CPT BILLING CODES FOR REIMBURSEMENT

With respect to who can use these codes, each state has a well defined and explained scope of practice for each license in the state. This is your guideline. Staying within your scope of practice will be a very important aspect of reimbursement. Another important factor will be the diagnosis. So, again the scope of practice in being able to be the source of the diagnosis or working with someone who can do this will help.

REFERENCES:

Striefel, S. (2001). The role of aspirational ethics and licensing laws in the practice of neurofeedback. Journal of Neurotherapy, 4(1), 43-55.

Striefel, S. (2003). The application of ethics and law in daily practice. In M. S. Schwartz and F. Andrasik (Eds.), Biofeedback: A practitioner’s guide (3rd Ed.) (pp. 813-834). New York: Guilford Press.

Striefel, S., Whitehouse, R., & Schwartz, M. S. (2003). Other professional topics and issues. In M. S. Schwartz and F. Andrasik (Eds.), Biofeedback: A practitioner’s guide (3rd Ed.) (pp. 835-866). New York: Guilford Press.

Whitehouse, R. (1997). Suggested coding guidelines based on CPT code answers from the AMA. Biofeedback, 25(2), A-13A.

Whitehouse, R. (1998). CPT coding issues: 1998 update. Biofeedback, 26(2), 14A-17A.

Article by: Sebastian “Seb” Striefel, PhD, and Bob Whitehouse, EdD as published in AAPB BIOFEEDBACK, Winter 2003 Volume 31, Number 4

CPT CODES

BIOFEEDBACK

90901 This code applies to biofeedback training using any modality.

90911 This code applies to biofeedback training of the perineal muscles and/or the anorectal or urethral sphincter. It includes EMG biofeedback, and/or manometry.

OTHER PSYCHIATRIC SERVICES OR PROCEDURES

90875 This code applies to individual psychophysiological therapy that incorporates biofeedback training by any modality with psychotherapy (e.g., insight oriented, behavior modifying or supportive psychotherapy). It must be face-to-face with the patient and session length is approximately 20-30 minutes.

90876 The definition for this code is the same as for 90875, but the session length is approximately 45-50 minutes in duration.

The only difference between the 90875 and 90876 is the length of the treatment session, i.e., 20-30 minutes versus 45-50 minutes. Anyone who can legally provide psychological/mental health services within their state can use the 90875 or 90876 codes. Of course not every insurance company pays for this service or they may pay for it within one client coverage policy contract and not within another, adding to the coding, billing, and reimbursement confusion. The code for psychotherapy without biofeedback is discussed later under the section on Other Codes.

Health and Behavior Assessment/Intervention Codes The new CPT Health and Behavior Assessment/Intervention codes were basically developed to recognize the work of professionals, like psychologists, with physical health problems. Their use does not require that there be a psychological diagnosis. Prior to their creation, psychological interventions could not be provided to those with medical or physical problems unless there was a psychological diagnosis to help verify “medical necessity.”

These new codes, 96150-96155, are used for health and behavior assessments and interventions where it is not necessary to make a psychological diagnosis (e.g., DSM IV). Of course one must engage in the activities that fit the definition for these specific codes. The health and behavior codes follow.

90834 Psychotherapy, 45 minutes with patient and/or family member

90837 Individual psychotherapy, 60 minutes

96150 This code applies to health and behavior assessment (e.g., health focused clinical interviews, behavioral observations, psychophysiological monitoring, health-oriented questionnaires). A practitioner can bill for each 15 minutes of face-to-face assessment with the patient. This code is used for the initial assessment.

96151 This code is used for reassessment(s).

96152 This code applies to health and behavior interventions. Each 15 minutes of face-to-face intervention with an individual client is billable.

96153 This code applies to group treatment/intervention (2 or more patients).

96154 This code applies to family treatment/intervention (with the patient present).

96155 This code applies to family treatment/intervention (without the patient present).

Other Codes That Are Potentially Useable Some other codes that might be used if approved by the third-party payer follow:

94010 This code applies to spirometry and includes a graphic record, total timed vital capacity, and expiratory flow rate measurement(s), with or without maximal voluntary ventilation.

94400 This code applies to the breathing response to CO2 (includes the CO2 response curve).

96002 This code applies to dynamic surface electromyography during walking or other functional activities for 1-12 muscles.

95957 This code applies to digital analysis of the electroencephalogram (EEG) (e.g., for epileptic spike analysis). (Some practitioners are using this code for QEEGs because it consists of a digital analysis of the EEG).

90806 This is the code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive psychotherapy in an office or outpatient facility for face-to-face sessions lasting approximately 45-50 minutes with the patient. (Note: some insurance companies will allow biofeedback to be used as a psychological modality if part of a psychotherapy treatment and provided by a licensed mental health provider, but not if provided by an unlicensed provider. Do not try to deceive the insurance company about what you are doing by using this code when only biofeedback services are provided. Doing so would be fraud).

QUANTITATIVE NEUROFEEDBACK OR QEEG

96020 This code applies to Functional Brain Mapping (QEEG)

With respect to who can use these codes, each state has a well-defined and explained scope of practice for each license in the state. This is your guideline. Staying within your scope of practice will be a very important aspect of reimbursement. Another important factor will be the diagnosis. So, again, the scope of practice in being able to be the source of the diagnosis or working with someone who can do this will help.

One thing that I have found useful is having a Neurologist read the raw EEG and provide a short report (it is also great because it will state, by a person who is qualified to do so, if the EEG falls within normal limits or not, possibly a liability issue that can be averted.)

If this is included in the report and the neurologist signs it, there is a better chance that the insurance company will reimburse.

95816 This code applies to EEG data collection

95957 This code applies to the digital Analysis of EEG

99090 This code applies to reference EEG database access and comparison

OTHER CODES

Some new Complimentary and Alternative Medicine (CAM) codes use five letters of the alphabet instead of numbers. The code CDAAP applies to biofeedback, counseling, mental health services, and practice specialties, e.g., assisting the client in modifying body functions using feedback from biofeedback instruments. The codes were developed by Alternative Link for over 4000 procedures that describe the patient encounter with nursing, CAM, and indigenous medical services. Laws governing providers of such services differ by state and are available at 877-621-LINK or. At present, it is unclear what role these codes will play in the coding, billing, and reimbursement of client services.

The World Health Organization (WHO) developed an IDC-9-CM code for treating the psychogenic aspects of a medical disorder using biofeedback. It is 94.39—other individual psychotherapy (biofeedback). It should be remembered that managed care considers insureds to be customers and uses a business code of ethics that emphasizes making money. This focus often appears to be opposite that of health care practitioners, such as those providing biofeedback, where the focus is on meeting the specific current needs of the client/patient.