Don't Restrict Psychiatrists' Use of CPT Codes

In comments to the departments of Health and Human Services, Labor, and Treasury on rules for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, APA drew attention to the way insurers may use differential reimbursement structures for psychiatrists or restrict the use of some Current Procedural Terminology (CPT) codes.

“It is not uncommon for an insurer to only reimburse psychiatrists for a narrow range of CPT codes which are specific to psychiatric care,” APA wrote to the three federal agencies on May 28.“ However, there are a number of codes, particularly the 'Evaluation and Management (E&M)' codes, which the insurer will reimburse to all other physicians. These E&M codes cover physician services that are essential to the care of patients, including coordinating care management, talking with patients' families, and discussing treatment options. As health care moves to a system where physicians are encouraged to spend time coordinating care of their patients, especially those with multiple chronic illnesses, this type of policy can become a serious limitation on the type of care a patient receives and on who is administering this care. This practice seems particularly discriminatory since CPT codes are open for all qualified physicians under Medicare, and similar reimbursement restrictions are rare to nonexistent for any other medical specialty. APA would encourage the departments to instruct insurers that limiting physician reimbursement to certain codes in an unequal manner is a violation of the MHPAEA08 [Mental Health Parity and Addiction Equity Act of 2008] and will not be permitted.” ▪