $ $60.55 $59.34 Not a Benefit Not a Benefit All Provider Types $ $76.18 $74.66 Not a Benefit Not a Benefit All Provider Types $ $72.55 $71.10 Not a Benefit Not a Benefit All Provider Types $ $86.49 $84.76 Not a Benefit Not a Benefit All Provider Types $ $82.37 $80.72 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit

6 Type of Service (TOS)* HCPCS - PSYCHIATRIC SERVICES RVU** Fee Fee RVU** Adjusted Fee Procedure Code Provider Type/Specialty Age Range Fee All Provider Types $ $46.11 $45.19 Not a Benefit Not a Benefit All Provider Types $ $43.91 $43.03 Not a Benefit Not a Benefit All Provider Types $ $52.70 $51.65 Not a Benefit Not a Benefit All Provider Types $ $50.19 $49.19 Not a Benefit Not a Benefit All Provider Types $ $68.74 $67.37 Not a Benefit Not a Benefit All Provider Types $ $65.46 $64.15 Not a Benefit Not a Benefit All Provider Types $ $75.32 $73.81 Not a Benefit Not a Benefit All Provider Types $ $71.74 $70.31 Not a Benefit Not a Benefit All Provider Types $ $ $99.64 Not a Benefit Not a Benefit All Provider Types $ $96.83 $94.89 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $49.83 $48.83 Not a Benefit Not a Benefit All Provider Types $ $47.46 $46.51 Not a Benefit Not a Benefit All Provider Types $ $56.42 $55.29 Not a Benefit Not a Benefit All Provider Types $ $53.73 $52.66 Not a Benefit Not a Benefit All Provider Types $ $72.75 $71.30 Not a Benefit Not a Benefit All Provider Types $ $69.28 $67.89 Not a Benefit Not a Benefit All Provider Types $ $79.05 $77.47 Not a Benefit Not a Benefit All Provider Types $ $75.28 $73.77 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $98.37 Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit All Provider Types $ $ $ Not a Benefit Not a Benefit , Not a Benefit Not a Benefit $49.39 $ , 18, 40/ Not a Benefit Not a Benefit $34.57 $ , Not a Benefit Not a Benefit $44.66 $ , 18, 40/ Not a Benefit Not a Benefit $31.26 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $18.68 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $19.29 $ , Not a Benefit Not a Benefit $68.49 $ , 18, 40/ Not a Benefit Not a Benefit $47.94 $ , Not a Benefit Not a Benefit $65.08 $ , 18, 40/ Not a Benefit Not a Benefit $45.56 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $41.77 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $40.01 $ , Not a Benefit Not a Benefit $ $100.78

7 Type of Service (TOS)* HCPCS - PSYCHIATRIC SERVICES Procedure Provider Age Adjusted Code Type/Specialty Range RVU** Fee Fee RVU** Fee Fee , 18, 40/ Not a Benefit Not a Benefit $70.55 $ , Not a Benefit Not a Benefit $95.93 $ , 18, 40/ Not a Benefit Not a Benefit $67.15 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $72.43 $ , 10, 19, 20, 21, Not a Benefit Not a Benefit $70.27 $ , $ $25.20 $ $ $24.70 $ , $ $24.00 $ $ $23.52 $ , 18, 40/ $17.64 $17.29 $17.29 $ , 18, 40/ $16.80 $16.46 $16.46 $ All Provider Types $ $28.07 $27.51 Not a Benefit Not a Benefit All Provider Types $ $26.73 $26.20 Not a Benefit Not a Benefit All Provider Types $ $44.68 $43.79 Not a Benefit Not a Benefit All Provider Types $ $42.55 $41.70 Not a Benefit Not a Benefit

8 Type of Service (TOS)* Procedure Code Provider Type/Specialty Age Range RVU** HCPCS - PSYCHIATRIC SERVICES Fee Fee RVU** Fee Adjusted Fee *Type of Service (TOS) 1 Medical Services **RVU Relative Value Unit Provider Type/Provider Specialty 3 County Indigent Health Care Program 10 Advanced Practice Nurse /51 97 All Provider Types Licensed Professional Counselor or Licensed Marriage and Family Therapist Comprehensive Care Program Social Worker Physician (D.O.) Physician (M.D.) Physician Group (D.O.) Physician Group (M.D.) Psychologist Licensed Clinical Social Worker (Licensed Master Social Worker) Psychology Group All payable provider types for these procedure codes will be discontinued