CSHCN Services Prgram Benefits t Change fr Outpatient Behaviral Health Services Infrmatin psted Nvember 10, 2009 Effective fr dates f service n r after January 1, 2010, benefit criteria fr utpatient behaviral health services will change fr the Children with Special Health Care Needs (CSHCN) Services Prgram. The CSHCN Services Prgram des nt prvide utpatient behaviral health services fr clients wh are als enrlled in Texas Medicaid, Texas Health Steps-Cmprehensive Care Prgram (THSteps-CCP), r Children's Health Insurance Prgram (CHIP). Outpatient behaviral health services are limited t n mre than 30 encunters by all practitiners per client per calendar year. Benefits include, but are nt limited t, psychlgical and neurpsychlgical testing, psychtherapy, psychanalysis, cunseling, and narcsynthesis. Labratry and radilgy services d nt cunt tward the 30 utpatient encunters per client per calendar year limitatin. Pharmaclgical regimen versight (prcedure cde M0064) and pharmaclgical management (prcedure cde 90862) als d nt cunt tward the 30-encunter per client, per calendar year annual limitatin. Pharmaclgical regimen versight refers t a brief, face-t-face ffice encunter fr the sle purpse f evaluating, mnitring, r changing drug prescriptins r making simple drug dsage adjustments. Pharmaclgical regimen versight is a lesser level f drug mnitring than pharmaclgical management. Pharmaclgical management refers t the in-depth management f psychpharmaclgical agents, which are medicatins with ptentially significant side effects. Pharmaclgical management represents a skilled aspect f client care and is intended fr use by clients wh are being managed primarily by psychtrpics, antidepressants, r ther types f psychpharmaclgic medicatins as well as by electrcnvulsive therapy (ECT). Prcedure cde 90862 cannt be billed when nly a brief ffice encunter t evaluate the client's state is prvided. The fcus f a pharmaclgical management encunter is the use f medicatin fr relief f a client's signs and symptms f mental illness. When the client cntinues t experience signs and symptms f mental illness, which necessitates a discussin beynd minimal psychtherapy/cunseling in a given day, the fcus f the service is brader and is cnsidered utpatient psychtherapy/cunseling rather than pharmaclgical management. Pharmaclgical management must be prvided during a face-t-face encunter with the client. A pharmaclgical management encunter may nt include mre than 20 minutes f utpatient psychtherapy/cunseling. Pharmaclgical management visits are billed as regular physician visits, nt as behaviral health visits. Pharmaclgical management visits shuld be cnducted n the basis f medical necessity. Authrizatin Requirements Authrizatin is nt required fr utpatient behaviral health services. The CSHCN Services Prgram may reimburse a maximum f 30 utpatient behaviral health services encunters by any practitiner per client, per calendar year.
Dcumentatin Requirements Services that are nt supprted by dcumentatin in the client's medical recrd are subject t recupment. All entries in the client s medical recrd must be clear and cncise, legible t individuals ther than the authr, dated (mnth/date/year), and signed by the perfrming prvider. Dcumentatin must include all f the fllwing: Beginning and ending times fr each cunseling sessin r test administered Diagnsis Supprt fr the medical necessity fr the chsen treatment All pertinent infrmatin abut the client's cnditin that substantiates the need fr services, including, but nt limited t, the fllwing: Reasn fr referral and/r presenting prblem Prir histry, including prir treatment Other pertinent medical, scial, and family histry Clinical bservatins and mental status examinatins The name f the test(s) (e.g., WAIS-R, Rrschach, MMPI) administered The scring f the test Narrative descriptins f the test findings An explanatin t substantiate the necessity f retesting, if testing is repeated Backgrund, symptms, impressin Narrative descriptin f the assessment Behaviral bservatins during the sessin Narrative descriptin f the cunseling sessin Treatment plan and recmmendatins, including expected lng-term and shrtterm benefits Fr the interactive psychiatric diagnstic interview (prcedure cde 90802), the medical recrd must indicate the adaptatins used in the sessin and the ratinale fr emplying these interactive techniques. The riginal testing material must be maintained by the prvider and readily available fr retrspective review by the Department f State Health Services (DSHS) r its designee. Pharmaclgical Management Services Dcumentatin Dcumentatin fr pharmaclgical management services must include the fllwing: Cmplete diagnsis Medicatin histry Current symptms and prblems (including the presenting mental status and/r physical symptms) that indicate the client requires a medicatin adjustment Prblems, reactins, and side effects (if any) t medicatins and/r ECT
Descriptin f ptinal minimal psychtherapeutic interventin (less than 20 minutes), if any Reasns fr medicatin adjustments/changes r cntinuatin Desired therapeutic drug levels, if applicable Current labratry values, if applicable Anticipated physical and behaviral utcmes Pharmaclgical Regimen Oversight Dcumentatin Dcumentatin fr pharmaclgical regimen versight (prcedure cde M0064) must address all f the fllwing infrmatin in the client's medical recrd: The client cnditin can be described as ne f the fllwing: The client has been evaluated and determined t be stable but cntinues t have a psychiatric diagnsis that needs clse mnitring f therapeutic drug levels. The client requires evaluatin fr prescriptin renewal, a new psychiatric medicatin, r a minr medicatin dsage adjustment. The prvider has dcumented the medicatin histry with current signs and symptms, and new medicatin mdificatins with anticipated utcmes. Reimbursement The 12-Hur System Limitatin The fllwing prvider types are limited in the CSHCN Services Prgram claims prcessing system t a maximum reimbursement f a cmbined ttal f 12 hurs per prvider per day fr inpatient and utpatient behaviral health services: Psychlgist Clinical nurse specialist (CNS) Nurse practitiner (NP) Licensed clinical scial wrker (LCSW) Licensed marriage and family therapist (LMFT) Licensed prfessinal cunselr (LPC) Dctrs f medicine (MDs) and dctrs f stepathy (DOs) are nt subject t the12-hur system limitatin because they can delegate services and as a result may submit claims in excess f 12 hurs per day. All prviders, including MDs, DOs, and each prvider t whm they delegate, are subject t retrspective review and recupment. Prcedure Cdes Included in the 12-Hur System Limitatin The fllwing table lists the utpatient behaviral health prcedure cdes included in the system limitatin. The table als includes the time increments the system applies based n the billed prcedure cde. The system uses the time applied time increments t determine whether the 12-hur-per-day system limitatin has been exceeded.
Prcedure Cde Time Assigned by Prcedure Cde Descriptin Time Applied 90801 N/A 60 minutes 90802 N/A 60 minutes 90804 20-30 minutes 30 minutes 90805 20-30 minutes 30 minutes 90806 45-50 minutes 50 minutes 90807 45-50 minutes 50 minutes 90808 70-80 minutes 80 minutes 90809 70-80 minutes 80 minutes 90810 20-30 minutes 30 minutes 90811 20-30 minutes 30 minutes 90812 45-50 minutes 50 minutes 90813 45-50 minutes 50 minutes 90814 70-80 minutes 80 minutes 90815 70-80 minutes 80 minutes 90847 N/A 50 minutes 96101 60 minutes 60 minutes 96118 60 minutes 60 minutes N/A = Nt Applicable LCSWs r LPCs may use nly the fllwing prcedure cdes when filing claims: 90804, 90806, 90808, 90847, and 90853. LMFTs may use nly the fllwing prcedure cdes and mdifier U8 when filing claims: 90804, 90806, 90808, 90847, and 90853. Nte: Prcedure cde 90853 is nt included in the 12-hur system limitatin. Psychlgical and Neurpsychlgical Testing Psychlgical (prcedure cde 96101) r neurpsychlgical (prcedure cde 96118) testing is limited t a ttal f 4 hurs per day and 8 hurs per calendar year, per client, fr any prvider. Claims submitted fr an amunt greater than 4 hurs per day and 8 hurs per calendar year must be submitted with dcumentatin f medical necessity. Interpretatin and dcumentatin time, including time t dcument test results in the client's medical recrd, is nt reimbursed separately and is included in the prcedure cdes fr psychlgical and neurpsychlgical testing. Prviders must bill the units f each half hur f testing and indicate that number f units n the claim frm.
Behaviral health testing may be perfrmed during an assessment by a CNS r NP but will nt be reimbursed separately. The mst apprpriate ffice encunter cde must be billed. Psychlgical r neurpsychlgical testing may be reimbursed n the same date f service as an initial psychiatric diagnstic interview (prcedure cde 90801) r interactive psychiatric diagnstic interview examinatin (prcedure cde 90802). Psychlgical testing (prcedure cde 96101) dne n the same date f service as neurpsychlgical testing (prcedure cde 96118) will be denied as part f anther service. Psychtherapy and Cunseling Reimbursement fr utpatient psychtherapy r cunseling is limited t n mre than 4 hurs per client per day. When mre than ne type f sessin (individual, grup, r family utpatient psychtherapy/cunseling) is prvided by any prvider n the same date f service, each sessin type will be reimbursed individually. Psychiatrists may bill fr services perfrmed by individuals under their supervisin; hwever, psychlgist, LMFT, LCSW, and LPC prviders may bill nly fr behaviral health services they actually perfrm. Interpretatin and dcumentatin time is nt reimbursed separately and is included in the prcedure cdes fr psychtherapy/cunseling. Psychtherapy and cunseling are billed in 15-minute units. Prviders must indicate the number f 15-minute units n the claim frm. Evaluatin and management (E/M) services will be denied if they are billed n the same date f service by the same prvider as a diagnstic interview examinatin (prcedure cde 90801 r 90802). E/M services will be denied as part f psychtherapy services when perfrmed n the same date f service by the same prvider. Prfessinal services are reimbursed at the lwer f the billed amunt r the amunt allwed by Texas Medicaid. Hspitals are reimbursed at 80 percent the rate allwed by the Tax Equity and Fiscal Respnsibility Act f 1982 (TEFRA), which is equivalent t the hspital s Medicaid interim rate. Pharmaclgical Regimen Oversight and Pharmaclgical Management Prcedure cdes 90862 and M0064 describe a physician service and cannt be either delegated t a nn-physician r incident t a physician s service. CNSs and NPs whse scpe f license permits them t prescribe may als use these cdes. The service must nly be billed by the physician, CNS, r NP actually perfrms the service.
If prcedure cdes 90862 and M0064 are billed fr the same date f service by any prvider, prcedure cde M0064 will be denied as part f prcedure cde 90862. E/M services include pharmaclgical management. Prcedure cdes M0064 and 90862 will be denied as part f any E/M service billed fr the same date f service by the same prvider. If the primary reasn fr the ffice visit is psychtherapy, the specific psychtherapy prcedure cde shuld be billed. Prcedure cdes M0064 and 90862 will be denied as part f any psychtherapy service billed n the same date f service by the same prvider. Prcedure cdes 90862 and M0064 are limited t ne service per day, per client by any prvider in any setting. Prcedure cde M0064 is limited t the ffice setting. Natinal Crrect Cding Initiative (NCCI) Limitatins The Healthcare Cmmn Prcedure Cding System (HCPCS)/Current Prcedural Terminlgy (CPT) cde(s) included in this article are subject t NCCI relatinships as indicated in the table belw. Any exceptins t NCCI cde relatinships are specifically nted. Prviders may refer t NCCI fr crrect cding guidelines and specific applicable cde cmbinatins. In the fllwing table, the prcedure cdes in clumn A will be denied when they are billed with the same date f service by the same prvider as the crrespnding prcedure cdes in clumn B: Clumn A (Denied When) M0064, 90802, 90862, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, r 99357 Clumn B (Billed n Same Day as) 90801
Clumn A (Denied When) M0064, 90801, 90862, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, r 97803 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90821, 90822, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, r 99357 90805, 90813, 90814, 90816, 90817, 90818, 90819, 90821, 90822, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, r 97803 Clumn B (Billed n Same Day as) 90802 90804 90805 90806
Clumn A (Denied When) 90805, 90806, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90826, 90827, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 90805, 90806, 90807, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90828, 90829, 90862, 90865, 97802, r 97803 90805, 90806, 90807, 90808, 90815, 90821, 90822, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90805, 90806, 90807, 90808, 90809, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802 r 97803 Clumn B (Billed n Same Day as) 90807 90808 90809 90810
Clumn A (Denied When) M0064, 36640, 90801, 90802, 90806, 90807, 90808, 90809, 90810, 90814, 90815, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90806, 90807, 90808, 90809, 90811, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862, 90865, 97802, r 97803 M0064, 36640, 90801, 90802, 90808, 90809, 90811, 90812, 90814, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90809, 90812, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862, 90865, 97802, r 97803 Clumn B (Billed n Same Day as) 90811 90812 90813 90814
Clumn A (Denied When) M0064, 36640, 90801, 90802, 90806, 90812, 90813, 90814, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90809, 90811, 90812, 90813, 90814, 90815, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, r 97803 M0064, 36640, 90801, 90802, 90809, 90812, 90813, 90814, 90815, 90816, 90824, 90826, 90827, 90828, 90829, 90845, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90809, 90813, 90814, 90815, 90816, 90817, 90826, 90827, 90828, 90829, 90862, 90865, 97802, r 97803 Clumn B (Billed n Same Day as) 90815 90816 90817 90818
Clumn A (Denied When) 90805, 90809, 90814, 90815, 90816, 90817, 90818, 90827, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90815, 90816, 90817, 90818, 90819, 90828, 90829, 90862, 90865, 97802, r 97803 M0064, 36640, 90801, 90802, 90816, 90817, 90818, 90819, 90821, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90805, 90806, 90807, 90808, 90809, 90817, 90818, 90819, 90821, 90822, 90827, 90828, 90829, 90845, 90862, 90865, 97802, r 97803 Clumn B (Billed n Same Day as) 90819 90821 90822 90823
Clumn A (Denied When) M0064, 36640, 90801, 90802, 90807, 90808, 90809, 90818, 90819, 90821, 90822, 90823, 90828, 90829, 90845, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99456, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90808, 90809, 90819, 90821, 90822, 90823, 90824, 90829, 90862, 90865, 97802, r 97803 M0064, 36640, 90801, 90802, 90808, 90809, 90821, 90822, 90824, 90826, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90822, 90826, 90862, 90865, 97802, r 97803 Clumn B (Billed n Same Day as) 90824 90826 90827 90828
Clumn A (Denied When) M0064, 36640, 90801, 90802, 90828, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, 99357, 99465, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, r 99480 M0064, 36640, 90801, 90802, 90807, 90808, 90809, 90812, 90813, 90814, 90815, 90818, 90819, 90821, 90822, 90826, 90827, 90828, 90829, 90847, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99291, 99292, 99341, 99342, 99343, 99344, 99345, 99347, 99340, 99354, 99355, 99356, r 99357 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, r 99357 Clumn B (Billed n Same Day as) 90829 90845 90847
Clumn A (Denied When) 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90847, 90849, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99291, 99292, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, r 99357 M0064, 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90847, 90849, 90853, 90862, 90865, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99291, 99292, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, r 99357 Clumn B (Billed n Same Day as) 90853 90857 97802 r 97803 90862
Clumn A (Denied When) M0064, 90801, 90802, 90862, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99291, 99292, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99354, 99355, 99356, and 99357 Clumn B (Billed n Same Day as) 90865 M0064, 90801, 90802, r 90862 90804, 90810, 90816, 90823, 90845, r 90865 Additinal benefit changes include: Prcedure cdes 90804 and 90808 may be reimbursed in the ffice, hme, utpatient hspital, and ther lcatins t the fllwing prvider types: LPC, LCSW, and CCP scial wrker. Prcedure cde 96118 may be reimbursed in the ffice setting t physicians, physician grups, psychlgists, and psychlgist grups. Prcedure cde 96101 may be reimbursed in the ffice setting t psychlgist grups. Prcedure cde 96101 may be reimbursed in the utpatient hspital setting t hspitals. Prcedure cde 96118 may n lnger be reimbursed in the hme, inpatient hspital, and utpatient hspital setting t a CNS r NP. Prcedure cde 96101 may n lnger be reimbursed in the ffice, hme, inpatient hspital, r utpatient hspital setting t a CNS r NP. Prcedure cde 96118 may n lnger be reimbursed in the hme and inpatient hspital setting t hspitals.