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CPT Coding Changes Affect VNS Therapy, ECT Treatment

The presence of a CPT code in the manual does not guarantee payment. Moreover, use of VNS therapy for treatment-resistant depression is new, and payment is likely to be determined by individual insurers.

Two changes in the Manual for Current Procedural Terminology (CPT)—one regarding vagus nerve stimulation (VNS) and another on electroconvulsive therapy—have been approved by the AMA's CPT Editorial Panel.

Regarding VNS, psychiatrists using the therapy for treatment-resistant depression should use codes 95970, 95974, and 95975 found in the neurology subsection of the manual. Those codes are for analysis and programming of the neurostimulators used in VNS.

VNS therapy, which had formerly been approved only for treatment of epilepsy, recently received Food and Drug Administration (FDA) approval for treatment-resistant depression.

Wording referring psychiatrists to the neurology subsection will appear in the 2007 edition of the manual. The FDA approval did not occur in time for it to be included in the 2006 edition, but psychiatrists caring for patients with treatment-resistant depression can use the codes now.

However, APA's Office of Healthcare Systems and Financing cautioned that the presence of a CPT code in the manual does not guarantee payment for a procedure or service. The recommended 95970, 95974, and 95975 codes for VNS already exist in conjunction with neurology services and are paid by the federal Centers for Medicare and Medicaid Services for treatment of epilepsy.

But use of VNS therapy for treatment-resistant depression is new, and payment for this treatment will be determined by the policies of the insurance carrier.

Psychiatrist Tracy Gordy, M.D., is chair of the CPT editorial panel. He said it is reasonable to assume that the Centers for Medicare and Medicaid Services will pay for use of the therapy for treatment-resistant depression. However, private-sector behavioral health insurance carveout companies may not yet pay for it, claiming it is covered by the parent company under neurological services. Until the new wording appears in the psychiatry section, clinicians seeking to use the code for treatment-resistant depression are advised to negotiate payment with the parent company.

At the request of APA, the Editorial Panel deleted CPT code 90871 (ECT, multiple seizure). All visits for ECT should now be coded using CPT code 90870. That change will be reflected in the 2006 edition of the manual.

Gordy told Psychiatric News that the change in the ECT coding reflects updated knowledge about the lack of efficacy of multiple-seizure ECT.

Members who experience problems in filing these claims should contact the APA Managed Care Help Line at (800) 343-4671.

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