from The National Psychologist, Vol. 14, No. 6 Nov/Dec pg. 20

AMA restructures CPT testing codes

By Paula E. Hartman-Stein, Ph.D.

A new system of coding procedures for psychological testing services slated to begin in January 2006 is likely to result in substantial increases of reimbursement, but only when the psychologist, without assistance from a technician, provides the service, according to James Georgoulakis, Ph.D., APA’s representative to the Relative Update Committee (RUC) of the American Medical Association’s (AMA).

With input from the APA and other professional groups, the AMA has recently revamped the Central Nervous System section of the Current Procedural Terminology (CPT) system. In an interview with The National Psychologist, Georgoulakis explained the code revisions that were released in early October.

Q: What is the major change that will result from the new coding system?

A: "One of the very key things about the new codes deals is the differentiation of when the psychologist is actually working with the patient, when a technician is working with the patient, and when the patient is working with the computer."

Q: In your opinion, is the new system an improvement for the practitioner?

A: "Prior to the new coding system, those psychologists who have been performing all of the work with the patient to a large degree have been shortchanged. Now I think we are correcting some of the inadequacies of the previous system. If the psychologist is administering a neuropsychological assessment, and he/she is face to face with the patient the whole time, the compensation should be at a greater rate for that clinician as opposed to the psychologist who utilizes a technician or the computer. I think this new differentiation is fair."

Q: What will the reimbursement be for psychological testing?

A: "The AMA just released the new codes, but the Center for Medicare and Medicaid Services (CMS) has not yet released the work values that determine reimbursement rates. We will know in late November with the publication of the Federal Register exactly what the work values will be for the new codes. It is likely that there will be substantial increases in reimbursement only when the psychologist does the work. CMS is supportive that there should be split codes and that the reimbursement will change accordingly. We’ve got to be cautiously happy about the new codes. But I won’t feel good till I see work values, practice expense and overhead values associated with the codes because that means now we can be paid. That is the bottom line."

Q: What are some specific code changes?

A: "For example, the former CPT code for neuropsychological testing, 96117, will be deleted, with three codes taking its place, codes 96118, 96119 and 96120. Code 96118 represents per hour unit of a psychologist’s or physician’s time, both face to face with the patient, preparing the test results, and writing the report. Code 96119 per hour will be used when a qualified technician does the testing, and code 96120 will be used when a computer is used for the administration of a psychological instrument."

Q: What other codes are deleted?

A: "96100, psychological testing, is replaced by 96101, 96102, and 96103, with the same corresponding breakdown of psychologist’s time, technician’s time, and use of a computer for test administration."

Q: Will code 96115, neurocognitive status exam, change in the same way?

A: "No, it will be deleted and replaced by code 96116, that actually has the same language as the 96115 had, but 96116 will only be coded for a psychologist’s or physician’s time. This change will help with reimbursement. The payor knows it is paying for face to face time and other professional time."

Q: Have any testing codes not been changed?

A: "The only code that looks the same is 96105, assessment of aphasia. The language of that code is the same."

Q: Will these new codes be used only with patients covered under the Medicare system?

A: "The Medicare system will use the new codes as of January 1, 2006. Ninety-nine percent of all private payors are utilizing the work values in some fashion. Everyone is keying off this system. The old codes will not exist in the CPT manual and all insurance companies use the same CPT codes."

Q: So will this change impact psychotherapy reimbursement?

A: "We’re only talking about the CPT codes of the Central Nervous System."

Q: Will the new codes impact the frequency of audits?

A: "Effective October 1, CMS has put together a demonstration project that is covering three states, California, New York, and Florida, with the sole purpose of monitoring the people who are monitoring the audits. We are going to have increased audits, there is no question about that. For every dollar Congress puts into monitoring, they get four dollars in return."

Q: How were the new codes and the work values determined?

A: "The codes were determined in accordance by the AMA’s policies of the RUC survey process."

Q: How will psychologists learn more about the new codes?

A: "Invest some money into buying the new 2006 CPT code book. Also APA will most likely set up some training seminars. There are a lot of coding issues that are not covered by simply studying the CPT manual."

Q: Congratulations on your hard work paying off on behalf of organized psychology. Do you feel heartened that your work has been successful in establishing the new codes?

A: "No matter how many times I say it, having a code is wonderful, you have to have the code to start with, but that is not enough. The issue becomes how much they pay for the codes, and it is likely that there will be very minimal payment when the computer is used during a testing battery."

Note: Georgoulakis and Tony Puente, Ph.D., were given special recognition at the APA convention for their dedication and hours of pro bono work with the AMA and CMS regarding changing the testing codes and setting up work values.

Paula Hartman-Stein, Ph.D. is a consultant, practitioner, and trainer who specializes in geropsychology in Kent, Ohio and is Director of geriatric psychology at Summa Health System in Akron, Ohio. She was one of seven psychologists who were involved with the original system that set up reimbursement for psychological services under Medicare. She can be reached through her website: www.centerforhealthyaging.com.