SALT LAKE CITY — New changes to Select Health’s billing practices are raising concerns among mental health therapists in Utah, with one local provider claiming the updates will create additional hurdles for both practitioners and patients seeking extended care.
Jessica Little, a licensed clinical social worker and owner of The Green Lotus Center for Personal Growth & Wellbeing, has voiced concerns about a specific change in Select Health policy CR-110. She argues it affects a sub-section of clients who require more than standard 60-minute therapy sessions, particularly those dealing with complex trauma and attachment-related disorders, including Post-Traumatic Stress Disorder (PTSD).
Little, who frequently uses Eye Movement Desensitization and Reprocessing (EMDR) in her practice, states that such treatments often necessitate sessions lasting 90 to 120 minutes. These extended periods are crucial for what she describes as “safe closure” to ensure clients return to a stable state and are not left overwhelmed with emotions, calling it “standard practice” in the field.
The policy issue traces back to 2023 when the American Medical Association (AMA) removed certain modifier codes that previously allowed billing for extended psychotherapy sessions. In response, the AMA developed a workaround, permitting providers to bill for two units of codes to ensure patients could still receive medically necessary, longer services.
Initially, many insurance companies did not recognize this new workaround, leading to limitations on billing for sessions beyond one hour. However, Little observed that over time, many insurers began to accept the revised billing method. Despite this trend, Little noted that in January, Select Health issued a notification, 15 days after the policy started, stating they would no longer be allowing that workaround, effectively ending reimbursement for extended psychotherapy sessions under the previous method.
This shift, according to Little, leaves patients who require 90-120 minute psychotherapy sessions without an appropriate outpatient reimbursement pathway through Select Health. She claims Select Health justified the change by citing AMA guidelines, but Little reported being “unable to find the guideline that codes limiting billing to one unit.” She has contacted the AMA, CMH, the state of Utah, and Medicaid Services, all of whom, she says, confirmed that using two units for billing is permissible, leading her to question Select Health for evidence of their stated guideline.
For independent practitioners like Little, who manages her own business without external billing support, these policy adjustments create a significant “headache” and add unreimbursed administrative work. The changes have forced her practice to modify client sessions and seek “creative” solutions, such as scheduling two one-hour sessions per week to meet the need for longer treatment. However, this often results in clients incurring additional co-pays, thereby increasing the financial burden on individuals seeking essential mental health care.
When asked about policy CR-110 and the concerns raised by therapists, Select Health provided a statement. The insurer affirmed its commitment to “supporting access to high-quality behavioral health care for our members.” Select Health clarified that the policy in question relates to established documentation requirements for time-based procedure codes. They stated the policy is designed to support accurate and consistent billing practices and maintains that it does not limit a provider’s ability to determine the most appropriate care or treatment plan for a patient. Select Health also emphasized its value for provider relationships and its ongoing efforts to work closely with providers to address questions and support member care.