In 2010, CMS introduced a series of new behavioral and mental health codes which I think are best described by a helpful document from the Family Medicine Digital Library:
billing codes acknowledge psychology’s role in physical health
now have a more accurate, refined way of billing for services
provided to patients with a physical health diagnosis, thanks to the
advent of six new reimbursement codes under the Current Procedural
Terminology (CPT) coding system. As of January 1, 2002, codes for
health and behavior assessment and intervention services now apply to
behavioral, social, and psychophysiological procedures for the
prevention, treatment or management of physical health problems.
Developing these new codes involved the combined efforts of the APA’s
Practice Directorate and the Interdivisional Healthcare Committee
(IHC), representing APA divisions 17, 22, 38, 40 and 54. This
constitutes a milestone in the recognition of psychologists as health
health and behavior assessment and intervention codes
– the initial assessment of the patient to determine the
biological, psychological, and social factors affecting the patient’s
physical health and any treatment problems.
– a re-assessment of the patient to evaluate the patient’s
condition and determine the need for further treatment. A
re-assessment may be performed by a clinician other than the one who
conducted the patient’s initial assessment.
– the intervention service provided to an individual to modify the
psychological, behavioral, cognitive, and social factors affecting
the patient’s physical health and well being. Examples include
increasing the patient’s awareness about his or her disease and
using cognitive and behavioral approaches to initiate physician
prescribed diet and exercise regimens.
– the intervention service provided to a group. An example is a
smoking cessation program that includes educational information,
cognitive-behavioral treatment and social support. Group sessions
typically last for 90 minutes and involve 8 to 10 patients.
– the intervention service provided to a family with the patient
present. For example, a psychologist could use relaxation techniques
with both a diabetic child and his or her parents to reduce the
child’s fear of receiving injections and the parents’ tension
when administering the injections.
– the intervention service provided to a family without the patient
present. An example would be working with parents and siblings to
shape the diabetic child’s behavior, such as praising successful
diabetes management behaviors and ignoring disruptive tactics.
I strongly recommend reading the document in question for more details.
Meanwhile, it appears that a small group of PCC clients has gotten on the bandwagon and is billing successfully for these codes. Given that the RVU value makes them worth about $20 ea (except for the 96153, which is a group code, and we’d expect multiuple units), this is good news.
It appears that PCC clients in NH, OH, PA RI, and CT have submitted and been paid for these codes. The average charge is around $40 (or 200% of Medicare) and the average payment is $26.44. I suspect that using this code requires a psychologist or social worker, but that may depend on your state scope laws.