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PCPA Seeks DPW Action on CPT Codes
January 31, 2013

At its January Board of Directors meeting, members requested that the association assist them in addressing changes to the 2013 Current Procedural Terminology (CPT) codes. Providers are experiencing a disconnect between national and local instructions on using CPT codes, resulting in concerns about duplicative systems, wasted resources, and the potential for disrupted cash flow, all which affect services to individuals.

A letter from Executive Director George Kimes to Department of Public Welfare (DPW) Secretary Gary Alexander requests that DPW address issues related to significant changes to CPT codes affecting behavioral health programs. DPW historically experiences delay in its annual update of CPT codes and has treated this update as a routine matter for which the process should be complete by June. However, given the critical nature of the update to behavioral health providers, PCPA asked Secretary Alexander to address the situation more rapidly and thoroughly.  

HealthChoices behavioral health managed care organizations (BH-MCO) are in varying stages of adopting the new codes, indicating that contracts with providers will identify when to use the new codes, which codes to use, and rates that will be paid. It is reported that some provider claims have rejected, some BH-MCOs are limiting codes that can be used, and some have changed the codes themselves (e.g., changing the time ranges). There should be consistency and uniformity in implementation of national, standard codes. All BH-MCOs should use the applicable codes in the way they were drafted by the American Medical Association and all applicable codes should be used. PCPA will continue to advocate for a rapid transition to consistent and uniform implementation of the 2013 CPT codes.

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