Broad View: March

By: Michael Ranney, MPA, OPA Executive Director

Issues with CPT codes continue to be the dominant theme of the calls and emails we are receiving from OPA members. We even had a psychiatrist call us with questions about the implementation of the codes. What I’ve gleaned from the questions and comments is that different plans under the umbrella of the same insurance company are handling the codes differently.

We’ve been working closely with the APA Practice Directorate’s Office of Legal and Regulatory Affairs. They have been very helpful (your practice assessment at work!) and they are looking at a variety of ways to advocate for psychology.

Several themes and issues have emerged from our experience here in Ohio and the problems that have arisen in other states.

Late payment by private insurers is a violation of Ohio’s prompt payment laws. APA has offered to send a joint complaint letter with us to any company that is still not paying or who has failed to comply with our prompt pay law. Let Bobbie Celeste or I know of prompt payment issues that you have pending. Also be sure to go to the Department of Insurance website and complete the prompt pay complaint form.

Significant rate cuts in connection with CPT code changes. We are gathering data on the extent of rate cuts, especially 90834, e.g., greater than 10 percent or $8. Thus far, we have anecdotal notes but don’t have rate sheets to confirm cuts. Please send us documentation of any significant cuts you have experienced.

Companies paying the same amount for 90837 and for 90834. Let us know if you’re aware of companies with this practice. There may be a parity issue if these companies are not treating similarly paired medical/surgical CPT codes in the same manner. Please let us know what you are experiencing with these codes.

Companies not paying codes that have been valued by CMS (or at least not listing them in their fee schedule), e.g., 90837 or interactive complexity 90785, but not crisis codes 90839 and 90840 add-on. Again, we are gathering data on the extent of this issue to share with APA.

Companies requiring pre-authorization for 90837. We know that UBH/Optum is doing this. We would like to know what other companies are requiring pre-auth or otherwise managing 90837, and would like to know their criteria/policies for that. Please share your experience and any documentation you have.