BCBS Updates June 2016
Attention Child and Adolescent Providers!!!
Reimbursement for the use of Play Therapy Equipment: Another look at CPT code 90785 - The “Interactive Complexity Add-On Code”
The Interactive Complexity Code can be used for reimbursement for Play Therapy Equipment (such as board games, playing cards, dolls, etc.) and or supplies such as paper and crayons used during a session (as well as sessions that require an interpreter/translator, maladaptive communication, mandating reporting activities, communication etc. ). The use of such materials must be documented in the treatment note for the session in which they were used just as the use of the code for any other reason must be documented. For more specific language on the use of the Interactive Complexity Code see: https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/business_of_practice/cpt/Interactive_Complexity_Guide_2012.pdf
In a recent conversation with Blue Cross Blue Shield, they indicated that what is considered “play therapy equipment” to be the purview of the profession as opposed to the insurance company. However, should a clinician have any questions regarding the use of any equipment, the New England Association of Play Therapists (NEAPT) is located here in Massachusetts and is a good local resource. Their website is http://newenglandplaytherapy.org/
Of course, MaMHCA is also here to help with any questions or concerns regarding the use of CPT Code 90785 as well as questions about play therapy and play therapy equipment.
MaMHCA Advocacy in Managing Behavioral Health Carve-Outs
Many third party health insurance payers ( e.g. Blue Cross Blue Shield, MassHealth re MBHP, Beacon Health,) use carve-outs to manage their behavioral health programs. Very often, clients (consumers) do not know this is the case and will say they are covered by a particular insurance, when their behavioral health benefits are actually managed by another group. Usually clinicians find this out when their claims are denied. The only way a clinician will find this out ahead of time is by calling the Behavioral Health/Substance Abuse Service number on the back of the client’s insurance card.
MaMHCA addressed the issue at a meeting with Blue Cross’ senior behavioral health policy managers in April. Along with the inherent difficulty of determining coverage overall, is the difficulty for both the client and the provider in determining if a therapist is a provider at the time a client calls for services. MaMHCA laid out the difficulty of trying to determine coverage during an initial phone call with a client who is using only the presence of a phone number listed on the back of their card to determine coverage. We requested the use of some indicator or logo on member cards that BCBS is not the provider for Behavioral Health/Substance Abuse Services when these services are “carved out” to another company.
In response to a follow-up email sent to the team by MaMHCA last week, we were assured that the team took our request back to administrators and that the issue is “being discussed”. In the meantime, be sure to call the Behavioral Health/Substance Abuse Service number on the back of the client’s insurance card and make a note of who answers the phone.
Important Notice from Blue Cross – November 1st Deadline for Payment Method: As of November 1st, 2015 Blue Cross and Blue Shield of Massachusetts (BCBSMA) will be denying claims for any providers that are not registered for direct deposit through PaySpan. Electronic Funds Transfer (EFT), through PaySpan, has been the BCBSMA standard method of payment since 2013. BCBS has reported to MaMHCA that 203 LMHC providers in their network have yet to sign up. If you are a BCBSMA provider, and want to continue to receive payment from them you must sign up with PaySpan before November 1, 2015.
The Massachusetts Behavioral Health Partnership (MBHP) plans to be in full compliance with CMS for coding requirements as of October 1, 2015.
In the event that the Emergency Services Program (ESP) is not able to respond within 60 minutes of time of readiness to an MBHP Member, MBHP provides the option of having the emergency department (ED) conduct the emergency behavioral health evaluation, utilizing internal expertise, and presenting the clinical information directly to the MBHP Clinical Access Line for review and authorization of a medically necessary level of care. (Alert 163)