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 Adult MHOTRS or Children’s MHOTRS.