In comments to the departments of Health and Human Services, Labor, and
Treasury on rules for implementing the Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008, APA drew attention to the way
insurers may use differential reimbursement structures for psychiatrists or
restrict the use of some Current Procedural Terminology (CPT)
codes.
"It is not uncommon for an insurer to only reimburse psychiatrists
for a narrow range of CPT codes which are specific to psychiatric
care," APA wrote to the three federal agencies on May 28."
However, there are a number of codes, particularly the 'Evaluation and
Management (E&M)' codes, which the insurer will reimburse to all other
physicians. These E&M codes cover physician services that are essential to
the care of patients, including coordinating care management, talking with
patients' families, and discussing treatment options. As health care moves to
a system where physicians are encouraged to spend time coordinating care of
their patients, especially those with multiple chronic illnesses, this type of
policy can become a serious limitation on the type of care a patient receives
and on who is administering this care. This practice seems particularly
discriminatory since CPT codes are open for all qualified physicians
under Medicare, and similar reimbursement restrictions are rare to nonexistent
for any other medical specialty. APA would encourage the departments to
instruct insurers that limiting physician reimbursement to certain codes in an
unequal manner is a violation of the MHPAEA08 [Mental Health Parity and
Addiction Equity Act of 2008] and will not be permitted." ▪