Direct Delivery of Health Care Services to Individuals National Register of Health Service Providers in Psychology To obtain your National Provider Identifier (NPI), read www.nationalregister.org/NPI.html. Only one number is needed no matter how many practice locations you have. Providers will need to have a number in order to submit claims electronically, which is required by May 23, 2008 in order to be reimbursed by Medicare & Tricare. Other insurers are likely to adopt the same identifier for claims reimbursement and may require it for electronic claims reimbursement. Medicare To enroll in Medicare, go to http://www.cms.hhs.gov/cmsforms/downloads/cms855i.pdf Reimbursement varies somewhat by the jurisdiction; thus, you need to pursue it at the state level.

• For further information, go to http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads
  /contact_list.pdf
• Specific question regarding billing:
  Medicare billing for H & B codes is in 15 minute increments. If you do psychotherapy, you bill either 20-30 (90804) or 45-50 (90806) minute blocks.

Where do I find the most up-to-date Medicare reimbursement rates? The CMS Physician Fee Schedule site allows you to look up by codes, by carrier, and by locality. Don’t be turned off by “physician” – all HCPC codes are listed, including psychologist codes. Click Physician Fee Schedule on the left, follow the prompts, and consent to AMA copyright (AMA owns the codes).  Go to http://www.cms.hhs.gov/PFSlookup/

Similarly, Medicaid reimbursement is handled by the individual jurisdiction.

Tricare

To enroll in Tricare, choose the appropriate region of the country from the online map and follow instructions. Note, however, if you are credentialed by the National Register, that is all the proof you need in terms of qualification, as you will see when you print the forms. 
http://www.mytricare.com/Internet/tric/tri/tricare.nsf/frontmap/Frms?OpenDocument&Expand=3

From the map the contact information opens up when the area is chosen.  There are essentially three entry points.  North and South regions go to one of two different addresses in SC.  West depends upon the state.  For instance, in California Managed Health Network (MHN) handles the application. We called MHN and were told that to become a TC "certified" - (non network provider) to go to the TriWest website: www.triwest.com Look in the provider section block and click on "find a form". This will take you to the appropriate form.

EIN (Employee Identification Number)

If you are a sole practitioner, you have a choice as to whether you use your SSN or obtain an EIN so as to avoid putting your SSN on official documents.  In these times of potential identity fraud, you may want to consider  applying for an EIN.  The best approach is always to consult the professional (lawyer, accountant, etc.) who is helping you establish your practice.

CPT Codes

In 2002, Medicare authorized payment for six current procedural terminology (CPT) codes for health and behavior assessment and intervention (H&B) services to prevent, treat, or manage behavioral health issues related to physical (rather than mental) health conditions. Interventions provided under these codes might include helping patients cope with medical illness and medical procedures, improving management of chronic conditions, or increasing adherence to medication and treatment protocols. Significantly, reimbursements for the H&B services are billed under medical services and are not subject to the 50 percent copay requirement under Medicare for outpatient mental health services.  Information taken from Medicare and Mental Health: The Fundamentals (November 2007) by Christopher Loftis and Eileen Salinsky of the National Health Policy Forum.

To find what APA prepared in 2004 about CPT codes, go to:  

Return to Developing Your Professional Practice

Updated: 8/15/2007