Concerns with CPT Codes Being Addressed by NASW
A large volume of clinical social workers have contacted the national office regarding claim denials. Denials for the month of January 2013 appear to have been precipitated by computer system problems created by the lack of notice from CMS to begin using the new psychotherapy codes on January 1, 2013. Many insurance companies have requested their mental health providers to refrain from billing until their computer systems have been updated. For clinical social workers who have received denials, insurance companies are requesting them to resubmit their claims.
Another concern expressed by members is the disparities in payment for the new codes. Per the Final Rule of the 2013 Physician Fee Schedule, CMS announced they were establishing interim work and practice expense values for the new psychotherapy codes until the entire family of psychiatric codes is surveyed. Having no permanent values for the codes has created additional chaos for the insurance community because they have no framework to determine proper reimbursement for the codes. NASW is working with the Centers for Medicare and Medicaid Services, American Medical Association, and other organizations to complete the survey process this year so that permanent values for the codes can be established in 2014. The national survey will take place in March 2013 and NASW will participate and survey its members.
The national office is also advocating for clinical social workers with the Centers for Medicare Services, American Medical Association, and the CPT Editorial Panel to enhance the implementation phase of the new codes and make changes to improve the interpretation and use of them. We have received constructive comments from many members and plan to use them to develop and revise psychotherapy codes.