To Whom It May Concern: 

There is strong medical evidence supporting the IPCA physician's request for medical psychology services, and denial of coverage for this service would run counter to the principles of evidence-based medicine.

• A study by Carragee showed that poor coping skills increases the risk that a person will develop low back pain three fold.  (Carragee ET Spine 2004 May 15;29(10):1112-1117)
• A study by Niemisto showed that depression, anxiety, and poor coping skills are the most improtant factors that predict outcome of medical and physical therapy treatment of back pain.  (Niemisto L J Rehab Med 2004 May;36(3):104-109)
• A study by Watson showed that depression and anxiety are more important than physical factors in predicting return to work after treatment of back pain.  (Watson P European J Pain 2004 Aug;8:359-369)

We are not requesting mental health servies.  We are requestion pain treatment. 

There is frequent misunderstanding surrounding the role of a psychologist in a clinic dedicated to treating medical conditions, and issues surrounding reimbursement for these services. Most third party payors have separate funding sources for medical treatment and for mental health treatment, and this has historically "split" the interdisciplinary treatment team and thus become a barrier to cost-effective integration of services for chronic medical (not mental) illness.

HCFA approved codes in 2002 that are intended to facilitate payment for certain psychologists’ services for medical conditions such as back pain, nerve injury pain,  and headache with physical health care dollars. These are the "Health and behavior assessment and intervention" codes 96150-96155 listed on page 368 of the 2002 CPT coder. The CPT coder says: "Codes 96150-96155 describe services associated with an acute or chronic illness (not meeting the criteria for psychiatric diagnosis), prevention of physical illness or disability….." IPCA bills these codes for psychologists’ services.

The Health Psychologist, vol 24, no 1: pg 11 describes HCFA’s intent for these codes: "Federal reimbursement for the health and behavioral assessment and intervention codes will come out of funding for medical rather than psychiatric services, and will not draw from limited mental health dollars." The situation has been simplified: CMS has showed us the way to reimburse for pain services from a psychologist out of medical dollars. The situation is now similar to that for neuropsychology services.

IPCA exists to prevent and reduce physical illness and disability due to pain, and that is the role of the psychologist in our program. The psychologist does not provide mental health servics.  Our psychologists treat medical problems through the techniques discussed in the 2002 CPT coder description of the new codes.  

What happens when a pain psychologist identifies a mental health diagnosis that is a barrier to medical treatment for pain?  The patient is referred for treatment by the payor’s contracted provider and the pain psychologist becomes the liaison between the contracted mental health providers and the physician-led team managing the painful illness.

I hope that this information clears the way for approval for the services requested for our patient.

Bennet Davis, M.D.
President, Integrative Pain Center of Arizona