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Discover the New Updates and Changes for Psychiatry Billing CPT Codes with Experts!

psychiatric billing
Discover 2024 psychiatry billing updates: new CPT codes, crisis care, telehealth, & E/M changes. Stay compliant and get accurate reimbursement with Transcure.

Overview

Do you know about the new psychiatry billing codes? The AMA has announced CPT code updates that introduce significant changes for psychiatric billing. These updates impact billing for Evaluation & Management visits, introduce new codes for crisis care psychiatry billing services, and revise telehealth billing procedures. These updates will totally change the way you bill for your psychiatric telehealth sessions. In this article, we’ll discuss these changes in detail to ensure you can adapt them smoothly and maintain accurate psychiatry billing practices.

Let us break down everything you need to know about the latest CPT code updates to ensure you stay compliant and get reimbursed properly for the valuable psychiatric services you deliver.

What Are the New Codes for Crisis Care?

This is great news for mental health providers! There are new psychiatric billing codes to help you get reimbursed for crisis care services you deliver. These codes are beneficial for situations where therapy takes place outside a traditional office setting, like a patient’s home.

This is great news for mental health providers! There are new psychiatric billing codes to help you get reimbursed for crisis care services you deliver. These codes are beneficial for situations where therapy takes place outside a traditional office setting, like a patient’s home.

Before 2024, therapists might have used general therapy codes, which didn’t reflect the urgency and intensity of a crisis session. Psychiatry billing for services outside an office was unclear, potentially leading to denials. Additionally, therapists might have received lower reimbursement for crisis care because traditional codes didn’t capture the specific nature of the service. Updated codes now offer a more precise and accurate way to bill for crisis intervention compared to the previous psychiatric billing system.

Here are the codes with descriptions:

  • Code G0017: This covers the first 60 minutes you spend with a patient in crisis, as long as the session happens somewhere other than your office. When it comes to psychiatric billing, this code is crucial for crisis intervention.

  • Code G0018: If the crisis session lasts longer than an hour, this code lets you bill for each additional 30 minutes you spend helping the patient. You can even use these codes for telehealth services, making it easier to provide critical support during a crisis no matter the location and improving access to behavioral health billing services.

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Understanding Code G0017:

This code helps providers explicitly bill insurance for the valuable work they do during crisis situations:

  • Psychotherapy for Crisis: Imagine a patient experiencing a sudden emotional or mental health emergency. Code G0017 applies to therapy sessions focused on helping them stabilize and develop a plan for ongoing support. This is vital for overall behavioral health billing services.

  • Not Your Typical Office Visit: The G0017 code is for situations where the therapy happens outside a traditional office setting. It can be a patient’s home, a hospital emergency room, or even a crisis center. Psychiatric billing services extend beyond the office, and this code ensures proper reimbursement.

  • Higher Reimbursement for Non-Facility Care: Insurance companies often have different rates for therapy depending on the location. G0017 uses the “non-facility rate,” which is generally higher than what you’d get for an in-office session. This code reflects the extra effort and resources needed for crisis intervention in non-traditional settings, making psychiatric billing more accurate.

  • ·First 60 Minutes: This code covers the initial hour of the crisis therapy session. If the session goes longer, there are additional codes (like G0018) to account for that extra time. Imagine a therapy session to address a mental health crisis that goes longer than an hour. G0017 would cover the first hour, and then for each additional 30 minutes that follow, therapists can use G0018 to bill for their time. This ensures they are fairly compensated for the extended crisis intervention provided outside their office, improving psychiatrist medical billing accuracy.

G0017 allows therapists to bill insurance for the first hour of a therapy session they provide to a patient experiencing a mental health crisis outside of their office. This acknowledges the importance of crisis intervention and the additional challenges of providing care in non-traditional settings, positively impacting psychiatric billing.

New Billing Rules You Need to Know for Psychiatry Billing!

In order to give patients more convenient access to care, telehealth has emerged as a useful tool for mental health professionals. However, certain significant changes to psychiatric billing are associated with this convenience, particularly in relation to in-home telehealth treatments. What you should know is described as follows:

  • Continuation of Telehealth Flexibilities in Psychology: Importantly, many of the telehealth flexibilities introduced during the COVID-19 public health emergency have been extended through at least the end of 2024. This means mental health providers can continue to deliver a wider range of services to patients via telehealth, including psychiatry services, and receive reimbursement for those services. This is a significant development for psychiatry billing and expands access to mental healthcare.

  • Health Behavior Assessments (HBAs): Now that they are being paid at a greater rate, HBAs are an essential step in creating a thorough treatment plan. This encourages more thorough assessments utilizing certain CPT codes (96156, 96159, for example) that explore a patient’s socioeconomic determinants of health, lifestyle choices, and possible risk factors. A more comprehensive picture of the patient’s condition is captured, which increases the accuracy of psychiatric billing.

  • Psychotherapy Medicare Support Continued: Medicare will continue to cover psychotherapy services furnished via telehealth, including both individual and group therapy. This ensures continued access to mental healthcare services through telehealth for Medicare beneficiaries, impacting psychiatry billing for this population.

  • Service Location: Billing accuracy depends on clear communication of the service location. Billers need to use specific “place of service” codes to indicate whether the psychiatric telehealth session occurred at the patient’s home (POS 10) or another location outside an office (POS 02). This ensures proper reimbursement based on the setting, improving the accuracy of psychiatric billing.

  • Double-Check When You’re at the Hospital: Things get a bit trickier if you’re providing telehealth services to a psychiatric patient at home while you yourself are physically located at a hospital. In these situations, an additional code (modifier 95) might be necessary to ensure accurate reimbursement for psychiatric billing services.

By understanding these new billing rules, you can ensure you’re getting properly reimbursed for your valuable telehealth services in psychiatry. This not only benefits your practice but also encourages the continued growth of accessible mental healthcare through telehealth, impacting behavioral health billing.

Changes to E/M Billing Time Ranges

This year also brings an important update to E/M billing for psychiatrists, which is the removal of time ranges used to determine the appropriate CPT code for office visits. Previously, E/M codes like 99214 (established patient visit, moderate complexity) had a range (e.g., 30-39 minutes) for total time spent with the patient. Now, in 2024, these codes have a single minimum time requirement that the psychiatrist must meet or exceed to use that code. This is a significant change in psychiatric billing.

What Does It Mean for Psychiatrists?

  • More Accurate Coding: This change aims to encourage a more accurate reflection of service complexity. Previously, a 29-minute visit could qualify for the same code as a 39-minute visit. Now, the code reflects the actual time spent with the patient, improving the accuracy of psychiatric billing.

  • Meticulous Timekeeping: Psychiatrists must make sure they precisely record the whole amount of time they spend with a patient during the session. This covers in-person meetings, going over medical records, paperwork, and care coordinating tasks. This is crucial for accurate psychiatric billing under the new E/M system.

  • Potential Impact on Reimbursement: Depending on how a psychiatrist previously coded visits based on time ranges, reimbursement could be affected. Visits previously coded under a higher time range code (e.g., 30-39 minutes) might now fall under a lower time category (e.g., 15-29 minutes) if the minimum time isn’t met. This could impact the revenue generated through psychiatric billing.

You can get more details about E/M time changes by visiting the CMS website.

Increased RVUs for Psychiatric Consultations via Non-Face-to-Face Methods

The landscape of mental healthcare billing underwent a significant shift with the introduction of new Current Procedural Terminology codes for non-face-to-face consultations between psychiatrists and primary care providers (PCPs). These codes, specifically 99446-99451, offer an opportunity for psychiatrists to potentially increase their Relative Value Units (RVUs) through efficient use of telecommunication and remote consultations. This is a positive development for both psychiatry billing and patient access to care.

Understanding RVUs

Relative Value Units are a system used by Medicare and many private insurers to determine reimbursement rates for healthcare services. Each service has an assigned code (e.g., CPT code) and an associated RVU value. Higher RVU codes generally translate to higher reimbursements. RVUs consider three factors:

  • Physician work: time, skill, and mental effort required to perform the service.
  • Practice expense: Overhead costs associated with delivering the service (e.g., staff, equipment).
  • Malpractice risk: The inherent risk associated with the service.

Challenges and the Reasons for the Rise of Non-Face-to-Face Consultations

Traditionally, billing for psychiatric consultations often required an in-person visit with the patient. This could create challenges for both patients and providers:

  • Accessibility: Scheduling in-person consultations can be difficult for patients facing transportation issues, time constraints, or childcare needs. This limits access to care and can negatively impact behavioral health billing.

  • Limited Collaboration: Geographic distance between PCPs and psychiatrists could hinder timely consultations and care coordination. This can lead to inefficiencies and potentially lower quality of care.

The introduction of CPT codes 99446-99451 addresses these challenges by allowing psychiatrists to bill for consultations with a PCP about a patient’s care without the patient being present. These consultations can be conducted securely through the following:

This expands access to care for patients and improves care coordination, positively impacting both psychiatry billing and patient outcomes.

Increased Efficiency and Potential for Higher RVUs

These new codes offer several advantages for psychiatrists:

  • Improved Efficiency: Remote consultations allow psychiatrists to manage more cases and potentially see more patients overall. This can increase productivity and revenue generated through psychiatric billing.

  • Increased Reimbursement Potential: The new codes are linked to specific time requirements. For instance, CPT code 99447 (consultation discussion with a PCP lasting 11-20 minutes) carries a higher RVU value compared to 99451 (consultations under 5 minutes that don’t require a discussion). This provides an opportunity for psychiatrists to earn higher RVUs through the efficient use of these codes, improving psychiatry billing.

Medicare Coverage for Marriage and Family Therapy (MFT) and Mental Health Counseling (MHC) Services

Medicare has also taken a significant step forward in expanding mental health coverage by allowing MFTs and MHCs to directly bill Medicare Part B for covered services furnished to Medicare beneficiaries. This eliminates the prior requirement to bill through another provider, simplifying the process for therapists and improving access to care for patients. This is a major development for both psychiatry billing and access to mental healthcare services.

  • Direct Billing: MFTs and MHCs can now directly bill Medicare Part B for covered mental health services they provide to Medicare beneficiaries. This streamlines the billing process for behavioral health services.

  • Telehealth Coverage: This coverage extends to services delivered via telehealth, allowing for greater flexibility and convenience for both psychotherapists and patients. This improves Medicare beneficiaries’ access to care.

  • Streamlined Process: Psychotherapists no longer need to bill through another provider, reducing administrative burdens and potentially improving efficiency. This simplifies the process for behavioral health billing.

Let Our Experts Simplify the Ever-Evolving World of Behavioral Health Billing for You!



Enrollment Requirements and Qualifications for MFTs and MHCs Direct Psychiatry Billing

To bill Medicare directly, MFTs and MHCs must enroll in the Medicare program and meet specific qualifications established by the Centers for Medicare & Medicaid Services. Here are the key requirements for psychiatry billing under Medicare:

  • Licensure: Therapists must be licensed in the state where they practice.

  • National Certification: They must hold a current national certification from a CMS-approved organization.

  • Medicare Participation Agreement: Therapists need to complete a Medicare Participation Agreement outlining their commitment to Medicare program rules and regulations. This ensures compliance with behavioral health billing standards under Medicare.

  • Tax ID Number and NPI: A valid Tax Identification Number (TIN) and National Provider Identifier (NPI) are required for identification and tracking purposes within the Medicare psychiatry billing system.

  • Enrollment Application: To become a participating provider in the Medicare behavioral health billing program, you must submit a completed enrollment application to CMS.

By meeting these requirements and enrolling in the Medicare program, MFTs and MHCs can expand their practice reach and provide valuable mental health services to a wider population of Medicare beneficiaries. This is a significant development for expanding access to mental healthcare services and improving psychiatric billing for MFTs and MHCs.

Master the New Psychiatry Billing Landscape with Transcure’s Expertise

Even if there are many changes and challenges, solving them doesn’t have to be a one-person job. Transcure, which employs over 1100 certified billers and coders, is ready to collaborate with you to streamline the difficult parts of 2024 psychiatric billing. Our staff makes sure your billing procedures are correct and in line with the most recent CPT codes while keeping up to speed on any regulatory modifications.

Transcure gives you the following resources to thrive in the updated psychiatric billing landscape:

  • Smooth Integration: We minimize mistakes, streamline the coding and billing process, and save you critical time by integrating with your current EHR system in a smooth manner.

  • Current Billing Employees: Our licensed professionals are well-versed in the most recent CPT codes that are unique to psychiatry billing, including those for telemedicine, crisis intervention, and remote consultations.

  • Optimized Reimbursement: To optimize your chances of reimbursement, our staff carefully examines your claims to make sure they accurately reflect the whole cost of the services you render.

  • Decreased Administrative Burden: You can concentrate on providing great patient care while we take care of every part of your psychiatric billing cycle.

With Transcure by your side, you can confidently adapt to the changes in 2024 psychiatric billing and ensure your practice receives the appropriate compensation for the vital services you deliver.

Conclusion

The significant changes to psychiatric billing have affected the way mental health practitioners perform their services and charge for them. The goal of these modifications is to increase access to treatment, efficiency, and accuracy. They include new codes for telemedicine and crisis care, updates on E/M billing, and the introduction of non-face-to-face consultation codes. It is important that mental health practitioners comprehend these adjustments in order to maintain compliance and guarantee appropriate compensation for the invaluable services they provide. But you don’t have to deal with this constant layer of CPT code updates and billing complexities; trust professionals like those at Transcure to help you reimburse timely and without denials.

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