New CPT Codes Went Into Effect on January 1
(Written by Jay Hale, Director of Quality Improvement & Clinical Operations)
The American Medical Association made significant changes to the
Current Procedural Terminology (CPT) that became effective January 1,
2013. The new system removes most of the CPT codes used by
behavioral health practitioners and substitutes Evaluation and
Management (E/M) codes, new CPT codes and a new concept called “add on”
codes for most former codes used to describe psychiatric care. As
CBHA providers continue to file claims using the new system, here are
things to consider:
Add-on codes are descriptors of a service that is done in
conjunction with another service or a descriptor of the complexity of a
specific service. These codes are used either in conjunction with
E/M codes or with certain CPT codes to describe the services
provided to the member during an office visit. There should be
appropriate documentation in the member’s file that not only supports
the main service, but also services described by the add-on code.
The add-on code should always be filed on the same claim form as the service to which it is attached. Filing an add-on code on a separate claim form will cause the claim to be returned to you for correction.
The new coding system removed the 90808 (75-80 minutes) from the set of
coding options. The extended session is now described as up to 60
minutes (90837). This code would typically be used for extended
sessions beyond the typical 45-50 minute session (90834) and would most
likely be implemented when a therapist needs to provide an evidence
based intervention, such as EMDR or Exposure Therapy, that take longer
than the standard session. CBHA expects that most on-going
psychotherapy will be billed as a standard session-90834 and created the
new fee schedule for 2013 to reflect this.
There is a new CPT code called “Psychotherapy for Crisis.” This
code is used to describe services that include “an urgent assessment and
history of a crisis state, a mental status exam and a disposition.”
(CPT Professional Edition, 2013) The code is to be used when there
is face-to-face time with a client who presents with a problem that is
“life threatening or complex and requires immediate attention to a
patient in high distress.” Per the latest guidelines from the AMA
(from the CPT Professional Edition, 2013), the code is used to report
“the first 30-74 minutes of psychotherapy for crisis on a given
date….Code 90840 is used to report additional block(s) of time, of up to
30 minutes each beyond the first 74 minutes.”
Please keep this in mind as you bill for services rendered to CBHA
members. If you have any questions, please call CBHA at (800)
Provider Hall of Fame
CBHA regularly distributes “Enrollee Satisfaction Surveys” to randomly
selected members, offering them a chance to provide feedback on the
services they received from both CBHA and its panel. This section
of our newsletter serves as a forum in which we like to acknowledge any
providers who were identified as providing outstanding service to our
Since the distribution of our Fall 2012 newsletter, we had several providers recognized by members. They include:
Cristin Whiting, PsyD, of Winston-Salem -- A member
stated, “Dr. Whiting has been excellent…and continues to help me
maintain a healthy life balance.” A second member also recognized
Dr. Whiting: “I was fortunate to be referred to [her]. She
is both competent and caring. I have achieved a great breakthrough
under her care.”
Jill Eilenberger, LMFT, LCSW, of Charlotte, NC, was
described as “a consummate professional who provided information for
aftercare as well. She is caring, compassionate and
knowledgeable. I would highly recommend her.”
A member was “very grateful for the [behavioral health] benefit and the care received from Michael Hayes, LPC,” of Winston-Salem, NC.
Fred Caudill, MD, in Matthews, NC -- A member
stated, “I have done so well with Dr. Caudill. I am extremely
pleased with him as my mental health provider.”
“I am very happy with the treatment I receive,” was a declaration regarding Margaret “Peggy” Fergus, LCSW, of Winston-Salem.
“Kris Grapes is exceptional,” commented a member who sees Kristin Grapes, PhD, in Winston-Salem.
Misty Collier, LPA, of Huntersville, NC, “is worth
her weight in gold!! She is excellent! A very knowledgeable
counselor. Great help.” A second member also
recognized Ms. Collier, stating, “Misty Collier is
One satisfaction survey recognized two providers. “Dr. Kris Grapes is excellent. So is Dr. Bruce Rau,” [MD of Winston-Salem].
Overall, the “Enrollee Satisfaction Surveys” were positive and members
are satisfied with the services provided by CBHA and its provider
panel. Thank you to everyone for the outstanding care you
administer to our members!
Behavioral Health Quality Improvement Committee for CBHA
The Behavioral Health Quality Improvement Committee (BQIC) provides
oversight of our network, by our network. Members commit to a
three-year term, meeting on the third Wednesday of every other
month. Dr. James Kimball, CBHA Medical Director, serves as the
Chairman of this committee.
CBHA would like to recognize the members of our provider panel that so
willingly give of their time to serve on BQIC. These providers
meet six times per year at the CBHA office to review our quality
improvement indicators, as well as oversee the credentialing process of
our network. The BQIC panel currently consists of:
James Kimball, MD
Gretchen Brenes, PhD
Christopher Aiken, MD
Laurel Link, LPC
Carole Collins, LPC
Timothy King, MD
Richard Martin, LPC
Stephen McCullough, PsyD
CBHA appreciates the aforementioned providers for their contributions
to our ongoing quality-improvement process. Additionally, their
input is beneficial in assuring appropriate provider credentialing and
We would like to take a moment to
recognize and thank Patti Patridge, LPC, for her time served on
BQIC. She recently had to rotate off the committee, because she
completed her three-year term. At our last meeting, she was
presented with a certificate of recognition for her service. Thank
you, Ms. Patridge, for your time, dedication and welcomed input during
Is your client in need of admission to an intensive level of care?
There are times when a CBHA member may come to you for outpatient
services, and it becomes apparent they are in need of an inpatient
setting, partial hospitalization or an intensive outpatient
program. Clients need assurance their admission to these services
is as seamless as possible. A factor to consider is that not all
facilities within your area may be in-network with
If you find yourself in a situation where a CBHA client needs an
intensive level of care, please, remember case managers are available to
assist you with locating an in-network facility. Call
1-800-475-7900 for assistance with identifying facilities for your CBHA
client, or, access our website, www.cbhallc.com
and click on “Provider Search” at the top of the page. Under
“Search by Specialty,” click on the down-arrow and choose “facility” for
a list of CBHA options in your area.
Frequently Asked Questions
1. What services require pre-registration?
All services require pre-registration. This includes:
outpatient therapy and medication management sessions; psychological and
neuropsychological testing; EMDR; outpatient consultations; ECT (both
outpatient and inpatient); behavioral health home visits; outpatient
Suboxone treatment; Gastric Bypass Evaluations and Vagus Nerve
Stimulators (VNS). Additionally, all intensive levels of services
(i.e., inpatient, partial and intensive outpatient programs) must be
pre-registered. Please, call, 1-800-475-7900 to speak with a
clinical case manager to obtain registration for these
2. How do I obtain registration for psychological and/or neuropsychological testing?
If there is not a registration for outpatient services already in
place, call CBHA to obtain authorization for consult visits so an
evaluation can be done in order to determine what type of testing will
be necessary. Prior to administering any testing, the provider
should access the CBHA website, www.chballc.com,
and obtain a copy of the “Psych Testing Request” form which can be
located by clicking on, “Providers,” then “Provider Forms.” The
form should then be submitted via fax (888-908-7140), or via mail (PO
Box 571137, Winston-Salem, NC 27157).
Upon receipt of the testing request form, a clinical case manager
submits it to our consulting psychologist for review, and the
psychologist renders a decision to the CCM within three business days of
the request. Most requests for testing are granted based upon a
need to clarify a clinical issue or a need to provide direction for
treatment planning. Please, keep in mind, testing for Learning and
Developmental Disabilities are generally not eligible under the
behavioral health plan; call to obtain details of specific health plans
managed by CBHA.
3. What is the process for registering outpatient sessions?
For initial outpatient services, CBHA registers 20 sessions for
psychotherapy within a 12-month period. For example, if you call
on 4/16/2013 to obtain a registration for outpatient sessions, that
registration would be active until 4/16/2014. For medication
management visits, the initial registration is open-ended, meaning there
is no limit to the number of sessions and there is no expiration
date. It is valid for as long as you are performing medication
CBHA registers the services for in-network providers in order to
promote coordination of care among treating providers, as well as, to
assure the patient is not receiving concurrent care by two
like-providers. Call CBHA at 1-800-475-7900 to obtain a
registration of care.
4. What if I need more psychotherapy sessions beyond the initial 20?
In order to request more psychotherapy sessions after the initial 20,
you will need to access the CBHA website and obtain a copy of the
“Outpatient Services Review” form and submit it, either via fax or
mail. The form will be reviewed by a CCM to ascertain the clinical
issues that support additional psychotherapy sessions, as well as
review for the projected conclusion of therapy.
5. Is group therapy covered under an outpatient psychotherapy registration?
Yes, registered visits cover individual as well as group therapy
sessions provided by the registered therapist. CBHA will not pay for
support groups provided by non-licensed therapists.
6. Can a patient see his/her therapist and psychiatrist in the same day?
An enrollee may see his/her therapist and psychiatrist in the same day
and receive insurance reimbursement if both providers have prior
7. If a network provider fails to obtain registration prior to providing treatment, will CBHA backdate that registration?
CBHA will not backdate if pre-registration is not obtained prior to the
provision of services. Please, remember, the patient can not be
held liable for the payment of services for lack of registration;
enrollees are only responsible for their co-pay or coinsurance. If
you have a case where you were unable to obtain pre-registration due to
extenuating circumstances, call CBHA to discuss the issue.
Please, note, CBHA does allow a five business-day grace period to obtain
registration for outpatient therapy and medication management visits.
It is imperative you review your client’s insurance card at each
session so you may be aware of any possible changes to his/her
behavioral health insurance. We provide behavioral health coverage
for a niche of the MedCost and Blue Cross Blue Shield
populations--among others--so, please, thoroughly review both sides of
the card to ensure you submit claims to the correct insurance
If a member’s claims administration is contracted through CBHA, this
information will typically be on the back of the insurance card.
If this is overlooked, it could ultimately lead to delayed reimbursement
for your services. In the most extreme case, it could even mean
you miss our timely-filing deadline, and rendered services would not be
eligible for payment.
We are a provider-owned managed behavioral health organization
dedicated to quality behavioral health care. CBHA strives to
ensure that enrollees receive quality care, that providers have the
resources to provide this care and that the benefit is used effectively
and efficiently. Being owned by three not-for-profit medical
schools (East Carolina University, University of North Carolina at
Chapel Hill and Wake Forest University) enables CBHA to provide quality
services at a competitive rate. Our relationship to the academic
medical centers is aimed at improving the delivery of behavioral health
services to the citizens of North Carolina and parts of both South
Carolina and Virginia through research and education. Ultimately,
our motto is “to do the right thing for the right reason.”