There is another significant advantage for psychologists who see individuals with Medicare for outpatient services. Traditionally, Medicare pays 50% of allowable costs for outpatient mental health services billed using Axis I diagnoses. This may be perceived by patients as a significant and disproportionate financial burden, and thus create a barrier to treatment. In contrast, Medicare pays 80% when using the H&B codes (the same as for other medical services). For private third-party insurers, it is anticipated that the H&B coded services will be handled through the same mechanisms as other physical illness benefits, and not relegated to more limited behavioral health “carve-out” plans.
At this time, the Medicare reimbursement rate for the H&B codes is lower than it could be in the future. This is because the “work value” is determined by who is using the code and how it is being used. Data being collected on these variables will be used to determine if a new weight of “work-value” is needed. The gravity of this process is apparent if one remembers that the assignment of a work-value must be a budget-neutral process for Medicare. In other words, if the value for the H&B codes is increased, values on other codes will be decreased.
Relatedly, it is important to note that the H&B codes are not exclusively for use by psychologists. Physicians, nurses, physical therapists and other non-physician providers are allowed to use these codes. Thus, the more psychologists (and physicians, whose services are generally valued more highly) use the codes, the more likely that the recommended “work value” will be at a higher rate. The APA Practice Directorate has advocated for psychologists to use the H&B codes as frequently as possible in order to influence this process.
Leadership is also at stake. Traditionally, the professional organization representing those who use the codes most will have the greatest leadership roles. APA has had the lead role during the development of the H&B CPT codes. However, psychologists must continue to use the codes most frequently in order for APA to maintain their leadership role in future development processes.
The H&B codes are neither mental health codes nor neuropsychological testing codes. They are used to capture behavioral, social and psychophysiological procedures for the prevention, treatment or management of physical health problems. This might include issues of adherence to medical treatment, symptom management, health promoting behaviors, health-related risk-taking behaviors, and overall adjustment to physical illness. While it is appropriate to bill using the H&B codes for services aimed at the prevention of problems associated with the existing medical diagnosis, the codes are not primarily for preventive services (e.g. general wellness programs).