Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Outpatient Mental Health | 05/04/2024 | Covered and Noncovered Services : CodesTopic #6123 Procedure Codes
Nationally recognized procedure codes such as CPT codes are required on all outpatient mental health claims submitted on the 1500 Health Insurance Claim Form. Claims or adjustments received without an appropriate procedure code are denied. The mental health and substance abuse maximum allowable fee schedule indicates maximum allowable fees and copayment rates.
Psychotherapy CPT procedure codes are time-based codes representing 30, 45, and 60 minutes of services. A unit of time has been reached when a provider has completed 51 percent of the designated time. To report psychotherapy, the session time must be at least 16 minutes. The proper procedure code is then selected based on the actual time closest to the time written in the code descriptor. This represents an actual time of 16 to 37 minutes for the 30-minute procedure codes (codes 90832 and 90833), 38 to 52 minutes for the 45-minute procedure codes (codes 90834 and 90836), and 53 minutes or greater for the 60-minute procedure codes (codes 90837 and 90838).
The following table lists the procedure codes and applicable modifiers that providers are required to use when requesting PA and submitting claims for outpatient mental health services. Not all providers may be reimbursed for all mental health services.
Outpatient Mental Health Services Procedure Codes
Procedure Code |
Description |
Enrolled Providers Who May Perform Service |
Required Modifier |
Allowable POS |
Allowable Units |
+ 90785 |
Interactive complexity
(List separately in addition to the code for primary procedure) |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90791 |
Psychiatric diagnostic evaluation |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90792 |
Psychiatric diagnostic evaluation with medical services |
Psychiatrist |
UA |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
APNP with Psychiatric Specialty |
UB |
90832 |
Psychotherapy, 30 minutes with patient |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
+ 90833 |
Psychotherapy, 30 minutes with patient when performed with an evaluation and management service
(List separately in addition to the code for primary procedure) |
Psychiatrist |
UA |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
APNP with Psychiatric Specialty |
UB |
90834 |
Psychotherapy, 45 minutes with patient |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
+ 90836 |
Psychotherapy, 45 minutes with patient when performed with an evaluation and management service
(List separately in addition to the code for primary procedure) |
Psychiatrist |
UA |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
APNP with Psychiatric Specialty |
UB |
90837 |
Psychotherapy, 60 minutes with patient |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
+ 90838 |
Psychotherapy, 60 minutes with patient when performed with an evaluation and management service
(List separately in addition to the code for primary procedure) |
Psychiatrist |
UA |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
APNP with Psychiatric Specialty |
UB |
90839 |
Psychotherapy for crisis; first 60 minutes |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
+ 90840 |
Psychotherapy for crisis; each additional 30 minutes
(List separately in addition to code for primary service) |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
N/A |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90845 |
Psychoanalysis |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90846 |
Family psychotherapy
(without the patient present), 50 minutes |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90847 |
Family psychotherapy
(conjoint psychotherapy)
(with patient present), 50 minutes |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12*, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90849 |
Multiple-family group psychotherapy |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90853 |
Group psychotherapy
(other than of a multiple-family group) |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 21, 22, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90865 |
Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital [Amytal] interview) |
Doctoral level |
HP |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Psychiatrist |
UA |
90870 |
Electroconvulsive therapy (includes necessary monitoring) |
Psychiatrist |
UA |
11, 19, 21, 22, 24, 51, 52 |
1 |
90875 |
Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes
|
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90876 |
Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90880 |
Hypnotherapy |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90887 |
Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
1 |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
90899 |
Unlisted psychiatric service or procedure |
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
N/A |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
96105 |
Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
3 |
Neurologist, Psychiatrist |
UA |
96110 |
Developmental screening (eg developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
2 |
Neurologist, Pediatrician, Psychiatrist |
UA |
96112 |
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
+ 96113 |
Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes
(List separately in addition to code for primary procedure) |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
6 |
Neurologist, Psychiatrist |
UA |
96116 |
Neurobehavioral status examination (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96121 |
Neurobehavioral status examination (clinical assessment of thinking, reasoning and judgement, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour
(List separately in addition to code for primary procedure) |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
3 |
Neurologist, Psychiatrist |
UA |
96130 |
Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96131 |
Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
7 |
Neurologist, Psychiatrist |
UA |
96132 |
Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96133 |
Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
7 |
Neurologist, Psychiatrist |
UA |
96136 |
Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96137 |
Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
11 |
Neurologist, Psychiatrist |
UA |
96138 |
Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96139 |
Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
11 |
Neurologist, Psychiatrist |
UA |
96146 |
Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only |
Doctoral level |
HP |
05, 06, 07, 08, 11, 13, 14, 19, 20, 21, 22, 23, 31, 32, 34, 49, 50, 51, 54, 57, 61, 71, 72 |
1 |
Neurologist, Psychiatrist |
UA |
96156 |
Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
96158 |
Health behavior intervention, individual, face-to-face; initial 30 minutes |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
+ 96159 |
Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
96164 |
Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
+ 96165 |
Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
96167 |
Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
+ 96168 |
Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
96170 |
Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
+ 96171 |
Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
All eligible providers |
N/A |
03, 04, 05, 06 07, 08, 11, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 56, 61, 62, 71, 72, 99 |
N/A |
H0046 |
Mental health services, not otherwise specified
(Note: Procedure code H0046 has been designated to be used only for mental health clinical consultations and should not be used to bill for any other services.)
|
Masters degree level |
HO |
03, 04, 05, 06, 07, 08, 11, 12, 15, 19, 20, 21, 22, 23, 26, 31, 32, 33, 49, 50, 51, 52, 53, 54, 56, 61, 62, 71, 72, 99 |
N/A |
Doctoral level |
HP |
QTT |
U6 |
Psychiatrist |
UA |
APNP with Psychiatric Specialty |
UB |
+ Add on procedure code.
* POS code 12 is allowable only for central nervous system assessments/tests and outpatient mental health services for members under 21 years of age. Services provided in the home (POS code 12) are only reimbursable when billed by a Medicaid-enrolled mental health outpatient clinic.
Independent providers who are able to bill Wisconsin Medicaid directly for outpatient mental health services are required to submit documentation that shows it is appropriate to use an alternative location to support the member's recovery when providing services outside of the provider's office or a school.
The outpatient mental health benefit does not include services provided in the home or community settings for members age 21 and over. See the Outpatient Mental Health and Substance Abuse Services in the Home or Community for Adults service area for outpatient services covered in the home or community for members age 21 and over. This benefit is a county-matched benefit.
Inpatient POS codes are not allowable for providers when payment for those services is included in the hospital's Medicaid DRG reimbursement. See the Inpatient Hospital service area for more information on what services are included in the DRG payments. |