100% Pre-Payment Review of CPT Code 99214

Medicare has initiated a special targeted pre-payment review of all CPT code 99214 services.  After conducting a review of documentation for this level outpatient office visit for an established patient, Medicare has concluded that the documentation often failed to meet the CPT documentation requirements for this service.  Psychiatrists may be using Code 99214 in combination with an add-on psychotherapy visit such as 90833, 90836, or 90838.  NYSPA has prepared a guideline for minimum documentation requirements for Code 99214.  Members can click here to read and download the NYSPA guidelines. Failure to record the minimum required documentation for a Code 99214 can result in disallowance or reduction to a lower level E/M code and recovery of overpayments.

Under pre-payment review, your claim will be pended until documentation is reviewed. If you do not respond to the records request, the claim will be denied.


NGS Medicare Will Soon Reject Handwritten Claim Forms

Beginning August 7, 2017 for upstate providers (localities 03 and 99) and November 13, 2017 for downstate providers (localities 01, 02 and 04) all handwritten claims submitted to NGS Medicare will be returned to providers with a note attached stating that a new claim will need to be submitted. All submitted, or resubmitted, claims after these dates will need to be either printed (not handwritten) paper claims or electronically submitted claims.


Medicare Update:  Act Now to Avoid a Medicare Penalty in 2019

Psychiatrists who treat Medicare Part B patients and who do not qualify for a 2017 exclusion have less than 2 months to participate in MIPS during 2017 to avoid a penalty in 2019.  The Merit-Based Incentive Payment System (MIPS) is the new Medicare Quality Payment Program that consolidates all pre-existing quality programs, including PQRS, the Medicare EHR Incentive Program and the Value-Based Modifier. 


Workers’ Comp Board: Physicians Must Register by January 15, 2018

The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. The goal of this process is to enable an injured worker to easily and accurately identify Board-authorized medical providers.

You should have been be notified in November when registration opened for Board-authorized medical providers. Authorized providers are asked to register with the Board and update their office address (es) and contact information by January 15, 2018. This registration process will be an ongoing initiative every two to three years.

Medical providers who have not registered by January 15, 2018 will:

  • be removed from the public directory of Board authorized providers, and
  • become ineligible for the Board’s disputed bill process.

Creating an Account in the New York State Health Commerce System (HCS). The Board will use the existing New York State Health Commerce System (HCS) for this registration process. For the initial registration and for future updates to your practice information, you will need to have an HCS account. If you don’t already have one, you can view directions to create an account on the New York State Department of Health website.

Need Help?
If you are not sure if you already have an HCS account, contact the Commerce Account Management unit (CAMU) at (866) 529-1890 and select option 1. For general questions about health care provider registration, please contact the Board’s Customer Support at (844) 337-6305.

Worker Comp Questions? Email us or call Customer Service at (877) 632-4996


DrFirst Named as New NYSPA Endorsed eRx Vendor

DrFirst ad



PA is pleased to announce that it has endorsed DrFirst as its new preferred vendor for electronic prescribing software. NYSPA's previous endorsement agreement with RxNT rec

ently ended and NYSPA has been in the process of identifying a new preferred vendor. As before, NYSPA's relationship with DrFirst will offer NYSPA members the opportunity to purchase electronic prescribing software at a significant discount.


Informational Webinar About DrFirst e-Prescribing Products

DrFirst, NYSPA's endorsed e-prescribing software vendor, offers a substantial discount for use of its e-prescribing smartphone application, iPrescribe, and its stand-alone e-prescribing software, Rcopia/EPCS. To learn more about DrFirst products, including how to sign up to use iPrescribe for one year at no cost to you, NYSPA members are invited to join the webinar presentation and product demonstration scheduled for Wednesday, June 27, 2018 at 7:00 pm. 

Please click on the link below to register for the June 27th webinar.

Register for June 27th webinar


Notice of Good Faith Estimate of Non-Deductibility of NYSPA 2019 Dues

The Omnibus Budget Reconciliation Act of 1993 included certain provisions denying tax deductibility for the portion of dues paid to 501(c)(6) professional organizations that is spent on influencing state or federal legislation. The law requires NYSPA to provide its members with a good-faith estimate of the portion of their dues which is attributable to lobbying and therefore, is non-deductible for federal income tax purposes.


APA Joins Health Care Community in Calling on Congress to Hold Hearings on Treatment of Children Separated From Parents at Border

Washington, D.C. – Today the American Psychiatric Association (APA) and 13 other health care organizations sent a letter to House and Senate oversight committees urging them to hold hearings with officials with the Department of Homeland Security Click here to read article on APA website


How Psychiatrists Can Help Immigrant Families

The separation of families seeking asylum at the U.S. border has left many in shock and disbelief and wanting to take action. A federal judge has ruled that the children under age 5 taken from their parents be returned, but the process is slow going. Click here to read article on APA website.


APA Statement Opposing Separation of Children from Parents at the Border

WASHINGTON, D.C. — The American Psychiatric Association issued the following statement from President Altha Stewart, M.D.: click to read position statement on APA website


New ICD–10–CM Coding Updates at a Glance

Click here to access the new ICD–10–CM codes that can be used beginning October 1, 2018.


Sexual Harassment Prevention Requirements for New York Employers - Training Videos Now Available

In 2018, New York State and New York City established new requirements for employers intended to prevent sexual harassment in the workplace.  Under the new requirements, all employers in New York State, regardless of size, must provide sexual harassment prevention training to all employees on or before October 9, 2019 and annually thereafter.  The State has now released training videos that may be used by employers to meet the training requirement.  The training videos are divided into Part 1 and Part 2 and are available in 8 languages.  The videos may be accessed at https://www.ny.gov/combating-sexual-harassment-workplace/employers#.


DrFirst Seeks Feedback on iPrescribe Mobile e-Prescribing Solution

NYSPA’s preferred e-prescribing vendor, DrFirst, is sending out a survey this week to all NYSPA members who have registered to use its mobile e-prescribing solution, iPrescribe. One in four respondents will qualify for a $25 gift card as long as they complete the survey by October 12th. Please use the following link to respond: https://drfir.st/iprescribe-css-nyspa.


New Medicare Proposals for E/M Documentation and Payment: Implications for Psychiatry

As reported in Psychiatric News, CMS has proposed significant changes in both the documentation and reimbursement for outpatient office visits (99202-99205 and 99212-99215). These proposals could create problems for psychiatrists billing for both an E&M and an add-on psychotherapy code (e.g., 99213+90836). These proposed changes will also likely impact commercial insurers. Click here to read a copy of NYSPA's comments in response to these proposed changes.

Prohibition on “Conversion Therapy” for Minors Passes NYS Senate and Assembly

NYSPA is very pleased to announce that both houses of the NYS Legislature have passed legislation that prohibits licensed mental health professionals from engaging in efforts to change a minor’s sexual orientation (so-called “conversion therapy”) and would define such efforts as professional misconduct (A.576, Glick/S.1046, Hoylman).  The bill passed the Senate by a vote of 57-4 and the Assembly by a vote of 141-7. Governor Cuomo has already announced his intention to sign the bills into law stating, “Conversion therapy belongs in the dustbin of history. Looking forward to signing this bill and ending this discredited, harmful practice in New York State.”  If signed into law, this legislation would make New York the 15th state to ban conversion therapy for minors. 


Mental Health & Substance Use Disorder Parity Report Act

Interested members may use the following link to send a thank you letter to Governor Cuomo, Assemblymember Gunther and Senator Ortt for their work on this important legislation:


Governor Cuomo Enacts One of NYSPA's Major Legislative Priorities: Law to Prohibit "Conversion Therapy" for Minors

NYSPA is very pleased to report that late last week Governor Cuomo signed into law legislation that prohibits licensed mental health professionals from engaging in efforts to change a minor’s sexual orientation (so-called “conversion therapy”) and defines such efforts as professional misconduct (A.576, Glick/S.1046, Hoylman).  The bill signing took place on Friday, January 25, 2019 in New York City and was attended by NYSPA members Frank Dowling, M.D., Jack Drescher, M.D., and Barry Perlman, M.D. and Jamie Papapetros from the NYSPA Government Relations office.


Parity/Access to Care Resources

Information and resources for New York psychiatrists and their patients experiencing difficulty in accessing insurance benefits for mental health and substance use disorder services


New York Enacts Historic Parity Reforms 

NYSPA is extremely pleased to report that the 2019-20 New York State Budget, approved this past weekend, includes landmark provisions aimed at enhancing parity for New Yorkers suffering from mental health conditions, substance use disorders and autism spectrum disorders. These provisions, called the Behavioral Health Insurance Parity Reforms (BHIPR), represent a comprehensive overhaul of the New York Insurance Law and seek to eliminate discrimination in coverage of care and treatment for mental health conditions, substance use disorders and autism spectrum disorders. The budget provisions apply to all health insurance and health benefit plans offered in New York State, including individual plans, group plans and HMOs. 

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