From: Provider Express <ProviderExpress@mail125.subscribermail.

com> Subject: 2013 CPT Codes: Authorization Requirements Date: January 30, 2013 4:31:12 PM EST To: drtbj@mac.com Reply-To: Provider Express <ubhonline@optum.com>
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Dear Network Provider, We are aware that you are working to adjust to and implement the new 2013 CPT Code Changes. We have identified two key points about which many providers are seeking clarification. Prior Authorization Requirements Outpatient Sessions Extended sessions, those beyond 45-50 minutes, have historically required prior authorization. With the implementation of the 2013 CPT Codes, Optum is retaining the prior authorization requirement for extended sessions. These two 60 minute codes require prior authorization: 90837 Psychotherapy, 60 minutes with patient and/or

family member + 90838 Add on code used with an appropriate E/M code Please note that widely available 2012 to 2013 code crosswalks reflect that 90837 is a replacement for the 90808 code used in 2012. Requiring authorization for this extended session does not represent a change. For guidance on authorization of extended sessions, please see our Coverage Determination Guidelines for Extended Outpatient Treatment Visits. Note that the former 90806 (4550 min psychotherapy) code has been replaced with 90834 and, as before, typically does not require prior authorization. 2013 CPT Code Resources Provider Express Optums provider website has a link on the home page, under Treatment Updates > CPT 2013 Info. Visit www.providerexpress.com to access Frequently Asked Questions, playback our presentation on CPT Code Changes or obtain links to other resources. Also our Coverage

Determination Guidelines may be found from the Provider Express home page under Quick Links > Guidelines/Policies > Coverage Determination Guidelines. American Psychological Association Practice Central site offers an overview of changes, frequently asked questions about use of the new codes, a code crosswalk, and more. Visit www.apapracticecentral.org > Reimbursement > Billing and Coding. American Psychiatric Association also provides general overview materials, a code crosswalk that includes more information on Evaluation and Management (E/M) codes, patient examples of how to apply E/M codes, documentation resources and more. Visits www.psych.org > Changes to Billing Codes for Psychiatry Effective January 1. The National Council for Behavioral Health offers resources aimed at helping providers through the CPT code changes including free webinars addressing coding and associated documentation requirements links to service guides and more. Visit www.thenationalcouncil.org >

Public Policy > Policy Issues & Resources > CPT Codes. This is a significant change for all of us. I encourage you to take a few minutes to carefully review our extensive CPT FAQs and to playback and view our presentation both of which are posted to Provider Express. Thank you for working to make this transition to the new codes as smooth as possible. We appreciate the care you provide to individuals and families every day. Sincerely, Deb Adler SVP, Behavioral Network Services

United Behavioral Health operating under the brand Optum U.S. Behavioral Health Plan, doing business as OptumHealth Behavioral Solutions of California

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