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Office of Mental Health

Appendix 3:
Draft Clinic Services Billing Codes and Rules

(Information in this chart is not final and is subject to change)

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  Service Name Proposed CPT Codes CPT Description Provider Qualifications Comment Face to Face or Phone Required/ Optional Allow-able Clients Anticipated Modifiers
1 Outreach & Engagement H0023 Behavioral health outreach service (planned approach to reach a targeted population) Skilled peer advocate or Parent Advisor as the minimal qualification.   FTF Required Identified Client and Collaterals None
2 Initial Mental Health Assessment, Diagnostic Interview, & Treatment Plan Development 90801
90802*
Psychiatric diagnostic interview examination MD/NPP, LMSW, LCSW, Licensed Psychologist, RN, Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), and Licensed Creative Arts Therapist (LCAT), Licensed Psychoanalysts Up to three assess-ments can be billed at a higher rate. Must be a minimum of 45 minutes

MD/NPP would bill this CPT code under the physician fee schedule.

*A billing modifier is still required with this CPT code in order to receive the higher rate.
FTF Required Identified Client and Collaterals Language

Evenings and Weekends

Offsite
3 Psychiatric Assessment
(established patient)
90805
90811*
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, minimum of 30 minutes face-to-face with the patient; with medical evaluation and management services MD/NPP *A billing modifier is still required with this CPT code in order to receive the higher rate.

An enhanced payment related to the use of the PSYCKES health self assess-ment tool will likely be developed

FTF Required Identified Client and Collaterals Language

Evenings and Weekends

90807
90813*
Individual psychotherapy, insight oriented behavior modifying and/or supportive, in an office or outpatient facility, minimum of 45 minute face-to-face with the patient; with medical evaluation and management services.
4 Psychiatric Consultation 99241-99245 Office consultation of various lengths and meeting the requirements of the various CPT codes. MD/NPP MD/NPP will bill these CPT codes under the physician fee schedule. The fee is fixed regardless of the length of visit.

Note: These codes pay for a doctor's time to see another doctor's patient.

FTF Required Identified Client and Collaterals Language

Evenings and Weekends

5 Crisis Intervention H2011 Crisis Intervention Service, per 15 minutes MD/NPP, Physician's Assistant with a mental health specialty, Licensed Psychologist, LMSW, LCSW, RN, LMFT, LMHC, LCAT, Licensed Psychoanalysts H2011 - For one person by telephone or in person- Minimum of 15 minutes generates reim-bursement for 1 hour. Available in multiple incre-ments per episode. 15 min-utes addi-tional ser-vice after each hour generates reimbursement for additional hour; to a maximum of 2 hours.

S9484. 15 minutes up to four hours (face-to-face); requires two or more clinicians for a majority of duration of visit. (Skilled peer advocate or Parent Advisor may substitute for one clinician)

S9485. More than 4 hours (face-to-face); requires two or more clinicians for a majority of duration of visit. (Skilled peer advocate or Parent Advisor may substitute for one clinician)

These codes are used for office, off-site and in-home visits – no modifier is required

Both Required Identified Client and Collaterals Language
S9484 Crisis intervention mental health services, per hour
S9485 Crisis intervention, mental health services, per diem (existing)
6 Psychotropic Medication Admin-istration 90779 Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion MD/NPP/RN/LPN/PA (with a mental health specialty)   FTF Required for Clinic Servicing Adults. Optional for clinic serving only Children Identified Client Language

Evenings and Weekends

7 Psychotropic Medication Treatment 90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

No time limit

MD/NPP/PA An enhanced payment related to the use of the PSYCKES health self assess-ment tool will likely be devel-oped. FTF Required Identified Client and Collaterals Language

Evenings and Weekends

8 Psycho-therapy 90804
90810*
Psychotherapy - Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, in an office or outpatient facility.

Minimum of 30 minutes

MD/NPP, Licensed Psychologist, LMSW, LCSW, RN, LMFT, LMHC, LCAT, Licensed Psychoanalysts MD/NPP will bill this rate code under the physician fee schedule.

*A billing modifier is still required with this CPT code in order to receive the higher rate.

Times for 90846-90853 are established by OMH

FTF Required Identified Client and Collaterals Off-Site

In-Home

Language

Evenings and Weekends

90806
90812*
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility.

Minimum of 45 minutes

90846 Family therapy/collateral w/o patient (30 minutes) (Family includes current definition of collaterals.)
90847 Family therapy/collateral w/patient (60 minutes) (Family includes current definition of collaterals.)
90849 Multiple-family/collateral group psychotherapy (60 minutes)
90853 Group psychotherapy (other than of a multiple-family group) (clients only) (60 minutes)
9 Develop-mental Testing 96110 Developmental testing; limited (eg, Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report (1 hour) LPHA   FTF Optional Identified Client and Collaterals Language

Evenings and Weekends

96111 Developmental testing; extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report (More than 1.5 hours) LPHA
10 Psycho-logical Testing - various 96101
96116
96118
96119
96120
96125
Psychological testing of various types and meeting the requirements of the various CPT codes MD/Licensed Psychologist   FTF Optional Identified Client and Collaterals Language

Evenings and Weekends

  Complex Care Manage-ment 90882 Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions Licensed Psychologist, LMSW LCSW, RN, LMFT, LMHC, LCAT, Licensed Psychoanalysts Must be ancillary to psycho-therapy or crisis. Both Required Identified Client and Collaterals  

Comments or questions about the information on this page can be directed to the Bureau of Financial Planning.