Blue Cross Blue Shield of MA (BCBSMA) has announced that they will be reimbursing for CPT Code 90837 starting January 1, 2015.
It is important to note that 90837 can be billed in only a few specific situations:
Exposure Response Prevention Therapy for Social Phobia, Social Anxiety Disorder and Obsessive Compulsive Disorder.
Cognitive Processing Therapy (CPT) for PTSD ages 13 and above.
EMDR Therapy for PTSD ages 18 and above.
DBT for Borderline Personality Disorder ages 13 and above.
To be reimbursed, you are required to obtain prior authorization for managed care members. To request prior authorization, use the Outpatient Mental Health/Substance Abuse Treatment Request Form (TRF), dated 9/14. This is similar to the TRF providers have been using, but version 9/14 includes a new box to check for 90837. The new TRF is available from BCBSMA. You will be able to request 8 (or possibly 12) sessions at a time.
If you are requesting 90837, you must fax a description of your training for the proposed treatment when you fax the TRF; you do not need to send your certification. Also, you have to include an outcome measure for 90837 under “Specific treatment goals.”
It is important to understand that BCBSMA will only consider approving requests for 90837 for the above therapies for the listed accompanying disorders. They will not reimburse a 53+ minute therapy hour for other treatments (such as regular psychotherapy) and diagnoses.
One other change in the new BCBSMA TRF is that a GAF score is not required, but you must “describe current functioning.”
In addition to the information above, please regularly check the following websites for more information on the topics you need to keep you informed.
As an NASW member you also have access to the following helpful telephone numbers:
Or join the local NASW-MA Chapter groups/services (more information about these services can be found on the Chapter’s website):
The information above was originally published in the November 2014 FOCUS newsletter.
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Author: Erica Kirsners, LICSW; Private Practice; Chair, SWTRS Commission; Member, HMO-MCO Commission.