New H&B Codes
This is an FYI related to new H&B Codes for 2020 (see attached). Check with your institutions for specifics of implementation as your EHRs may not yet be updated to reflect these changes and I imagine that in some cases some payers may not be exactly ready either. So, do your homework.
The long and short of it appears to be a new set of codes replacing the original set which get rid of the “re-assessment” code, consolidate the time frames so that there is one code for 16-30 minutes in length and then an add-on code for each category when a visit goes longer that 31 minutes.
Fun, fun, fun.
Thanks for sending this, Neftali.
Has anything changed as far as LCSWs being able to use these codes?
Licensed Clinical Social Workers are still unable to be reimbursed for H & B Codes under Medicare. In 2019, Senators Debbie Stabenow, MSW (D-MI), and John Barrasso, MD (R-WY) introduced the Improving Access to Mental Health Act (S. 782/H.R. 1533), in part to address this issue. There are 3 facets to this act which target increasing Medicare beneficiaries’ access to mental health services summarized here:
1. reimbursing outside CSWs for providing mental health services to patients in skilled nursing facilities
2. reimbursing CSWs for addressing emotional and psychosocial concerns related to a health condition under Health and Behavior Assessment and Intervention (HBAI) Services
3. increasing the Medicare reimbursement rate for CSWs
For more information, see link to the Act here:
I recently met with Debbie Stabenow and with one of her health care staffers about this and have been doing some advocacy here in MI. They need more support (from both sides of the aisle) to get this in order to get it passed… and hope to move it forward within the next few months. Please consider reaching out to your representative to urge support of S.782/H.R. 1533.
All this information has been very helpful. I have another H&B code question: For shared medical visits within primary care that are co-led by a medical provider (MD) and a BH provider (psychologist), such as for obesity/weight management, hypertension, diabetes, chronic pain, etc, is it possible for both the medical provider and the psychologist (using the H&B group intervention code) to bill for the visit?
More generally, would this be possible for shared medical visits for patients with a DSM psychiatric condition (e.g., substance use disorder), such as for addictions groups (e.g., within a suboxone program)?
Many thanks in advance!
Hi Kate - I will be interested to hear what more experienced others say, but what I've been told is that the short answer is no; both PCP & BHC cannot bill for the same time period. That said, I've been told that if enough time is spent w/ the patient, for billing purposes you can split the time and treat it as 2 visits - a PCP visit w/ the BHC present, and a BHC visit w/ PCP present, and bill accordingly.
Also, if there was a DSM diagnosis I would be thinking that that cannot be used with HBI, that attaches more to a psychotherapy cpt code.
HBI diagnosis gets attached to medical diagnosis versus DSM ones, correct?
When our BHCs are seeing someone in MAT for SUD diagnosis treatment planning and support we are usually billing a therapy or assessment code (90791, o4 90832 etc).
Also, can Clinical Social Workers (LISW) bill HBI codes?
Interested to hear others thoughts.
Hello, Clinical Social Workers cannot bill the HBI codes for Medicare, but can with some commercial insurers and some state Medicaid programs. If you state does not allow CSW’s to bill these codes for Medicaid patients, please advocate that they pick up the codes. And we should all advocate nationally that CMS and Medicare change the rules to allow CSW’s to deliver this service and get paid for it re: the link below in this email chain.
What many folks are doing with the IMAT groups that include a provider and a behavioral health clinician – the provider is billing a “shared medical visit” E/M for a portion of the group, e.g. the first 30 minutes, and the CSW is billing a group therapy code 90853 for the second half of the group. So, they are billing for separate time periods and also separate foci of the group visit. So, the service, documentation and billing all connect.
We are fortunate in NC to have masters level BHPs of all types with the ability to bill HBAI (and CoCM!)
Same day, different time slots captured for psychotherapy and a PCP visit = yes
Same time slot (unsplit) for any two visits = nope
Same day HBAI and PCP visit for =
Not for our NC Medicaid since the billing is “Incident To” the PCP and creates two events by one provider (PCP) for same Dx and only one will be paid. It is a challenge to have patents return for HBAI focused interventions and a same day handoff cannot always be captured in billing unless other coding options are used such as a 90832 to address or r/o comorbidities. Regardless, the intervention and opportunity to engage the Pt should take place.
For Medicare same day with doctoral level BHPs - I am not sure since they can bill HBAI under their own NPI
HBAI intel: https://www.apaservices.org/practice/reimbursement/health-codes/health-behavior-codes-changing
Do you know if there is any data on the utilization of these codes by MA level professionals in NC or how we could get that? It may be helpful to advocate in other states if there is data to set a precedent by and potentially ease the concerns other states may have about opening reimbursement to more providers.