Beginning Jan. 1, 2020, psychologists will receive higher payments for providing treatment to Medicare patients who receive services for coping with or managing a physical health condition.
APA had been strongly advocating for changes to psychologists’ payments for these treatments—billed as Health Behavior Assessment and Intervention (HBAI) services—to more accurately represent current clinical practice. As part of its advocacy, APA urged psychologists to submit comments to the Centers for Medicare and Medicaid Services (CMS) in support of a new coding structure for HBAI services and proposed value increases (see chart below).
CMS listened. They accepted APA’s recommendations and issued their approval of the rate increases in the agency’s 2020 Medicare Physician Fee Schedule Final Rule, released Nov. 1.
CMS noticed psychologists’ efforts, stating in the final rule that the “total number of comments for the HBAI CPT codes are from Psychologists who are uniformly pleased to see that CMS has accepted all of the AMA RUC’s recommended increases for the Health Behavior Assessment and Intervention (HBAI) services....”
“The rate increases are strong evidence that CMS recognizes the importance of addressing the psychological factors that affect patients’ physical health problems. The new HBAI code set will make it financially more sustainable for psychologists to provide HBAI services and expand access to psychological care for patients with physical health conditions,” says APA Chief of Professional Practice Jared Skillings, PhD, ABPP.
Although CMS accepted APA’s recommended values, Medicare will still not cover Health Behavior Family Intervention services offered without the patient being present.
APA will continue to review and analyze the 2,500-page final rule and provide further details on payment policies and other issues that psychologists need to be aware of in the next issue of “PracticeUpdate.”
Visit APA Services’ Reimbursement webpage for more information and updated resources related to HBAI and other coding and billing issues.
Article published Nov. 7, 2019
Finalized coding changes and work RVUs for HBAI services in 2020
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CPT ® Code
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Code Descriptor
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2020 wRVU
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Health Behavior Assessment Services
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Assessment or Re-Assessment
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96156
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Health behavior assessment or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making)
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2.10
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Health Behavior Intervention Services
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Individual Intervention
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96158
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Health behavior intervention, individual, face-to-face; initial 30 minutes
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1.45
|
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✚ 96159
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Each additional 15 minutes (List separately in addition to code for primary procedure)
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0.50
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Group Intervention
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96164
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Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
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0.21
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✚ 96165
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Each additional 15 minutes (List separately in addition to code for primary procedure)
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0.10
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Family Intervention with Patient Present
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96167
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Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
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1.55
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✚ 96168
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Each additional 15 minutes (List separately in addition to code for primary procedure)
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0.55
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Family Intervention without Patient Present
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96170*
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Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
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1.50
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✚96171*
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Each additional 15 minutes (List separately in addition to code for primary procedure)
|
0.54
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“ ✚ ” Indicates an Add-On Code to be reported with primary service/base code
