How the Medicare/ Medicaid paperwork makes the mental health providers crazy in NC

Psychologists and other mental health providers bill utilizing CPT codes. For instance, the CPT code (CPT is a trademark associated w/ the American Medical Association) for 45-50 min of psychotherapy, is 90806.

Back in 2000, the American Psychological Association was instrumental in creating what are known as the Health & Behavior codes, specifically, 96150, 96151, 96152----continuing thru the series as associated with group therapy and family therapy. However, these first three are the most commonly utilized.

Why was this important for psychologists? Because the H & B codes are on the MEDICAL side of billing rather than the MENTAL HEALTH side of billing. Medical CPT codes are reimbursed at an 80% rate. Mental health codes are reimbursed at about 55%.

To suit: "Tobacco dependence among individuals with a mental illness or an addiction is a tremendous problem that goes largely ignored." http://www.nyc.gov/html/doh/downloads/pdf/csi/cessation-mental-ill-or-addiction.pdf

BIG DIFFERENCE in pay for the psychologist or mental health provider.

However, the problem is this: Medicaid will only crosswalk (that is the automatic procedure whereby a Medicare code----Medicare is always primary with people who have dual eligibility---and that is most people who have Medicare) as per the 96150 and 96151 ASSESSMENT codes.

This means that I cannot be reimbursed when I continue to see someone who has overlapping physical health issues and mental health issues.

Most people w/ mental health issues have overlapping physical health issues.

Indeed, 80% of people w/ mental health issues of a chronic nature, smoke cigarettes compared to 20% of the rest of the population.

That's a lot of chronic illness and it has not even begun to be addressed. And these H & B codes are one way to do that but not if one is being paid at the lousy 90806 (series including 90804; 90808) rate.

I have asked APA's Diane Pedulla to comment on this matter. She is an attorney who works at APA in Washington D.C.

Here is my letter to the regional coordinator for NC Medicaid regarding this matter:

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Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC
cell phone: 404 964 5338 email: hammondmv@netzero.com

March 7, 2009

Dear Melanie Whitener, the NC DHHS Medicaid regional consultant for many counties in western NC: melanie.whitener@ncmail.net:

You stated, as per the Health & Behavior codes, specifically 96152 (this is what 96152 is: Service: Intervention-Individual), that there is no crosswalk from Medicare to Medicaid :

"I checked in the Medicaid system, and there is no crosswalk code for 96152. This service is not reimbursable to your provider type/specialty at this time. With the recent added coverage of the 96150 and 96151 code, we do anticipate changes to also cover 96152, but I do not know for sure when that will happen."

This is concerning to me as 96150 (this is what 96150 is: Service: Assessment-Initial) and 96151 (this is what 96151 is: Service: Re-Assessment) are both assessment codes but which are not being followed up by the ability to utilize them further as pertaining to psychologists.

This means the following: when I have a dually eligible client (has both Medicare, as primary, and Medicaid), with chronic health problems overlapping with mental health issues, I have no way to be reimbursed as per their Medicaid account.

Can you please advise me as to how I can register my concern associated w/ this matter?

Thank you.

Marsha V. Hammond, PhD

Clinical/ Health Licensed Psychologist, NC