Description

Enrolled Providers Who May Perform Service

Allowable POS

+ 90785

Interactive complexity

(List separately in addition to the code for primary procedure)

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90791

Psychiatric diagnostic evaluation

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90792

Psychiatric diagnostic evaluation with medical services

Psychiatrist

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

90832

Psychotherapy, 30 minutes with patient

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 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

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

90834

Psychotherapy, 45 minutes with patient

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 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

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

90837

Psychotherapy, 60 minutes with patient

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 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

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

90839

Psychotherapy for crisis; first 60 minutes

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 90840

Psychotherapy for crisis; each additional 30 minutes

(List separately in addition to the code for primary service)

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90845

Psychoanalysis

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90846

Family psychotherapy (without the patient present), 50 minutes

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90847

Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90849

Multiple-family group psychotherapy

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90853

Group psychotherapy (other than of a multiple-family group)

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90865

Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital [Amytal] interview)

Doctoral level

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

90870

Electroconvulsive therapy (includes necessary monitoring)

Psychiatrist

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

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

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

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90880

Hypnotherapy

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

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

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

90899

Unlisted psychiatric service or procedure

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

96101¹

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting test results and preparing the report

Doctoral level

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

96102¹

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

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

96103¹

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

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

96105¹

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

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

96110¹

Developmental screening, with interpretation and report, per standardized instrument form

Doctoral level

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

96111¹

Developmental Testing (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report

Doctoral level

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, Pediatrician, Psychiatrist

96116¹

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

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, Pediatrician, Psychiatrist

96118¹

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

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

96119¹

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

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

96120¹

Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report

Doctoral level

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

96150²

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

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

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96151²

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; Re-assessment

Masters degree level

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

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96152²

Health and behavior intervention, each 15 minutes, face-to-face; individual

Masters degree level

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96153²

Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)

Masters degree level

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

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96154²

Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present)

Masters degree level

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

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96155²

Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present)

Masters degree level

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

6

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 99354

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour

(List separately in addition to code for office or other outpatient Evaluation and Management service)

Masters degree level

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

+ 99355

Prolonged service in the office or other 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

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

QTT

Psychiatrist

APNP with Psychiatric Specialty

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

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

NA

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

+

Add on procedure code.

¹

PA is not required for central nervous system assessments and tests (codes 96101–96120). Up to six units per DOS of any combination of these services may be covered. Central nervous system testing may be part of the mental health evaluation, but it does not require PA and must be billed under the appropriate codes.

²

A maximum of eight units of assessment and/or intervention services, per member, per DOS, may be reimbursed for procedure codes 96150–96154 and a maximum of six units of assessment and/or intervention services, per member, per DOS may be reimbursed for procedure code 96155.

^*

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 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.