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Psychiatry Cpt Insurance Reimbursement - DOC

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					                                         CPT Codes Cheat Sheet

Psychiatry Codes: 90801-90899
    Used to treat patients with a primary mental disorder
    “According to Medicare, the „psychiatry‟ CPT procedure codes 90801-90899 may be
   used by mental health specialists; physicians, physician extenders (such as nurse
   practitioners, clinical nurse specialists, or physician assistants), and non-physicians, such as
   clinical social workers (CSW) licensed by the State; and clinical psychologists, licensed by
   and subject to State criteria, operating within the scope of their practice as defined by the
   State” (Smith, 2007; Psychiatry Codes Section, ¶ 1).
    Some of the most commonly used CPT codes in this category are (Grohol, 2007):
        o 90801: Psychological Diagnostic Interview Examination
        o 90802: Interactive Diagnostic Interview
            (with language interpreter or other mechanisms)
        o 90816: Individual medical psychotherapy inpatient (20-30 minutes)
        o 90804: Individual medical psychotherapy outpatient (20-30 minutes)
        o 90818: Individual medical psychotherapy inpatient (45-50 minutes)
        o 90808: Individual medical psychotherapy outpatient (45-50 minutes)
        o 90847: Family psychotherapy with patient present
        o 90846: Family psychotherapy without patient present
        o 90847: Group psychotherapy

Health Behavioral Assessment and Intervention (HBAI) Codes: 96150-96155
    These codes are used by non-physicians such as psychologists or other mental health
       professionals
    HBAI codes are different from the psychiatry codes because the focus is on a
       primary medical diagnosis and the mental health symptoms are a result of the medical
       problem
    “The codes capture services addressing a wide range of physical health issues, such as
       patient adherence to medical treatment, symptom management, health-promoting
       behaviors, health-related risk-taking behaviors, and overall adjustment to physical
       illness” (“Health and Behavior,” 2004, Third section, ¶ 2).
    “[HBAI codes] apply to behavioral, social, and psychophysiological procedures for the
       prevention, treatment, or management of physical health problems” (“Health and
       Behavior,” 2004, ¶ 1).
    These codes cannot be used to bill for services provided for a patient‟s mental health
       diagnosis nor can they be billed on the same day as a psychiatric CPT code (Smith,
       2007).
    The mental health professional must determine the predominate service he/she provided
       to the patient to accurately bill a psychiatric or HBAI code
    Reimbursement from Medicare for these codes comes out of medical services funding
       rather than psychiatric services funding; some private insurance companies may not have
       yet determined their reimbursement rates for these codes (“Health and Behavior,” 2004).




                                                                                       Zeiderman, 1
      Some of the most commonly used CPT codes in this category are (“Health and
       Behavior,” 2004):
        o 96150: The initial assessment of the patient
        o 96151: A reassessment of the patient to evaluate the patient‟s condition and
           determine the need for further treatment
        o 96152: The intervention service provided to an individual
        o 96153: The intervention service provided to a group
        o 96154: The intervention service provided to a family with the patient present
        o 96155: The intervention service provided to a family without the patient present

Link to a more in-depth description of each HBAI code and FAQ‟s can be found at:
http://www.apapracticecentral.org

Evaluation and Management Codes (EM):
    Used with a primary physical or mental illness diagnosis
    Most successfully used by physicians (MD‟s), Physician Assistants (PA‟s) or other
       physician extender
    Medicare does not typically accept EM codes used by psychologists (Smith, 2007)

Testing CPT Codes (Psychological & Neuropsychological): (“Summary of changes,” 2006)
    In 2006, a revised list of testing CPT codes was instituted and now reflects who actually
       completed the testing; a psychologist, a technician, or a computer
    Common testing codes:
          o 96101: Psychological testing, interpretation, and reporting per hour by a
             psychologist
          o 96102: Psychological testing per hour by a technician with interpretation and
             reporting by a psychologist
          o 96103: Psychological testing by a computer with interpretation and reporting by a
             psychologist
    Common neuropsychological testing codes:
           96118: Neuropsychological testing, interpretation and reporting per hour by a
             psychologist
           96119: Neuropsychological testing per hour by a technician with interpretation
             and reporting by a psychologist
           96120: Neuropsychological testing by a computer with interpretation and
             reporting by a psychologist
           96116: Neurobehavioral status exam

Drug and Alcohol Codes:
    Many codes with extreme specificity; Medicare/Medicaid and private insurance each
       reimburse differently
    Unofficial definition guide created by The National Association of State Alcohol and Drug
       Abuse Directors (NASADAD) with the support of the Substance Abuse and Mental Health
       Services Administration (SAMHSA)
    This guide can be found at:
       http://www.hipaa.samhsa.gov/pdf/2007_SA_HCPCS_CodeDefinitons.pdf

                                                                                   Zeiderman, 2
References:

American Psychological Association Practice Organization. (February 2004). Health and
      behavior CPT codes. Retrieved August 16, 2010, from
      http://www.apapracticecentral.org/reimbursement/billing/secure/new-codes.aspx

American Psychological Association Practice Organization. (January 2006). Summary of
      changes to the testing codes for 2006. Retrieved August 16, 2010 from
      http://www.apapracticecentral.org/reimbursement/billing/cpt/secure/2006-toolkit-
      changes.pdf

Grohol, J. M.(August 2007). CPT codes for psychology services. Retrieved August 16, 2010,
       from http://psychcentral.com/lib/2007/cpt-codes-for-psychology-services/

Smith, Shelagh. (December 2007). Examples of states’ billing codes for mental health services,
       publically funded. Retrieved August 16, 2010, from the Substance Abuse and Mental
       Health Service Administration (SAMHSA):
       www.hipaa.samhsa.gov/pdf/Ex_States_Billing_Codes_public_MH-Services.pdf




                                                                                  Zeiderman, 3

				
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