For Dates of Service Before July 1, 2013

Procedure Codes

CPT codes are required on all outpatient mental health claims submitted on the 1500 Health Insurance Claim Form. Claims or adjustments received without a CPT code are denied. Providers should refer to the maximum allowable fee schedule for maximum allowable fees and copayment rates.

For procedure codes that do not indicate a time increment, providers are required to use the rounding guidelines per the CPT manual.

The following table lists the CPT 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

CPT Code	Description	Enrolled Providers Who May Perform Service	Required Modifier	Allowable POS	Additional Information
90785	Interactive complexity (Psychotherapy using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication.)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99	For psychiatric procedures with interactive complexity, providers are required to use the appropriate psychiatric CPT procedure code along with the interactive complexity add-on code (90785). Providers should bill their usual and customary charge for interactive complexity. However, ForwardHealth does not reimburse an additional amount for interactive complexity; ForwardHealth will process claim details for interactive complexity (procedure code 90785) as an allowed detail with a zero dollar payment.
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90791^**	Psychiatric diagnostic evaluation	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90792^**	Psychiatric diagnostic evaluation with medical services	Psychiatrist	UA	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		APNP with Psychiatric Specialty	UB
90832^***	Psychotherapy, 30 minutes with patient and/or family member	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90833^***	Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service	Psychiatrist	UA	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99	Billed with appropriate E&M procedure code.
		APNP with Psychiatric Specialty	UB
90834^***	Psychotherapy, 45 minutes with patient and/or family member	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90836^***	Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service	Psychiatrist	UA	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99	Billed with appropriate E&M procedure code.
		APNP with Psychiatric Specialty	UB
90837^***	Psychotherapy, 60 minutes with patient and/or family member	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90838^***	Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service	Psychiatrist	UA	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99	Billed with appropriate E&M procedure code.
		APNP with Psychiatric Specialty	UB
90839^***	Psychotherapy for crisis; first 60 minutes	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90840	Psychotherapy for crisis; each additional 30 minutes	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99	This is an add-on procedure code and can be used only in conjunction with procedure code 90839.
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90845^***	Psychoanalysis (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90846	Family psychotherapy (without the patient present) (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90847^***	Family psychotherapy (conjoint psychotherapy) (with patient present) (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90849^***	Multiple-family group psychotherapy (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 22, 23, 26, 31, 32, 33, 49, 50, 54, 56, 57, 60, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90853^***	Group psychotherapy (other than of a multiple-family group) (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 22, 23, 26, 31, 32, 33, 49, 50, 54, 56, 57, 60, 71, 72, 99
		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) (quantity of 1.0 = 60 minutes)	Doctoral level	HP	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 22, 23, 26, 31, 32, 33, 49, 50, 54, 56, 57, 60, 71, 72, 99
		Psychiatrist	UA
90870	Electroconvulsive therapy (includes necessary monitoring)	Psychiatrist	UA	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 49, 50, 51^, 56, 57, 60, 61^*, 71, 72, 99
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); approximately 20-30 minutes	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90876	approximately 45-50 minutes	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90880	Hypnotherapy (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		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 (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
90899	Unlisted psychiatric service or procedure (quantity of 1.0 = 60 minutes)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96101	Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorshach, WAIS), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
96102	Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
96103	Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
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	01, 03, 04, 05, 06, 07, 08, 09, 11, 12, 13, 14, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Neurologist, Psychiatrist	UA
96110	Developmental screening, with interpretation and report, per standardized instrument form	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Pediatrician, Psychiatrist	UA
96111	Developmental Testing (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Pediatrician, Psychiatrist	UA
96116	Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Pediatrician, Psychiatrist	UA
96118	Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
96119	Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
96120	Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report	Doctoral level	HP	01, 05, 06, 07, 08, 09, 11, 12, 13, 14, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 34, 49, 50, 51^, 54, 57, 60, 61^*, 71, 72
		Neurologist, Psychiatrist	UA
96150	Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face- to-face with the patient; initial assessment	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96151	re-assessment	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96152	Health and behavior intervention, each 15 minutes, face-to-face; individual	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96153	group (2 or more patients)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96154	family (with the patient present)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB
96155	family (without the patient present)	Masters degree level	HO	01, 03, 04, 05, 06, 07, 08, 09, 11, 15, 20, 21^, 22, 23, 25, 26, 31, 32, 33, 49, 50, 51^, 54, 56, 57, 60, 61^*, 71, 72, 99
		Doctoral level	HP
		QTT	U6
		Psychiatrist	UA
		APNP with Psychiatric Specialty	UB

^*	The POS codes "21," "51," and "61" are not allowable for Master's-level providers (including QTTs). Payment is included in the hospital's DRG reimbursement.

^**	Assessment services are limited to eight hours every rolling 12 months per member before PA is required under DHS 107.13(2)(c)4, Wis. Admin. Code, for procedure codes 90791 and 90792.

^***	For procedure codes 90832-90839, 90845, 90847, 90849, and 90853, the 15- hour/$825 limit without PA is applied per billing provider in a calendar year. The 15-hour/$825 limit without PA does not accumulate when services are provided to a member in an inpatient hospital.

Inpatient hospital or residential care services: Wisconsin Medicaid, the BadgerCare Plus Standard Plan, and the BadgerCare Plus Benchmark Plan cover "partial hospital" services under a separate benefit — day treatment/day hospital services (DHS 107.13[4], Wis. Admin. Code).