The Health and Behavior Assessment and Intervention CPT Codes

by Government Relations Staff

June 7, 2005 — Effective January 1, 2002, new billing codes designed to capture behavioral services provided to patients to address physical health problems became effective. There are six health and behavior codes, two for assessment procedures and four that reflect intervention services. There is one code for the initial assessment of the patient and another for a reassessment. The intervention codes are for services with an individual, a group, a family including the patient and a family without the patient present.

Since the inception of the codes, APA has been tracking their progress with both Medicare and private insurance. The increase in Medicare claims from 2002 to 2003 was spectacular as the number of health and behavior services billed by psychologists more than tripled in one year. As a result of this tremendous growth psychologists received $4.5 million more in Medicare payments for health and behavior services in 2003. We expect the Centers for Medicare and Medicaid Services (CMS) to release new information on the utilization of the health and behavior codes by psychologists in 2004 before the end of the summer.

We have also seen a steady increase in the number of private insurance carriers reimbursing for services under the codes. At this time last year we knew of 10 private carriers who were paying for health and behavior services; now the list has grown to 18 and includes the following companies:

  • Aetna
  • Anthem BC/BS
  • BC/BS of Alabama, Missouri, North Carolina, North Dakota and Rhode Island
  • CareFirst BC/BS
  • Cigna
  • Fortis
  • Humana
  • Mid-Atlantic Medical Services
  • Mutual of Omaha
  • Nationwide Mutual
  • QualChoice
  • RISKCO (Virginia)
  • River Quest PPO (St. Louis, MO)
  • WPPA (Wichita, KS)

We are aware that some psychologists are still encountering difficulty in billing for health and behavior services, especially with private insurance carriers. Any psychologist who needs assistance in resolving billing problems under the codes should contact the APA Practice Directorate’s Government Relations office at (202) 336-5889.