New CPT Codes and Services for 2013

Posted by: Jonathan Neufeld, PhD, HSPP on Monday, January 7, 2013 at 12:00:00 am

New CPT Codes and Telehealth Services for 2013


By now most of you are well aware of the changes in Medicare and the CPT code system for 2013. For those of you who may not be, here is a brief summary. The changes are relatively minor, but they will affect some key services that are provided via telemedicine, and make payments available for several new services that programs may want to consider.


First the CPT code changes. The Current Procedural Terminology (CPT) system is a proprietary nomenclature for describing medical procedures and services. It is copyrighted by the American Medical Association, which collects licensing fees for its use. Almost every US health care entity uses these codes in its billing system, since every US payer pays for medical services using this system.


For 2013, the specific codes for several mental health services are being changed to better differentiate and specify various services that have tended to end up poorly categorized, either by being lumped together under the same code with significantly different services, or being split into separate codes when, in fact, they are very similar services. For example, a psychiatric diagnostic session, formerly coded as 90801, could be an intake assessment performed by a psychiatrist, leading to a treatment plan that includes prescription medication, or it could be an intake performed by a psychologist or mental health counselor, leading to a course of psychotherapy or behavioral treatment. The new coding system differentiates these two services into 90791 (diagnostic evaluation without medical services) and 90792 (diagnostic evaluation with medical services). One would expect payers to begin providing different levels of payment for these two codes to reflect this difference as well.


An example moving in the other direction is the now-defunct code for psychiatric medication management, 90862. This code will no longer be used, and, in its place, the appropriate Evaluation and Management (E&M) code is required. E&M codes are designed to capture varying levels of case complexity and time spent evaluating and managing each case. Varying levels of documentation are also required, corresponding to the complexity of the case. Psychiatric medication management (90862) is in many ways a subset of medical evaluation and management, so a separate category was deemed unnecessary. In addition, the 90862 code has been billed for a wide variety of levels of case complexity and actual encounter times, so the use of E&M codes is expected to better capture the varying complexity and time spent managing these patients.


Inpatient and outpatient psychotherapy codes (90804-90815 and 90816-90829) have also been combined into a single set of codes covering these services in either setting (90832-90838 with interactive complexity add-on code +90875).


The full list of codes and changes for 2013 prepared by the American Psychiatric Association is available here and from the National Council here. A subset of the codes that applies to psychologists and other non-physician mental health providers is available on the American Psychological Association website here. The most frequently used codes and their changes are as follows:


Old Code

2013 Code

90801 Psychiatric diagnostic evaluation

90791 Evaluation without medical services

90792 Evaluation with medical services

90862 Psychiatric medication management

Appropriate E&M Code: 99212-99215

90806 Outpatient psychotherapy (45-50 min.)

90834 Psychotherapy, 45 min.


The other major change for 2013 (so far) in the telemedicine world is Medicare's decision to cover additional health and behavior interventions and screenings provided via telemedicine. These new services are often brief (15-30 minutes) and/or periodic (annual or semi-annual) counseling or assessments focused on key health behaviors, health indicators, or risk factors.


Included in these newly covered telehealth services are:

  • G0396-G0397 structured screening and intervention for alcohol and substance abuse (to go along with last year's addition of brief screening and intervention for tobacco use)

  • G0442-G0443 Annual alcohol misuse screening and brief counseling for alcohol misuse

  • G0444 Annual depression screening

  • G0445 Behavioral counseling to prevent STDs

  • G0446 Behavioral counseling to reduce cardiovascular disease

  • G0447 Behavioral counseling for obesity


The full list of codes and services, with descriptions, is available in the MLN Matters Newsletter available here.


The addition of these codes suggests a growing understanding at CMS and across the medical community that health behavioral interventions are one essential key to improving outcomes and reducing long term expenditures for chronic disease care, and that these interventions can be effectively delivered via telemedicine through live interactive video. New services taking advantage of these codes to structure interventions aimed at doing just this are sure to follow. As with many telemedicine services, it may take some time to determine precisely which elements are key to implementing effective behavioral interventions for these conditions. However, coverage for these services will undoubtedly help programs and providers eager to develop and implement these potentially life-changing behavioral interventions.

blog comments powered by Disqus