AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Introduced by: New York Delegation
Subject: Health and Behavior Assessment/Intervention
Referred to: Reference Committee G
(Samuel P. Solish, MD, Chair)
Whereas, The American Medical Association developed the 96150-96155 codes to identify Health and Behavior Assessment/Intervention services and listed them in the AMA Current Procedural Terminology code book around 2002 with a footnote which says these services should not be billed by physicians
Whereas, Medicare carriers across the country have had a lot of trouble with these codes insofar as understanding the coding system and the added burden of receiving an inadequate coverage explanation from the Centers for Medicare and Medicaid Services (CMS); and
Whereas, New York State Medicare carriers produced a Local Medical Review Policy (LMRP) that indicates that the provision of these services is limited to a psychologist who has specialty or subspecialty training in health and behavior assessment; and
Whereas, There is no board or specific training program that would enable a psychologist to apply for this particular specialty qualification; and
Whereas, The CMS instruction apparently requires that the behavior modification needs to be specifically related to a physical disease (e.g., The beneficiary had pulmonary disease and/or heart disease and smoking cessation or weight loss counseling would be considered as a covered service for these codes. However, the need to stop smoking or weight loss counseling
, in and of themselves would not be covered by Medicare under this policy.); and
Whereas, The LMRP appears to be discriminatory since: (a) it restricts this service from anybody with a prediagnosis of any mental illness; and (b) physicians are not expected to utilize these codes; therefore be it
RESOLVED, That our American Medical Association urge the Centers for Medicare and Medicaid Services (CMS) to reconsider the premise behind the usage of AMA-CPT codes 96150-96155 since the current instructions appear discriminatory in that the policy defining the use of these codes excludes patients with mental illness and restricts usage to clinical psychologists without defined/accredited training (Directive to Take Action); and be it further
RESOLVED, That our AMA urge CMS to enable these codes to be utilized for tobacco cessation and weight loss
, which supports the primary movement toward the ultimate goal of health prevention. (Directive to Take Action)
Fiscal Note: Lobby accordingly at estimated staff cost of $1,859.
RELEVANT AMA POLICY
H-490.943 Tobacco and Smoking.
Our AMA: (1) supports health insurance coverage and reimbursement for smoking cessation efforts; and (2) encourages state medical associations to develop lists of pharmacies that have voluntarily banned the sale of tobacco for distribution to their members. (Res. 427, I-92; Reaffirmation A-97; Reaffirmation I-99; Reaffirmation A-01)
H-490.926 Medicaid and HMO Support for Smoking Cessation.
Our AMA: (1) requests Congress to provide matching funds for Medicaid coverage for evidence-based programs and FDA approved products that lead to smoking cessation; and (2) seeks the requirement that state Medicaid programs, prepaid health plans and insurance companies provide evidence-based approaches for smoking cessation and nicotine withdrawal, including FDA-approved pharmacotherapy, as part of their standard benefit packages. (Res. 421, A-98)
H-95.994 Statement on Use of Amphetamines in Obesity.
Our AMA believes that the Drug Enforcement Administration of the Department of Justice should be offered every encouragement in the prosecution of those few individuals who prescribe CSA II amphetamine drugs for non-medical reasons in order to profit at the expense of patients who are drug dependent. (CSA Rep. C, part 2, I-77; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)
H-150.953 Obesity as a Major Public Health Program.
Our AMA will: (1) urge physicians as well as managed care organizations and other third-party payors to recognize obesity as a complex disorder involving appetite regulation and energy metabolism that is associated with a variety of comorbid conditions; (2) work with appropriate federal agencies, medical specialty societies, and public health organizations to educate physicians about the prevention and management of overweight and obesity in children and adults, including education in basic principles and practices of physical activity and nutrition counseling; such training should be included in undergraduate and graduate medical education and through accredited continuing medical education programs; (3) urge federal support of research to determine: (a) the causes and mechanisms of overweight and obesity, including biological, social, and epidemiological influences on weight gain, weight loss, and weight maintenance; (b) the long-term safety and efficacy of voluntary weight maintenance and weight loss practices and therapies, including surgery; (c) effective interventions to prevent obesity in children and adults; and (d) the effectiveness of weight loss counseling by physicians; (4) encourage national efforts to educate the public about the health risks of being overweight and obese and provide information about how to achieve and maintain a preferred healthy weight; (5) urge physicians to assess their patients for overweight and obesity during routine medical examinations and discuss with at-risk patients the health consequences of further weight gain; if treatment is indicated, physicians should encourage and facilitate weight maintenance or reduction efforts in their patients or refer them to a physician with special interest and expertise in the clinical management of obesity; (6) urge all physicians and patients to maintain a desired weight and prevent inappropriate weight gain; (7) encourage physicians to become knowledgeable of community resources and referral services that can assist with the management of overweight and obese patients; and (8) urge the appropriate federal agencies to work with organized medicine and the health insurance industry to develop coding and payment mechanisms for the evaluation and management of obesity. (CSA Rep. 6, A-99)
H-150.965 Eating Disorders.
The AMA (1) adopts the position that overemphasis of bodily thinness is as deleterious to one's physical and mental health as is obesity; (2) asks its members to help their patients avoid obsessions with dieting and to develop balanced, individualized approaches to finding the body weight that is best for each of them; (3) encourages training of all school-based physicians, counselors, coaches, trainers, teachers and nurses to recognize unhealthy eating, dieting, and weight restrictive behaviors in adolescents and to offer education and appropriate referral of adolescents and their families for interventional counseling; and (4) participates in this effort by consulting with appropriate specialty societies and by assisting in the dissemination of available educational and counseling materials pertaining to unhealthy eating, dieting, and weight restrictive behaviors. (Res. 417, A-92; Appended by Res. 503, A-98)
H-150.993 Medical Education in Nutrition.
H-165.975 Minimum Benefits in Required Employer Health Insurance.