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How can Behaviorists get Reimbursed for Behavioral Health Services in Today’s Health Care System?

By: SBM Obesity and Eating Disorders Special Interest Group Co-Chair Stephanie L. Fitzpatrick, PhD | Published: December 11, 2014

Over one-third of adults in the United States are obese and 9.3% have diabetes. There are several studies—including large clinical trials such as the Diabetes Prevention Program—that have demonstrated that behavioral lifestyle interventions are effective treatments for obesity, diabetes prevention and management, and hypertension prevention and management. In research, lifestyle interventions are typically developed by individuals with behavioral medicine training and delivered by psychologists, registered dietitians, or other professionals with behavioral training. However, in the clinical care setting, these professions struggle to get reimbursed for the services they are trained to deliver.

In 2011, the Center for Medicare & Medicaid (CMS) decided to cover intensive behavioral therapy for obesity delivered by primary care physicians and practitioners in a primary care setting. This was a major decision as it indicated acknowledgment of obesity as a health condition. Unfortunately, psychologists and registered dietitians are not considered primary care physicians or practitioners and therefore cannot bill under this decision. 

The creation of health and behavior (H&B) codes has provided a means to bill for behavioral health services. However, some insurers—including Medicaid—do not acknowledge these billing codes. Even with the availability of H&B codes, in some settings, behaviorists can only get reimbursed for behavioral weight loss counseling if the patient also has an obesity-related chronic condition such as diabetes, hypertension, or sleep apnea. Some insurers limit the number of hours of behavioral health services they cover. For instance, Medicare only covers three hours of medical nutrition therapy in the first year and only two hours in subsequent years for patients with diabetes or kidney disease.

In other words, the current reimbursement policies for behavioral health services are not aligned with the established evidence in the literature. However, with the Affordable Care Act and emergence of patient-centered medical homes, behavioral health services and preventive health services are being highlighted as key services to provide in order to reduce health care cost. 

So what are behaviorists doing to get reimbursed for delivering behavioral health services?  What efforts do we need from the Society of Behavioral Medicine (SBM) on behalf of practicing behaviorists to improve coverage for behavioral services? Please share your thoughts by joining the discussion on LinkedIn. You can also answer a one-question poll and view the results.