An anxious month for social workers, psychologists and psychiatrists
Therapists who accept health insurance submit a bill that includes a code for your visit. 90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist. As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.
Therapists aren’t sure which code to use and, they aren’t sure how much they’ll be paid. Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs. Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.
“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.
Psychiatrists may see an improvement in payments for some visits because they’ll be able, for the first time, to bill for medical care they provide while monitoring the effects of medications. But the new codes do not resolve ongoing concerns about whether mental health providers are paid at the same rate as are doctors who deal with physical health. Under the new codes, it does not appear that psychiatrists who evaluate a patient’s physical response to medication will be paid what an internist would to make a similar evaluation.
“If a psychiatrist does the same work as any other physician, they should be paid the same,” says Don Condie, the Immediate Past President of the Massachusetts Psychiatric Society. Equal pay would “benefit patients because we’re trying to find a way to pay for the care of complex patients who take a lot of time but for whom, currently, there is little financial incentive to take care for.”
The American Psychiatric Association has posted guidance for members here.
Jeffrey Simmons, medical director for behavioral health at Blue Cross Blue Shield of Massachusetts (BCBSMA)says the insurer just received the new codes in late December but hopes to revise billing software and have a new reimbursement plan out by the end of this month. Simmons says “once providers get used to the new system, everything will settle down pretty easily.”
But many therapists aren’t sure. So be ready if the therapist you or your child sees brings up the delicate issue of payment. It’s a hot topic in the mental health community right now.
Note: A spokeswoman for BCBSMA says the insurer pays psychiatrists and primary care providers at the same rate for the same services.