Commentary: medicaid reimbursement and utilization of health and behavior codes: year one in Oklahoma.

In 2002, the Centers for Medicaid and Medicare Services (CMS) approved and activated the health and behavior Current Procedural Terminology (CPT) codes (H&B codes) with the purpose of improving services delivered to patients within the medical system (Foxhall, 2000). The implementation of H&B codes for use by licensed clinical psychologists was the culmination of efforts by the American Psychological Association (APA) Practice Directorate and the Interdivisional Healthcare Committee starting in 1997. The APA has been continually working with Medicare and private insurance companies to improve access and reimbursement of the codes, but Mullins, Ambrosino, Duncan, Smith, and Phelps (2010) noted that adoption and reimbursement from Medicaid continues to lag behind. These authors reported on results of a survey of success with Medicaid reimbursement for pediatric psychologists and the typical process for psychologists pursuing reimbursement for the codes. Unfortunately, the majority of respondents either did not have Medicaid reimbursement or were unaware of the source of the funds (e.g., State Medicaid office, Health Care Authority, the Behavioral Health Division).Currently, no data have been published on the number of states that provide Medicaid reimbursement for H&B codes. Since Medicaid is administered at the state level, monitoring of successful Medicaid reimbursement remains a challenge. Few articles have been published since Noll and Fischer’s (2004) commentary on the H&B codes, and it remains unclear how accessible the codes are across the country, in part because of the variability in reimbursement across states, and the lack of a systematic way to track this information. The purpose of this commentary is to provide an overview of the process of obtaining Medicaid reimbursement for the H&B codes in Oklahoma and to report on the data compiled by the state’s Medicaid program on the utilization and reimbursement of the codes during their first year of implementation. Additionally, in Oklahoma postdoctoral fellows and predoctoral interns enrolled in accredited training programs are permitted to bill Medicaid for services while under the supervision of a licensed psychologist; therefore, the process of opening up the codes for use by psychology trainee as well as utilization of H&B codes are reported in addition to services provided by licensed psychologists.