Information For Dates of Service Before October 1, 2015

Procedure Codes

CPT codes and modifiers are required on all claims for outpatient mental health and substance abuse services in the home or community for adults. Claims or adjustments received without a CPT 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 CPT codes and modifiers that providers are required to use when submitting claims for outpatient mental health and substance abuse services in the home or community for adults. Not all providers may be reimbursed for all mental health and substance abuse services in the home or community for adults.

Outpatient Mental Health and Substance Abuse Services in the Home or Community for Adults Procedure Codes

CPT Code	Description	Enrolled Providers Who May Perform Service	Required Modifier	Allowable POS	Additional Information	Allowable Units
+90785^*	Interactive complexity (List separately in addition to the code for primary procedure)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 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, Wisconsin Medicaid 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.	1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90791	Psychiatric diagnostic evaluation	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90792	Psychiatric diagnostic evaluation with medical services	Psychiatrist	UA, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		APNP with Psychiatric Specialty	UB, UC
90832	Psychotherapy, 30 minutes with patient and/or family member	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
+90833^*	Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)	Psychiatrist	UA, UC	04, 12, 13, 14, 33, 34, 55, 56, 99	Billed with appropriate E&M procedure code.	1
		APNP with Psychiatric Specialty	UB, UC
90834	Psychotherapy, 45 minutes with patient and/or family member	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
+90836^*	Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)	Psychiatrist	UA, UC	04, 12, 13, 14, 33, 34, 55, 56, 99	Billed with appropriate E&M procedure code.	1
		APNP with Psychiatric Specialty	UB, UC
90837	Psychotherapy, 60 minutes with patient and/or family member	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
+90838^*	Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure)	Psychiatrist	UA, UC	04, 12, 13, 14, 33, 34, 55, 56, 99	Billed with appropriate E&M procedure code.	1
		APNP with Psychiatric Specialty	UB, UC
90839	Psychotherapy for crisis; first 60 minutes	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
+90840^*	Psychotherapy for crisis; each additional 30 minutes (List separately in addition to the code for primary service)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99	This is an add-on procedure code and can be used only in conjunction with procedure code 90839.	N/A
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90845	Psychoanalysis	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90846	Family psychotherapy (without the patient present)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90847	Family psychotherapy (conjoint psychotherapy) (with patient present)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90849	Multiple-family group psychotherapy	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90853	Group psychotherapy (other than of a multiple-family group)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
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, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
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, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90880	Hypnotherapy	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
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, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		N/A
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
90899	Unlisted psychiatric service or procedure	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		N/A
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
99199	Unlisted special service, procedure or report (Physician travel time)	Masters degree level	HO, UC, U3^**	99		12
		Doctoral level	HP, UC, U3^**
		QTT	U6, UC, U3^**
		Psychiatrist	UA, UC, U3^**
		APNP with Psychiatric Specialty	UB, UC, U3^**
+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 or 90837)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		1
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC
+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 services)	Masters degree level	HO, UC	04, 12, 13, 14, 33, 34, 55, 56, 99		4
		Doctoral level	HP, UC
		QTT	U6, UC
		Psychiatrist	UA, UC
		APNP with Psychiatric Specialty	UB, UC

^*	Add-on procedure code.

^**	Providers are required to indicate modifier U3 in addition to the appropriate professional level modifier and informational modifier when submitting claims for travel time using procedure code 99199.

^***	Only providers who are eligible to provide evaluation and management services can report this procedure code with evaluation and management services.

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

Substance Abuse Treatment Procedure Codes

HCPCS Code	Description	Enrolled Providers Who May Perform Service	Required Modifiers	ICD-9-CM Diagnoses Allowed^*	Telehealth Services Covered?	Allowable POS	Allowable Units
H0005	Alcohol and/or drug services; group counseling by a clinician	Bachelors degree level	HN, UC	303-305.92	No	04, 12, 13, 14, 33, 34, 55, 56, 99	1
		Masters degree level	HO, UC
		Doctoral level	HP, UC
		Psychiatrist	UA, UC
H0022	Alcohol and/or drug intervention service	Bachelors degree level	HN, UC	303-305.92	Yes	04, 12, 13, 14, 33, 34, 55, 56, 99	1
		Masters degree level	HO, UC
		Doctoral level	HP, UC
		Psychiatrist	UA, UC
T1006	Alcohol and/or substance abuse services, family/couple counseling	Bachelors degree level	HN, UC	303-305.92	Yes	04, 12, 13, 14, 33, 34, 55, 56, 99	1
		Masters degree level	HO, UC
		Doctoral level	HP, UC
		Psychiatrist	UA, UC

^*	The list of ICD-9-CM diagnosis codes for outpatient mental health and substance abuse services in the home or community is inclusive. However, not all Medicaid-covered outpatient mental health and substance abuse services in the home or community are appropriate or allowable.