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The Medicare Improvements for Patients and Providers Act (MIPPA) becomes effective January 1, 2010. It is expected that parity will mean a 30% increase in behavioral health spending over the next five years.
As the parity provisions are phased into Medicare, there is a formula for calculating the decreased amount for patient copayments using a series of phase-in multipliers. The phase-in process will not apply to two outpatient mental health services which will both be covered at 2014 rates immediately. They are brief office visits for monitoring or changing drug prescriptions used to treat a mental health disorder (cpt codes 90862 and 90805) and partial hospitalization services billed by hospital outpatient departments and community mental health centers. However, since the professional services of providers to partial hospitalization are billed separately from the partial hospitalization program of services and their services are subject to the MIPPA changes in the limitation.
Diagnostic evaluations (cpt codes 90801 and 90802) and tests to establish or confirm a patient’s diagnosis are also not subject to the MIPPA. CMS instructed Medicare contractors to deem initial visits as diagnostic. In cases where a diagnosis takes more than one visit, the Medicare contractor may request documentation to justify the additional visit.
