We continually make adjustments to improve our documentation and coding compliance. If there are situations in which your records are requested, or inappropriate coding is identified from the past, our team will be in contact with you regarding any remediation needed.

Please note: the rules below are not new. Headway made these changes to align with coding guidelines and to improve adherence to compliance standards.

 

Psychological and Neuropsychological Testing codes

Psychological and Neuropsychological Testing CPT codes will be blocked on Headway as of 4/24/24 (both for insurance and private pay clients). This adjustment applies to the following CPT codes:

  • 96116, +96121
  • 96130, +96131
  • 96132, +96133
  • 96136, +96137
  • 96138, + 96139
  • 96146

For some context, Headway is not able to efficiently submit these codes, because of some limitations with our internal systems.

Psychotherapy for Crisis (90839) and Evaluation & Management codes

Crisis code (CPT code 90839) is blocked from billing with Evaluation and Management codes (99202-99205 or 99212-99215) on the Headway platform as of 12/18/2023. 

For some context, we've found that payers are denying these claims based on a duplication of services – the crisis therapy session code (90839) and E&M codes are not significant, separately identifiable, nor distinct procedural services. Coding guidelines do not allow for a duplication of services.

Crisis psychotherapy cannot be reported on the same day or within the same service as an E&M service. The higher complexity leveling within medical decision making and its determination incorporates the crisis services offered under the 90839 service code.

If there is an actual crisis in the E&M session and you document the reports reviewed, resources accessed, and referrals made for the patients safety, then the documentation would meet the higher complexity standards for Medical Decision Making. The key is to document all the necessary elements to meet these complexity standards for 99205 or 99215. 

Learn more about Evaluation and Management (E/M) codes with add-ons.

 

One psychotherapy add on code per E&M session 

Only one psychotherapy add-on code can appear with an Evaluation and Management Code (99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215). Additional psychotherapy codes will be blocked on the same session on the Headway platform as of 12/18/2023. 

Learn more about Evaluation and Management (E/M) codes with add-ons.

 

One E&M code per one day or session 

Only one Evaluation and Management code can appear on the same day, for the same client. The use of multiple E&M codes will be blocked on Headway as of 12/18/2023. 

Learn more about Evaluation and Management (E/M) codes.

 

Disclaimer

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

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