New DHS Benefit, Psych Consults to PMPs – Not Quite Ready for Prime Time

The Minnesota Department of Human Services (DHS) is promoting coordination of care between primary medical providers (PMP) and behavioral providers. In the past, DHS had a benefit that covered psychiatric consultations provided to primary medical providers. According to DHS staff, no psychiatrists ever billed for this service, so obviously it was not being provided to primary medical providers even though it was a potentially helpful concept. DHS recently expanded this benefit to cover consultations to PMPs by licensed psychologists, as long as the psychologist is working within the scope of their license. 

Information about the new DHS coverage for this service is available at:

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_138238

 The DHS guidelines for this new services state:

Consultation includes communication between a consulting professional (psychiatrist or psychologist) and a primary care provider for the purpose of medical management and behavioral health care and treatment of a recipient. A psychologist may provide consultation about alternatives to medication, medication combined with psychosocial treatments, and potential results of medication usage. The provider may conduct the consultation without the recipient present.

Both the consulting psychologist and the PMP medical professional are able to bill for the consultation. Both use the 99499 billing code, but with a different modifier for each of the participants. The DHS guidelines for billing for this service specially allow for it to be provided as a non-face-to-face service,  and the consultation may be done by phone or other telehealth medium.

According to the DHS reimbursement info, this service pays the psychologist $67.91.

Here are a few factors to consider for psychologists who might be interested in providing this service:

  •  I have done these consultations in the past, and found them to be interesting and rewarding. They often are for patients who are challenging or perhaps difficult for, the PMP. In my experience, PMPs were very appreciative.
  • The PMPs often initially wanted to discussion medication, but the discussion often evolved so that we were discussing treatment factors that clearly are psychology territory – for example, helping the PMP respond to difficult behaviors, treatment compliance problems, engaging the patient or family, and obtaining referrals to network mh/behavioral professionals.
  • Referrals from PMPs to a psychologist for a consultation require that the PMP obtain authorization from the pt, and that the PMP, or their staff, provide a copy of the release and info necessary for billing to the consulting psychologist. This may be perceived by PMP and staff to be a nuisance, and may be a barrier to referrals.
  • The psychologist has to bill – does not collect from the PCP- and therefore has to create, in effect, a new patient case in your billing system and clinical records for each encounter, which makes it less of a good deal financially as there will be some overhead for each encounter.
  • The benefit applies to all MHCP contracts (“straight” MA and “PMAP MA”), but the PMAP companies were only recently notified of the new benefit, and have not yet added the 99499 billing code to their fee schedule. In fact, I called the 4 primary PMAP companies (BCBS, Medica, HealthPartners and UCare) and the staff that I talked to at 3 of them were totally unaware of the new benefit. In regard to when we would actually be able to bill using the 99499 code, they were all unable to give me a date and could only state that would be added sometime in 2015 when they update their fee schedule. This could be in early 2015, potentially, in the case of UCare or could potentially be in June or July. Optum staff told me that they would send out a bulletin notifying Optum/Medica providers of the change, but the rest said that it would be up to us to track the new fee schedule and determine whether the 99499 code has been, in effect, activated for each of the other PMAP plans.
  • I did some provisional marketing of this new service to a few PMP clinics in my vicinity. None had heard of the new benefit, and also had not heard of the previous benefit covering psychiatric consultations to PMPs. All had some difficulty conceptualizing how the consult would actually work- would the PMP be able to call and get a consult immediately, while the patient was in their office? Would they need to schedule a time for the consult that fits with the schedules of both the PMP and the psychologist- and if so, could this be accomplished in a timely manner?

So, we are left with a new billing code for a limited number of insurance plans, starting with MA only, and it will be a challenge to keep track of when it is added to the other plans.   It is potentially, I think, an interesting and important expansion of the practice of psychology in Minnesota- but there are a few bugs to be worked out before it is ready for full implementation.

11-23-14:  the 3rd bullet point was added today.  RS

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