New 2020 CPT Code Changes that May Be of Interest to Mental Health and Behavioral Health Service Providers
Frequently Asked Questions
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Q: What is changing?
Annually, in October, the American Medical Association (AMA) defines and releases a new set of Current Procedural Terminology (CPT) codes. This new set of CPT codes is effective on Jan. 1, 2020. Mental health and behavioral health service providers may use some of these CPT codes when submitting claims for services.
The 2020 code set has several changes that may impact provider billing, as some codes currently used were either deleted or modified. Key changes include changes to Health and Behavior Assessment and Intervention codes currently billed under the code range 96150-96155. This FAQ is not intended to be an all-inclusive list of CPT code changes. Please refer to the Q&A below to find out where you can find information about all CPT code changes.
Q: Who is impacted by the CPT code changes?
Any provider performing and billing for these services may be impacted by this CPT code change.
Q: When does Beacon plan to begin accepting the new code set?
Beacon will begin accepting the new CPT codes for 2020 dates of service beginning on Jan. 1, 2020.
Q: Are you planning to accept the new CPT codes before the compliance date?
No. Beacon will not accept the new codes prior to the official date established by the American Medical Association). All 2019 dates of service must be submitted with the 2019 code set regardless of when they are billed.
Q: Will Beacon have a transition plan in place for providers who are not ready to use the new code set by Jan. 1, 2020?
No. HIPAA laws require providers to use the new codes for 2020 dates of service beginning Jan. 1, 2020.
Q: Should 2019 dates of service be billed separately from 2020 dates of service?
Yes. Claim lines should not span years. 2019 dates of service should be billed separately from 2020 dates of service.
Q: How do I purchase a CPT Coding Manual?
AMA creates the CPT Coding Manual and purchasing information can be found at: https://commerce.ama-assn.org/store/.
Q: Will authorization be required for any of the new codes that are replacing the codes from range 96150-96155 that are terminating on Dec. 31, 2019?
Benefit plans can differ. If authorization was required for any code within the 96150-96155 sequence under a particular benefit/plan in 2019, authorization may likely continue to be required for the new code(s) in 2020. If authorization was not required for any code within the 96150-96155 sequence in 2019, authorization will not be required for the new code(s) in 2020. Be sure to verify benefits for each member to confirm whether authorization will be required.
Q: I have an authorization for services represented by codes in the 96150-96155 range that will still be active in 2020; however, the authorization was granted using the old codes. Will the authorization still be valid, or will I need a new authorization?
If your authorization was code-specific using the old code(s), the authorization will not be valid for any service dates on or after Jan. 1, 2020. You will need to request a new authorization using the new code(s).
If your authorization for services represented under these codes was granted using an “umbrella code” such as TST, OTP, TIN, etc., the authorization will still be valid for service dates on or after Jan. 1, 2020. If you have any questions, call the Beacon Customer Service Department that handles the member’s benefit plan to discuss the authorization on file. Member-specific phone numbers are typically located on the member’s identification (ID) card. They will direct your call to the team that handles authorization requests if necessary.
Q: Can I use the old codes to bill for dates of service on or after Jan. 1, 2020?
No. If old codes are used to bill for services rendered on or after Jan. 1, 2020, the claims will be denied. A corrected claim will need to be submitted using the new codes when billing for services rendered on or after Jan. 1, 2020.
Q: What if I begin the Health and Behavior Assessment and Intervention Services prior to Jan. 1, 2020, but I finish the intervention after Jan. 1, 2020?
If your authorization is under an umbrella code, both the services and claims before and after Jan. 1, 2020 will be payable under the umbrella.
If you have a code-specific authorization that was granted for the old codes, only services prior to Jan. 1, 2020 will be payable under this authorization. You will need to request a new authorization using the new codes for services rendered on or after Jan. 1, 2020.
Q: How do I request authorization for dates of service on or after Jan. 1, 2020?
Beacon is updating its existing form(s) and provider portal information to accommodate these changes. The forms (see next question for steps to form), and the provider portal (both eServices and ProviderConnect) will also be updated as necessary. For now, you will need to download a copy of the new form, when available online, complete it, and fax it into the number on the form. Unless a plan participates in fax submission, moving forward providers will be expected to review the member’s benefit through our provider portal and submit authorization requests electronically. Please contact the customer service department that handles the member’s benefit plan if you need assistance or need to be connected to the team that handles authorization requests. Their number is located on the back of the member’s ID card.
Q: Where can I find the authorization form?
- For Beacon Health Options providers and commercial accounts, look for Clinical Forms under the Forms menu in the Providers section.
- In addition, certain state and health plans have contract-specific forms. Visit the “Network Specific Info” page to locate your plan and review to see if there are applicable forms.
If you have additional questions and need to be connected with the team that handles the member’s benefit plan or to be connected to the team that handles authorization requests, please contact the customer service department at the number located on the back of the member’s ID card.
Q: Where can I find information about the new codes effective Jan. 1, 2020?
Q: Who should I call at Beacon if I have any questions or need to get an authorization adjusted?
The customer service department that handles the member’s benefit plan can assist with any questions or direct you to the team that handles authorization requests. Their number is located on the back of the member’s ID card.