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OPA Insurance Committee Survey: CPT Codes and Session Length

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Wednesday, June 28, 2017

Many psychologists who work in private practice have become well familiar with the many difficulties which continually develop as they interact with insurance companies. Policy and procedures imposed by these entities constantly evolve, creating an ever-moving target so difficult for many psychologists to follow. The most recent difficulty encountered by most of our members involves our use of the psychotherapy CPT (Current Procedural Terminology) codes. For those who are less familiar, these are codes which describe, through their definition, the type of psychotherapy provided (individual, family, etc.)  Individual psychotherapy codes are further specified by session time (30, 45, or 60 minutes). Most psychologists who are experienced at psychotherapy emphasize that a variety of factors, including patient need, diagnosis being treated, and clinical judgement, are considered when choosing the most appropriate procedure.

Recently, a number of insurance companies have begun to restrict or limit the use of certain codes. For example, some require preauthorization for the 60-minute code, while others have sent warning letters to clinicians who “overuse” this longer session time. Together with OPA’s insurance committee, I have been monitoring this circumstance and have felt considerable concern about the reasoning behind the emergence of these newer policies. Specifically, many of the insurance companies have justified these restrictions by reasoning that most clinicians do not use longer session times routinely. This idea stands in direct contradiction to information gathered informally by OPA’s Insurance Committee and me. Through conversation and email, many of you have reported you consider the 60-minute psychotherapy session crucial to your treatment approach with clients. Others have stated they would use the 60-minute session much more often, but are unable to due to insurance company restrictions.

In response to these confusing and contradicting circumstances, OPA’s Insurance committee has developed their own survey. The purpose of the survey is to gather accurate, objective information about psychotherapy CPT codes commonly used by psychologists and others. The survey takes only a minute or two to complete, and the results will be used to help advocate for our members on this issue. It would be enormously beneficial to our efforts if you will take that minute to participate in our survey now:

https://www.surveymonkey.com/r/XKLMWQ9

It would also be quite helpful if you would pass along the link to the survey to other mental providers in your practice or community. I will be happy to report survey results as well as other efforts related to this issue as they develop. 

On a related note, many psychologists who are Medicaid providers have been experiencing confusion regarding the implementation of Medicaid Behavioral Health Redesign. The proposed redesign changes were initially scheduled to be implemented July 1 of this year. Due to a number of concerns expressed about readiness by community mental health providers, the implementation of the redesign has been postponed.  Ohio Department of Medicaid will continue the existing mental health and substance use disorder service codes, billing logic, rates and policies until a future date for Behavioral Health Redesign implementation is determined. However, qualified Ohio hospitals who offer outpatient community behavioral health services may begin implementing the new behavioral health code set and policies beginning August 1, 2017. Please let me know if you would like further details. The Ohio Department of Medicaid will also continue staffing its Rapid Response telephone lines (1-800-686-1516, Option 9) in order to respond to questions from providers.

Jim Broyles, PhD, OPA Director of Professional Affairs

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