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Blue Cross corrects two problems affecting accurate payment of new psychiatric codes

March 25, 2013


Effective January 1, 2013, the American Medical Association (AMA) made more than 650 code changes to the Current Procedural Terminology (CPT) manual. Among those were significant changes to the psychiatry category, with the creation of new codes and guidelines as well as substantial code deletions.


Since the effective date, the California Medical Association (CMA) has been receiving calls from psychiatrists regarding two concerns with the way their claims are being processed by Blue Cross. Many practices are reporting that when they submitted a claim for an Evaluation and Management (E/M) code with a psychotherapy add-on code, the Blue Cross system is deducting two copays, one on the E/M and one on the add-on code.


Additionally, physicians are reporting that they believe the pricing methodology Blue Cross is using undervalues some of the new psychotherapy codes. In some examples provided, the reimbursement rates for the E/M combined with the psychotherapy add-on code were less than what was previously received.

CMA raised these concerns with Blue Cross and has learned that the system problem causing a double co-pay to be deducted was corrected on March 5. Blue Cross is in the process of automatically reprocessing the affected claims.


CMA has also learned that Blue Cross has made the decision to increase rates for several of the new psychotherapy codes, including CPT 90833, 90836 and 90838. Additionally, for psychiatrists who are on the standard Prudent Buyer fee schedule, Blue Cross has increased pricing for E/M codes (99202-99205, 99212-99215, 99223, 99232-99233). The new pricing went into effect on March 13 and is retroactive to January 1. Blue Cross is in the process of reprocessing the affected claims.


Although Blue Cross does not yet have an estimated time of completion for the reprocessing of affected claims, the payor has assured CMA that interest would be paid automatically as required by law.


Blue Cross will soon be sending written notification to physicians on these issues.


While physicians do not need to resubmit claims in order to receive the additional money due, CMA encourages physicians to create an internal list of all affected claims to ensure that all claims are eventually paid correctly.


For more information about how to utilize the new codes, see the crosswalk created by the American Psychiatric Association, available on its website at www.psychiatry.org (look for “2012 to 2013 CPT Codes Crosswalk"). CMA’s Coding Corner in the February issue of CMA's practice management newsletter, CMA Practice Resources (CPR) also includes a discussion on the 2013 changes to psychiatric codes. "Coding Corner" is a regular column that focuses on coding, compliance, and documentation issues relating specifically to physician billing. Past issues are available in the CMA resource library at www.cmadocs.org.


The new Blue Cross pricing information can be found on the Blue Cross website at www.anthem.com/ca/home-providers.html (login, then select “Mental Health Practitioner Fee ScheduleUpdate” under the “What’s New” section, locate your payment area, scroll to page 4 and click on “Section 3”). Physicians with questions can contact Blue Cross Network Relations at (855) 238-0095 or networkrelations@wellpoint.com.


Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmadocs.org.

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