CPT Code effective January 2013

Act By Date: 
Changes take effect January 2013


October 10, 2012
Dear CSWA Members,


    Here is another report on the CPT code changes due to take place on January 1, 2013.

    The code for a diagnostic interview, previously 90801, has been changed to 90791.
    A code for crisis psychotherapy has been created, 90839 for 60 minutes.  Every half hour in addition to initial hour can be billed separately under the code 90840.
    The codes for psychotherapy listed in my last post are detailed here:
-   90832 (30 minutes with time range allowed = 16 - 37 minutes) 
-   90834 (45 minutes with time range allowed = 38 - 52 minutes) 
-   90837 (60 minutes with time range allowed = anything beyond 53 minutes)
    A summary of the changes in CPT codes created by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry can be found at http://www.aacap.org/galleries/default-file/Psychiatric_Services_crosswalk.pdf
    CMS will issue their decision on the Relative Value Units (RVUs) applied to psychotherapy on November 2, 2012, in the Federal Register.  If the RVUs increase, there will likely be an increase in rates for Medicare and private insurers.  If the RVUs decrease or stay the same, there will likely be a decrease in rates.
    The decision on the 27.9% cut to Medicare rates due to the Sustainable Growth Rate (SGR), a formula for determining reimbursement rates for Medicare providers which has been in place for 15 years but not enforced, will be made by Congress prior to January 1, 2013.  If the SGR cut is not stopped by Congress, it will go into effect for all Medicare providers on 1/1/13.  This will likely be reflected in rates of private insurers.  
    As you can see there are many issues that will affect reimbursement rates for LCSWs in the next two and a half months.  Hopefully, they will not have an overall negative impact.  I will let you know information about these issues as soon as I receive it. 
Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association
lwgroshong [at] clinicalsocialworkassociation [dot] org

Legislative Alerts

  • 05/08/2015 - 10:21pm

     We were glad to note this month that NASW is joining us in pursuing our goals for Medicare parity. The more the social work community is united on legislative goals that benefit all LCSWs and our patients, the more successful we are likely to be.