Coding Guidelines
The guidelines of the Correct Coding Initiative (CCI) supersede all coding instructions in this Billing and Coding Article. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 may be used only by
a Clinical Psychologist (CP)
, (Specialty Code 68).
What is the modifier for mental health?
Modifier 59
is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.” Submitting claims for mental health services appropriately, using Modifier 59, will help ensure timely and accurate payment of claims.
Is 90834 covered by Medicare?
Individual psychotherapy for 45 minutes in an outpatient setting. The Centers for Medicare Services (CMS) defines 90834 as insight oriented, behavior modifying, supportive, and/or interactive psychotherapy.
Services not to be included in coding insurance claims with 90834 are: Teaching grooming skills
.
How often can 99484 be billed?
BHI CPT code:99484 is special because it does not require a psychiatric consult. This code can be billed
once a patient reaches 20 minutes of care from the clinical staff
, typically directed by a provider or other qualified healthcare professional (QHP).
What is CPT code G2064?
G2064 is a valid 2022 HCPCS code for
Comprehensive care management services for a single high-risk disease
, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 …
What is the revenue code for 96156?
Code 96156 has been added to report
behavior assessment
, or re-assessment specific for health-focused clinical interview, behavioral observations, and clinical decision making.
Does 96130 need a modifier?
What modifier should I use when billing CPT 96130?
When 96130 is billed with an E&M code, the E&M code should be billed first with a modifier 25
. 96130 should be billed last with a modifier 59.
Who can Bill 96132?
Who can bill for CPT code 96132?
A variety of qualified healthcare providers
can bill for CPT 96132 after administering neuropsychological assessments. There is a high-level requirement for a clinical psychologist or a physician, such as a psychiatrist or neurologist, to supervise diagnostic tests.
What is a 95 modifier?
Per the AMA, modifier 95 means: “
synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
.” Modifier 95 is only for codes that are listed in Appendix P of the CPT manual. There is considerable overlap between situations for using GT and 95.
What is GT modifier used for?
The GT modifier is used
to indicate a service was rendered via synchronous telecommunication
. In 2018, CMS replaced the GT modifier with POS 02.
What does ha modifier mean?
HA –
Child/adolescent program
.
How do you bill for group psychotherapy?
However, the group therapy session must be clearly distinct or independent from other services and billed
using a -59 modifier
. The group therapy CPT code (97150) and the direct one-on-one 15-minute CPT Codes for therapeutic procedures (97110 – 97542) are subject to Medicare’s National Correct Coding Initiative (NCCI).
What is CPT code?
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals
a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency
.
What is the CPT code for psychotherapy?
90834
– Psychotherapy 45 minutes. 90837 – Psychotherapy 60 minutes. Some health insurance companies may consider 90834 as the standard psychotherapy session.
Who can Bill 99453?
CPT Code 99453
Healthcare providers
may get reimbursement for the onboarding and education of patients; it includes the time spent with the patient or the primary caregiver in giving instructions about the medical device(s).
What does CPT code 90791 mean?
Code 90791 represents “
integrated biopsychosocial assessment, including history, mental status, and recommendations
.” It originated in 2013, when many of the mental health CPT codes were reworked, replacing code 90801.
IS 99211 being deleted in 2021?
CPT code 99211 (established patient, level 1)
will remain as a reportable service
. History and examination will be removed as key components for selecting the level of E&M service. Currently, history and exam are two of the three components used to select the appropriate E&M service.
Can you bill G2064 and G2065 in the same month?
PCM services G2064 and G2065
should not be billed together in the same month
. PCM services cannot be billed for at the same time as CCM services or interprofessional consultations. Patients may receive PCM services from more than one clinician as long as the care provided is for different conditions per clinician.
What is CPT code G2065?
G2065 is a valid 2022 HCPCS code for
Comprehensive care management for a single high-risk disease services
, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic …
What is PCM billing?
New principal care management (PCM) codes
allow practices to bill for care management for services provided to patients with one serious chronic condition by a specialist or primary care physician
. PCM limits billing by the same practitioner for the same patient simultaneously with other care management services.
Who can bill CPT 96146?
CPT Code 96146 is used
when tests are administered by a computer
and is defined as “Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only”.
What does CPT code 96150 mean?
CPT Codes. 96150.
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.
What is the CPT code 96158?
CPT
®
96158, Under
Health Behavior Assessment and Intervention Procedures
. The Current Procedural Terminology (CPT
®
) code 96158 as maintained by American Medical Association, is a medical procedural code under the range – Health Behavior Assessment and Intervention Procedures.
Does Medicare pay for 96160?
Medicare plans to pay an average of $4.67
for codes 96160 and 96161.
What does CPT code 96138 mean?
CPT
®
96138, Under
Psychological and Neuropsychological Test Administration and Scoring
. The Current Procedural Terminology (CPT
®
) code 96138 as maintained by American Medical Association, is a medical procedural code under the range – Psychological and Neuropsychological Test Administration and Scoring.
What is the difference between 96130 and 96132?
Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour.
Neuropsychological evaluation services should now be billed using CPT code 96132 for the first hour and 96133 for each additional hour.
