NYS Creates Volunteer Mental Health Hotline to Help with Coronavirus Crisis

Within the last few hours, Governor Cuomo announced the creation of a state-wide hotline to provide free mental health services to individuals at home who may be experiencing stress and anxiety due to the COVID-19 crisis. The Governor has called upon mental health professionals to volunteer to create a reserve of mental health professionals to provide telephone and/or telehealth counseling for individuals in need. NYSPA has contacted the Governor’s office and advised them it will be sending a communication to its members to encourage participation in this important initiative on behalf of New Yorkers in need.  

Urgent Telemedicine Update

The Centers for Medicare & Medicad Services has announced that additional emergency measures have been put into place to temporarily expand the use of telemedicine. These measures will include allowing providers to conduct telemedicine visits with patients who are located in their homes. The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site (i.e., physician's office or other location) and the patient at home.


Coding and Billing Update for Telemedicine

CPT Codes
When providing psychiatric services by telemedicine, psychiatrists should use the same CPT codes used for an in-person encounter (e.g., 99212+90836 for a combination psychotherapy service, 99215 for a standalone E/M service or 90845 for psychoanalysis).

For all services being provided via telemedicine, use Place of Service (POS) Code 02. Please note that use of POS 02 is required for services provided to Medicare beneficiaries. Please note that some commercial carriers also require the use of modifier 95 to indicate the use of telemedicine. Modifier GT is no longer in use and was retired effective 1/1/18.  


Telemedicine Software Offered by DrFirst

We would like to make members aware that DrFirst, NYSPA’s endorsed electronic prescribing software vendor, offers Backline, a telemedicine product that may be of assistance to private practitioners. Backline is available at a $300 annual subscription. DrFirst has assured us that the software product complies with all applicable regulations, including HIPAA.  


Telehealth Information From Commercial Carriers

To assist members in navigating telemedicine rules and changes to existing requirements, we have compiled the below links to the websites of commercial insurance carriers that have issued updated information regarding the COVID-19 emergency.  Please reach out to individuals carriers if you have any questions or concerns regarding individual policies.   If you encounter any problems, please let NYPSA know.  We will be adding links for information posted by additional carriers if and when it becomes available: 


Information Regarding the Use of Telemedicine Related to the COVID-19 crisis 

March 13, 2020
This afternoon, President Trump declared a national emergency and confirmed that Health and Human Services Secretary Azar has been granted the authority to waive existing laws to enable the provision of telemedicine services across the country. We await additional information from CMS, particularly regarding the lifting of current Medicare restrictions on the provision of telemedicine in a patient’s private home. 


2020 Medicare Update Webinar

Presented by: Seth P. Stein, Esq. & Rachel Fernbach, Esq.
Webinar Date: December 18, 2019


NYSPA Lead Plaintiff in Class Action Lawsuit Against United Healthcare and Affiliates

NYSPA is pleased to announce that it has joined as first named plaintiff in a class action lawsuit against United Healthcare and affiliates addressing access to coverage


Empire Blue Cross Blue Shield Double-Copay Issue

In response to member reports, NYSPA recently contacted Empire BlueCross BlueShield

New OMH Regional Centers of Excellence 

The New York State Office of Mental Health (OMH) recently announced its Regional Centers of Excellence Plan 
a plan that calls for major changes in State-operated mental health services, representing a shift from inpatient services to community-based services.


Avoiding the 2015 Medicare PQRS Payment Reduction

All physicians who treat Medicare patients and who fail to report required PQRS quality measures during the 2013 calendar year will be subject to a 1.5% payment reduction in 2015. 


New York Health Benefit Exchange Webinar

On August 14, 2013, the New York Chapter of the American College of Physicians hosted a webinar


Ann M. Sullivan, MD Appointed Next OMH Commissioner

NYSPA is proud to report that Governor Andrew M. Cuomo has announced the appointment of Ann M. Sullivan, MD as Acting Commissioner of the New York State Office of Mental Health (OMH) in November 2013.  


DOH Establishes Transition Period for I-Stop Compliance

As you know, the new I-Stop duty to consult goes into effect on August 27, 2013. The Department of Health recently posted the below message on its website, which indicates that all practitioners unable to establish an HCS account and access the PMP despite good faith efforts may continue to write prescriptions for Schedule II, III and IV medications.  DOH expects this period of transition to last through October 2013.


PQRS Clarification

In response to our recent website article on the new PQRS 2015 payment reduction, NYSPA has received several inquiries from members regarding the use of Measure #9 (Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD)


NY Times Highlights NYSPA Class Action Lawsuit

The New York Times recently published an article entitled "Lacking Rules, Insurers Balk at Paying for Intensive Psychiatric Care," which addresses the failure of health insurance carriers to cover the cost of care for individuals with serious mental illness. 

NYSPA/APA Successful in Reversing Improper Denials of Claims Submitted To UBH/Optum

NYSPA was recently contacted by two members who had been receiving improper denials from United Behavioral Health/Optum for claims for the new combination psychotherapy CPT codes (e.g., 99212+90836), Optum was refusing to provide reimbursement for the psychotherapy add-on code because the provider had failed to document start and stop times for the psychotherapy portion of the session alone (as opposed to the E/M portion). This practice, clearly in violation of CPT, was being applied to both in-network and out-of-network benefits. 


Court Finds Plausible Parity Violations by United but Requires Claims To Be Brought Against Plan Sponsors

On October 31, 2013, United States District Judge Colleen McMahon dismissed a class action mental health parity lawsuit brought by four patients, a psychologist, a psychiatrist, and NYSPA (on behalf of its members and their patients) against UnitedHealth Group


Obama Administration Issues Final Rule Implementing Mental Health Parity and Addiction Equity Act

On Friday, November 8, 2013, the Obama Administration issued a Final Rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA).  In general, NYSPA and the APA are pleased with the Final Rule, which includes clarification on many important issues, including insurer transparency, nonquantitative treatment limitations and reimbursement rates, among others.  

To read the APA Talking Points on the Final Rule, please click here.
To read the APA Talking Points on the Parity Law in general, please click here.   

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