Billing / Billing Codes

Section 1848(2) (B) of the Omnibus Budget Reconciliation Act of 1990 requires the Centers for Medicare and Medicaid Services (CMS) to review all relative values units (RVUs), also known as work values, of Current Procedural Terminology (CPT) codes every five years and perform updates as needed. In 2010, NASW participated in the fourth Five Year Review sponsored by CMS and the American Medical Association Relative Value Scale (RVS) Update Committee (RUC). Known as the psychotherapy survey, the process for social work purposes consisted of surveying 13 psychiatric CPT codes used by clinical social workers who diagnose and treat mental illness. Psychiatrists, psychologists, and nurses also participated in the Five Year Review through their professional association.

The American Psychiatric Association is seeking clinical social workers to participate in field trials for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).  The field trials are designed to test the feasibility and clinical usefulness of the proposed diagnostic criteria and measures in clinical settings. The trials also examine whether the measures capture changes in patients' symptom levels over time and are informative for treatment planning.

In May 2010, NASW will participate in a national psychotherapy survey sponsored by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association. The last psychotherapy survey was conducted in 1997 and surveyed the outpatient individual psychotherapy Current Procedural Terminology (CPT) codes.

The proposed fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is available for public review and comments from February 10 to April 20, 2010 at the following Web site: www.DSM5.org.  It is a revised draft of the standard of classification of mental disorders which will be released in its final version sometime in 2013.  It will replace the DSM-IV.

Current Procedural Terminology (CPT) Codes for psychotherapy are being considered for review to increase the work and practice expense values associated with reimbursement rates.  Work values are based on the time and the required mental effort and judgment to perform a service, and the stress encountered due to the potential risk to the patient.  Practice expense values include direct expenses of a clinical practice including clinical labor activities, medical supplies, and equipment.

New Current Procedural Terminology‚ (CPT) codes became available for use in reimbursement on January 1, 2006. Known as the Central Nervous System (CNS) Assessments and Tests, the codes are used to report services performed by testing the cognitive function of the CNS. These services are also commonly referred to as psychological tests which include testing of the cognitive processes, visual motor responses, and abstract abilities. The administration of these tests generates material that is developed into a formal written report.