Medicaid Billing Codes For Behavioral Health

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What Are The Three Categories Of Cpt Codes

Behavioral Health Billing & Coding 101: How to Get Paid
  • Pathology and Laboratory: 80047 to 89398
  • Medicine: 90281 to 99199 and 99500 to 99607

Each of these sections contains subfields to correspond to a particular healthcare field and include guidelines to follow. For example, therapists commonly use psychotherapy CPT codes falling in the range of 90832 to 90853 under the Medicine’s psychiatry section. Psychiatrists, primary care physicians, and other authorized prescribers might use evaluation and management codes for providing general medical services.

CPT codes also have various modifiers. Modifiers have two numbers or letters, and you can add them to a CPT code. They describe specific critical parts of a procedure.

Some codes have instructions below them in parentheses to tell the coder there may be a better code to use. Codes must be as specific as possible for a mental health billing claim to get accepted.

Medicare Cpt Billing Codes For Mental Health

Heres a list of the most common CPT codes for mental health services, which youll use with every payer, both private and public.

  • 90832 Individual psychotherapy for 30 minutes
  • 90833 Individual psychotherapy for 30 performed with an E/M service
  • 90834 Individual psychotherapy for 45 minutes
  • 90836 Individual psychotherapy for 45 performed with an E/M service
  • 90837 Individual psychotherapy for 60 minutes
  • 90838 Individual psychotherapy for 60 performed with an E/M service
  • 90846 Family psychotherapy for 50 minutes without the patient present
  • 90847 Family psychotherapy for 50 minutes with the patient present
  • 90853 Group psychotherapy
  • 96127 Brief behavioral or emotional assessment
  • 96130 Evaluation services including reporting, treatment planning, clinical decision-making, interpreting test results, and providing feedback to patient, caregivers, or family members
  • 96131 Testing evaluation services, psychological and neuropsychological
  • 96136 Test administration and scoring, first 30 minutes
  • 96137 Test administration and scoring, additional 30 minutes
  • 99354 Prolonged services, first 60 minutes
  • 99355 Prolonged services, first 60 minutes with an E/M service
  • H0032 Mental health service plan

Psychotherapy Codes For Psychologists

All mental health professionals including psychologists, psychiatrists, nurses, and social workers delivering psychotherapy services use the same applicable CPT® codes when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid, and private health insurance carriers. This family of codes was last revised in 2013 in order to simplify the coding framework and allow all codes to be used in all settings, instead of describing site-specific services however, additional revisions were made to CPT code 90785 Interactive Complexity, in 2022 to ensure proper use and reporting of the service.

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New Cpt Codes For Behavioral Health Services

Every year, health professionals can expect revised or new mental health CPT codes. According to the American Psychological Association, as of Jan. 1, 2020, psychologists must use new therapy CPT codes to get reimbursed for health behavior assessment and intervention services from third-party payers. Providers use these services to address psychological, emotional, cognitive, or behavioral issues that impact the treatment of a physical health problem. Psychologists may provide these services to an individual, group, or a patient’s family to help the client cope with physical health conditions.

HBAI codes require a physical health diagnosis or an ICD code and are not for mental health services. Here are the code revisions.

For additional information about the 2021 E/M coding changes, check out our blog post here.

Billing For Multiple Treatments

Insurance Reimbursement Rates for Psychotherapy [2021]

The chart and the example above works for single treatments in a day, but what about when you provide multiple treatments within a single day? Lets look at a couple of different scenarios.

1. Multiple Short Treatments

When you provide more than one timed treatment and each is less than 8 minutes, you would bill one unit of time. Per the guidelines, whenever multiple timed treatments are offered within one day, with each taking less than 8 minutes, you should total up the time spent on all treatments, then bill one unit of time for the CPT code that you spent the most time on. So, if two treatments are provided that are under 8 minutes each, where one is 7 minutes and one is 5, the total exceeds 8 so one unit of time can be billed, and the time will be billed to the treatment that was 7 minutes of time.

2. Multiple Treatments of at Least 8 Minutes

In this situation, youre providing more than one service in a day and each of the services are over 8 minutes of time. Regardless of the treatment time, the CMS guidelines say you should total up the time spent on all treatments and bill based on the total time. So, if three treatments are provided that are 8 minutes, 10 minutes, and 14 minutes, the total time is 32 minutes which equates to two units of 15-minute time increments. In this example, the CPT code corresponding to the 14-minute treatment will be billed 2 units of time.

See how KASA can help make billing simpler so you can focus on helping your clients.

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Cpt Code Reimbursement Rates

Reimbursement rates depend on the insurance payer, location, and practitioner level. For instance, a psychiatrist will receive a higher reimbursement rate than a social worker.

The CPT code you choose also affects compensation. In general, the longer you spend with a patient delivering services, the more you’ll get paid. For example, according to the Mississippi Division of Medicaid’s 2020 fee schedule, psychotherapy rates were:

  • 90832: $60.07
  • 90834: $79.90
  • 90837: $119.68

If you’re concerned you’re not getting the highest reimbursement rate possible, let us know at ICANotes. We’ve designed our electronic health record software to help behavioral health specialists maximize reimbursement.

ICANotes keeps track of documentation elements in clinical notes and automatically calculates the highest-level E/M code supported by a note. ICANotes makes it easy to establish all the required details of accurate E/M documentation by providing pre-templated buttons and an easy-to-use interface. With ICANotes, clinicians can stay up to date on CPT changes and make sure they comply with the Health Insurance Portability and Accountability Act.

Early And Periodic Screening Diagnostic And Treatment

8.280.4.E Other EPSDT Benefits

Other health care services may include other EPSDT benefits if the need for such services is identified. The services are a benefit when they meet the following requirements:

  • All goods and services described in Section 1905 of the Social Security Act are a covered benefit under EPSDT when medically necessary as defined at 10 C.C.R. 2505-10, Section 8.076.1.8, regardless of whether such goods and services are covered under the Colorado Medicaid State Plan.
  • For the purposes of EPSDT, medical necessity includes a good or service that will, or is reasonably expected to, assist the client to achieve or maintain maximum functional capacity in performing one or more Activities of Daily Living and meets the criteria set forth at Section 8.076.1.8.b – g.
  • The service provides a safe environment or situation for the child.
  • The service is not for the convenience of the caregiver.
  • The service is medically necessary.
  • The service is not experimental or investigational and is generally accepted by the medical community for the purpose stated.
  • The service is the least costly.
  • The following services are covered:

  • Individual Psychotherapy – Therapeutic contact with one member of more than 30 minutes, but no more than two hours.
  • Individual Brief Psychotherapy – Therapeutic contact with one member of up to and including 30 minutes.
  • Assessment and monitoring
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    Typical Reimbursements By Type Of Therapist

    Type of Therapist
    ~$70-80

    These rates can vary significantly therapist to therapist but are good benchmarks for comparison.

    How about CPT Codes? How do they affect the rate of reimbursement? This is a difficult and complex calculation, depending on the level of education, location, and license. The AMA has created a code search feature on their website that shows payment based off CPT Code and location.

    This information is somewhat incomplete and is based off medicare payments and does not specify a number of other important factors. However, this tool is still very useful to compare the relative value CPT Codes against one another.

    Private insurance will be correlated with some deviation from these numbers.

    G8hi1 Proposed Descriptor And Potential Payment Amount

    Beginners Guide to Mental Health Billing for Mental Health Providers

    GBHI1, the proposed code, is described as:

    Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month, with the following required elements:

  • initial assessment or follow-up monitoring, including the use of applicable validated rating scales

  • behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes

  • facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by Medicare law to prescribe medications and furnish E/M services, counseling and/or psychiatric consultation and

  • continuity of care with a designated member of the care team.

  • CMS currently intends to value GBHI1 the same as for CPT code 99484 because the services closely mirror each other.

    The proposed 2023 non-facility national payment amount for both CPT code 99484 and HCPCS code GBHI1 is $41.35.

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    What Are The 2022 Cpt Codes For Behavioral Health Integration

    Medical reimbursements are tied to Current Procedural Terminology codes. They categorize and specify billing rates and rules for procedures, treatments, and care services.

    If youre a medical care provider, you likely know this. But do you know the rates and workflows for Medicares wellness programs? Like, Behavioral Health Integration ?

    Knowing the billing codes for BHI will give you a better idea of whats expected, both by the patient and Medicare.

    Understanding billing codes will also help you project revenues and optimize your staffs capacity. Without this information, you risk disorganization and a clouded outlook.

    At ThoroughCare, weve worked with more than 600 clinics and physician practices to help them streamline and capture Medicare reimbursements.

    Our software assists with BHIs rules and regulations, and it tracks all activities related to providing the program, such as screening assessments and care plan creation, making it easier to bill for.

    In this article, well briefly review the requirements of BHI, as well as the programs CPT codes. Well also provide an example return-on-investment of an effective monitoring program.

    With this information, youll better understand BHI billing expectations and standards. Youll also see how care coordination software can simplify the program.

    Behavioral Health Cpt Add

    A CPT Add-on Code is a code describing a service performed in in conjunction with a primary service. Many of these add-on codes are associated with a specific CPT Code or a small set of CPT Codes and cannot be used otherwise.

    For instance, the behavioral health CPT Code for interactive complexity can be used for a diagnostic or a normal psychotherapy session but not a crisis psychotherapy session .

    Add-on Codes are identified by a + sign in front of the number, i.e. +90840 is an add-on code for extra time in the case of crisis psychotherapy.

    On CMS 1500 forms CPT Add-on codes are simply added on a new line.

    Add-on codes are extremely important to use in order to most accurately describe the services being rendered and to ensure your services are maximized per session.

    We help the mental health providers that work with us in our billing service do all of this for every appointment.

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    Common Behavioral Health Case Management Cpt Codes

    Like licensed counselors, clinical social workers who provide psychotherapy services use CPT codes to get reimbursed. Here’s a CPT description list of frequently used codes, according to the National Association of Social Workers:

    • 90832: 30 minutes of psychotherapy
    • 90834: 45 minutes of psychotherapy
    • 90837: 60 minutes of psychotherapy
    • 90785: Interactive complexity add-on
    • 90846: 50 minutes of family psychotherapy without the patient present
    • 90847: 50 minutes of family psychotherapy with the patient present
    • 90853: Group psychotherapy

    Psychiatry Evaluation And Management Codes

    New Redesign Info from Medicaid â Behavioral Health Billing Solutions, LLC

    Psychiatrists may use E/M codes to bill for evaluation and management services either alone or with psychotherapy. For psychiatrists and other physicians, psychotherapy is an add-on code to the primary E/M service.

  • 99202 to 99205: Outpatient E/M services for a new patient
  • 99211 to 99215: Outpatient E/M services for an established patient
  • 99241 to 99245: Consultations for a new or established patient in an outpatient setting
  • 99221 to 99223: Initial hospital E/M services for a new or established patient
  • 99231 to 99233: Hospital E/M services for a new or established patient after initial visit
  • 99251 to 99255: Inpatient consultations
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    Use Icanotes For Fast And Accurate Billing

    Proper coding requires knowledge and practice. Most behavioral health clinicians want to spend their time and energy providing patient care not worrying about coding and claims. ICANotes can step in and take care of the work for you, so you can get back to doing what you love.

    With ICANotes, you can expect automatic coding at the highest reimbursement level possible to ensure claims get accepted and you get paid. Without the need to fix errors or resubmit claims, youll save time, money, and energy. To experience the benefits of ICANotes firsthand, today!

    How To Use The Correct Cpt Code In Psychiatry

    The CPT code set is a complex system. It is not always easy to determine if you’ve met the required elements to code appropriately for the maximum reimbursement amount. It may help to break the process down into steps for new and established patients.

    First, you might bill two types of psychiatric service or procedure CPT codes for new patient office visits. These are:

    • E/M codes
    • Psychiatric diagnostic evaluation codes

    Depending on the situation and time involved, it may be appropriate to bill for both codes. Here are a few guidelines to follow.

    • E/M: Use E/M codes when evaluating a new medical issue. With the AMA’s 2021 coding changes, you can select an E/M code based on the complexity of medical decision-making or the total time you spent on the patient’s care on the day of the encounter. If you provide E/M services with a psychotherapy add-on code, you must choose a code based on medical decision-making and not total time.
    • Psychiatric diagnostic evaluation: Use psychiatric diagnostic evaluation codes for a diagnostic assessment. You may need to use these codes more than once if it takes more time to complete the initial evaluation.

    Regarding established patients, the rules allow you to bill an E/M service with every psychotherapy visit, but they don’t require you to do so with every encounter. Only bill E/M services if you addressed and documented a separate medical issue during the visit.

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    A Guide To Medicare Mental Health Billing Codes

    Navigating the requirements of Medicare can be a challenge. But heres some good news CPT codes are the same for all payers, whether they are a private insurer or a government program, like Medicare. Once you know the appropriate codes to use for each of the services you provide to clients, that piece of the puzzle is solved.

    The rules around timed and untimed codes, however, are more complex. Medicare has strict specifications for calculating how to bill for time increments, and youll want to be sure you follow their guidelines. Heres what you need to know about CPT billing codes for mental health and Medicares 8-Minute Rule.

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    Billing Medicaid Managed Care for Other Limited Related Health Services-Webinar #3

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    New Behavioral Health Integration Opportunity: G

    CMS notes several times throughout the 2023 Proposed Rule that the COVID-19 public health emergency has increased the demand for behavioral health services and created new barriers to accessing these services.

    In response to stakeholder feedback, clinical data, scientific evidence, and the increased need for mental health services, CMS is creating a new G-code for 2023 to allow CPs and CSWs to furnish and bill for BHI when they are the patients primary treating clinician for covered behavioral health services.

    The Most Common Psychotherapy Cpt Codes

    While family therapists and counselors may not use E/M codes like psychiatrists or primary care physicians, they will bill for psychotherapy services. The American Psychological Association lists standard CPT codes used by therapists.

    • 90832: 30 minutes of individual psychotherapy
    • 90834: 45 minutes of individual psychotherapy
    • 90837: 60 minutes of individual psychotherapy
    • 90845: Psychoanalysis
    • 90846: 50 minutes of family psychotherapy without the client present
    • 90847: 50 minutes of family psychotherapy with the client present
    • 90849: Multiple-family group psychotherapy
    • 90853: Group psychotherapy

    Though CPT codes describe specific times, such as 30, 45, and 60 minutes, therapists have some flexibility, since sessions might go over or under that exact amount.

    When choosing a psychotherapy CPT code, therapists must select the closest one to the time spent in the session. The APA lists the following psychotherapy session durations.

    • 90832: Choose this code for sessions that run between 16 and 37 minutes.
    • 90834: Select this code for sessions that are 38 to 52 minutes long.
    • 90837: This code is appropriate for sessions lasting 53 minutes or longer.
    • 90846 or 90847: Choose these codes for 26 minutes or more of family psychotherapy.

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