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CPT Coding and Reimbursement

The Current Procedure Terminology (CPT) code set is used to denote the medical and surgical procedures and diagnostic services rendered by clinicians. The CPT coding system provides a uniform language for describing these services for all billing and documentation and, under HIPAA, is required to be used to record care by all health care professionals in the United States.

For the clinician, the key to appropriate insurance reimbursement lies in accurate procedure coding. Coding errors can lead to delayed payments or rejections of submitted claims. Consistent errors may trigger audits, or even charges of fraud and abuse, and removal from managed care networks. Always verify CPT information with the AMA's current CPT manual, which is the ultimate authority on procedure coding.

Procedure Coding Resources for APA Members

Update on 2021 Office/Outpatient E/M Billing and Documentation

CMS has finalized changes to the way office/outpatient E/M codes (99202-99215) will be chosen and documented. Note that the following changes apply only to the office/outpatient E/M services; continue to bill and document as you always have in all other settings.

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APA Member-Only Resources

APA has created the following resources for its members on the 2021 billing and documentation changes. These are accessible by clicking the link below and signing in with your member credentials.

  • Recorded Webinar: Update on 2021 Changes to Billing and Documentation for Outpatient E/M Services
  • Webinar Slides
  • Quick Guide to the 2021 Update to Billing and Documentation for Outpatient E/M Services

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Evaluation and Management (E/M)

Practical Information on E/M Coding from Psychiatric News

Codes to Know

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