Medicare Milestone: All Carriers Now Cover Health and Behavior Services

by Government Relations and Communications Staff

May 31, 2006 — In a significant development for Medicare beneficiaries and psychologists in Florida, the local Medicare carrier will for first time begin reimbursing for health and behavior assessment and intervention services.

The Florida carrier, First Coast Service Options, was the only local Medicare carrier in the nation that had refused to cover services under the Health and Behavior Current Procedural Terminology (CPT)® codes. With the Florida coverage decision, which took effect April 11, 2006, all Medicare carriers now reimburse psychologists for services under the health and behavior codes.

The Health and Behavior CPT Codes, which took effect in January 2002, apply to psychological services that address behavioral, social and psychophysiological conditions in the treatment or management of patients diagnosed with physical health problems. The APA Practice Directorate and other key APA representatives developed and won inclusion of the codes in the CPT manual published by the American Medical Association (AMA).

The decision by First Coast Service Options to cover the Health and Behavior CPT Codes in Florida resulted from years of advocacy by professional psychology. The carrier had denied coverage of the codes in Florida since 2002. The Practice Directorate engaged both the national and regional offices of the Centers for Medicare and Medicaid Services (CMS) in its efforts to obtain coverage for the codes in Florida. The Practice Directorate also provided First Coast Service Options with research data on the effectiveness of health and behavior services.

First Coast Service Options is also the local Medicare carrier for Connecticut, where it permitted reimbursement under the codes. Last year the carrier proposed dropping coverage of the codes in Connecticut, in order to make the policies in Florida and Connecticut consistent.

Psychologists reacted quickly to oppose this proposal and made a strong case for covering the codes in both states. The Connecticut Psychological Association (CPA), aided by materials from the Practice Directorate, submitted a letter to First Coast Service Options contesting the proposal to drop coverage of the codes in Connecticut.

Psychologists also testified in support of coverage of the codes at a First Coast Service Options hearing on the proposed change. In their testimony, they discussed the need to create a more integrated health care system, explaining that the health and behavior codes offer a concrete way to begin to treat the whole person, rather than treating emotional and psychological stress-related functioning as separate from physical and medical functioning. They also pointed to scientific literature and outcomes research indicating that health and behavioral interventions are effective and cost-effective.

As a result of organized psychology’s efforts, First Coast Service Options reversed course and decided to continue paying for the codes in Connecticut while agreeing to initiate coverage in Florida.

For additional information related to the Health and Behavior CPT codes, visit the CPT Coding section.

Current Procedural Terminology ©2006 American Medical Association. All Rights Reserved.