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Welcome  » May 19, 2022 10:33 PM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Outpatient Mental Health
05/19/2022  

Covered and Noncovered Services : Codes

Topic #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.

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
+ 99354 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour

(List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202–99215])

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
+ 99355 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes

(List separately in addition to code for prolonged service)

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 4
Doctoral level HP
QTT U6
Psychiatrist UA
APNP with Psychiatric Specialty UB
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.

 
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