Each year, the American Medical Association (AMA) releases updates to the Current Procedural Terminology (CPT) code set. The panel that’s responsible for the project aims to update the list to account for advances in technology and medical knowledge as well as best practices that have made their way to the forefront each year. The 2020 set of CPT codes for mental health accomplishes this, as it provides therapists greater flexibility and accounts for use of digitally-based services, among other things. These new codes became active on January 1, 2020. Let’s look at the changes that apply specifically to behavioral health.
2020 Changes to CPT Billing Codes for Mental Health
Fortunately, there are only five changes that impact mental health. In one case, a single code replaced two existing codes, while in other cases, two codes replaced a single existing code. Most of the changes happened to the codes describing intervention services.
- Codes 96150 and 96151 replaced by code 96156 — Codes 96150 and 96151 were timed codes that covered face-to-face initial assessment (96150) and reassessment (96151) services, including health-focused clinical interviews, behavioral observations, health-focused questionnaires, and psycho-physiological monitoring. These codes are replaced with code 96156, an untimed code that includes both assessment and reassessment services as event-based. And the new code no longer dictates face-to-face as a requirement.
- Code 96152 replaced by codes 96158 and 96159 — Code 96152, a 15-minute timed health and behavioral intervention code describing a service provided to an individual, has been broken into two separate codes: 96158 and 96159. 96158 is used for the first 30 minutes of the intervention, and 96159 is used for a subsequent 15 minutes of time spent.
- Code 96153 replaced by codes 96164 and 96165 — Code 96153 was another 15-minute timed code that described health and behavior intervention services delivered to a group of two or more patients. Similar to the change to the individual intervention services code, this code has been broken into two codes (96164 and 96165) that describe the first 30 minutes of the service and subsequent 15 minutes, respectively.
- Code 96154 replaced by codes 96167 and 96168 — The 15-minute timed code 96154, describing family intervention services with the patient present, was also broken into two separate codes designating the first 30 minutes (96167) and subsequent 15 minutes (96168).
- Code 96155 replaced by codes 96170 and 96171 — Code 96155, a 15-minute timed code that described family intervention services without the patient present, was similarly broken into codes 96170 and 96171, designating the first 30-minutes, and subsequent 15-minutes, respectively.
Impact of the Changes
Why were these changes made? A major change is that assessment services are no longer time-based. This frees providers to treat these services as they would other event-based services. Additionally, the new assessment code makes it possible to accommodate digitally-based services since the face-to-face requirement was eliminated.
The changes to the intervention codes are designed to give providers more time with their patients and encourage a stronger patient-provider relationship. Neither patients nor providers should feel the expectation to rush through services.
Remember that the old codes that were replaced are no longer valid. So if you’re using those codes when you bill insurers, your claims will be rejected. You may find it helpful to print out the list above and keep it handy.