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 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

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

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

96110

Developmental screening (eg developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

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

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

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

+ 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

96138

Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes

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

96139

Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes

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

11

Neurologist, Psychiatrist

96146

Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only

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

96150¹

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

96151¹

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

96152¹

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

Masters degree level

8

Doctoral level

QTT

Psychiatrist

APNP with Psychiatric Specialty

96153¹

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

96154¹

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

96155¹

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 evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) 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 or psychotherapy 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 evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) 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

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.