For the last 25 years I have focused my efforts on matching psychologists’ education, training, expertise, and talents to the reimbursement system approved by the federal government’s Medicare system, and to the Current Procedural Terminology. Starting in the late 1980s, I worked for five years on developing health insurance codes in collaboration with the American Psychological Association (APA).  In 1992, when APA received a seat for a formal advisor, I began to represent psychology and APA. During the last six years, I have served on the actual panel. More descriptive information on this panel can be found at the AMA website.

Common Procedural Terminology (CPT), developed almost 50 years ago by surgeons and physicians, is the most widely accepted nomenclature used in the reporting of health services under public and private health insurances. CPT is owned and copyrighted by the American Medical Association (AMA) and licensed by the Center for Medicare & Medicaid Services (CMS). These codes are maintained by the CPT Editorial Panel who meets three times a year to discuss issues associated with new and emerging health care practices, procedures and technologies.  A new CPT code for professional psychological services is developed initially by a Health Care Professional Advisory Committee (also called HCPAC), all non-physicians, then is edited and researched by a selected CPT work group and finally moves to the CPT panel for review and possible approval. These ideas are often vetted simultaneously by a panel of experts convened by APA. This was done for the health and behavior, central nervous system assessment as well as the psychotherapy and applied behavior analysis codes. If successful, this process can take anywhere from two years to twelve years. If not successful, the results may be more clearly visible within two years.

Out of the approximately 8,000 codes, around 60 are possible codes for psychologists to utilize. These codes fall within a few major categories including Psychiatric/Mental Health, Central Nervous System Assessment, and Health and Behavior. Miscellaneous codes also cover things such as preventative measures and telehealth. Psychiatric/Mental health codes were added in the 1970s, testing codes 20 years later and Health and Behavior codes soon thereafter. In between, biofeedback codes were modified as well as expanded and almost all codes currently used were significantly modified and re-valued.

Due to changes in practice patterns and increasing co-morbidities, codes established for psychotherapy have undergone major changes in 2013.  More change is expected for codes used by our profession.  The most extensive and recent changes are for psychiatric interviewing (diagnosis) and psychotherapy codes (intervention) with the end codes being more granular and sensitive to time, and take into consideration intensity and the type of service.

Education on these changes is important for professionals using the codes so that they stay informed on their proper use.  Improper use of the codes may lead to possible audits, fines, or even incarceration. At present, APA is represented at CPT meetings (the part that involves determining what health care practices can be done and, generally speaking, how they are done) by Neil Pliskin.  The RUC side (determining the relative code value) is represented by James Gourgoulakis.  Additionally, the Director of APA’s new Office of Healthcare Financing is Randy Phelps. This group is working on numerous projects including, but not limited to, studying the need for other psychotherapy and testing services. An increasing interest has been placed on integrative care as well.

In order to help individuals versed on CPT and professional psychological services, a website was established in order to disseminate information on the tsunami of change. If you are interested in the webinars or educational materials please visit www.PsychologyCoding.com for more information.

Written by Antonio E. Puente (with the assistance of John Capps & Aaron Dedmon). Dr. Antonio E. Puente is a Professor of Psychology at the University of North Carolina Wilmington and has maintained a private practice in clinical neuropsychology since 1982. He was APA’s first advisor to the AMA CPT Panel (1992-2007) and on the actual panel since 2008.