Changed/Added Procedure Codes

 

 

The Centers for Medicare and Medicaid Services (CMS) revises the nomenclature within the HCPCS/CPT each quarter.  When a HCPCS/CPT code is deleted, the SC Medicaid program will discontinue coverage of the deleted code and new procedure codes for behavioral health services may be added.  The SC Medicaid program will not accept billing of discontinued codes for dates of service on the date on which the code is discontinued.  

Effective with dates of services on or after January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS), in accordance with the Current Procedural Terminology (CPT), codes with new descriptions and units of measure have changed.

Code 90801 has been deleted and replaced by 2 different codes representing different assessment functions.  Procedure Code 90791 is used for diagnostic evaluation of a client without the medical component. Procedure Code 90792 is used for diagnostic evaluation with the medical component. The following codes apply to RBHS providers only.

2012 Codes

Description

Unit

Frequency

Modifiers

2013  Codes

Description

Unit

Frequency

Modifiers

Rates

90801

This code splits into 2 separate codes on Jan. 1, 2013

Psychiatric Diagnostic Assessment with Medical Evaluation

1 Encounter

 -

 per every 6 months

AF

HP

AM

SA

90791

Psychiatric Diagnostic Assessment without Medical Evaluation

1 Encounter    -

per every 6 months

AH-Clinical Psych.

HO-Master’s level

$81.80    $81.80

90792

Psychiatric Diagnostic Assessment with Medical Evaluation

1 Encounter

-

per every 6 months

AF-Physician

AM-Phys. Assist

SA-Nurse Pract.

$445.60 $221.82             $201.74             

 

Effective January 1, 2013, the 90804 unit code has been deleted and replaced by 3 separate encounter codes depending on the time spent face to face with the beneficiary in the session.   One encounter is equal to 1 unit per date of service.

Procedure Codes 90832, 90834 and 90837 are to be used for individual psychotherapy by physicians or other qualified professionals as defined in the RBHS Policy Manual or Licensed Independent Practitioner’s Rehabilitative Services Manual.    

 

2012 Codes

Description

Unit

Frequency

Modifiers

2013  Codes

Description

Unit

Frequency

Modifiers

Rates

90804

This code splits into 3 separate codes on Jan. 1, 2013

Individual Psychotherapy

20 - 30 min

30 minutes -

6 per day

AF                             AM

AH

SA

HO

90832

Individual Psychotherapy

30 min

1 Encounter

-

per day

AF-Physician                             AM-Phys. Assist             

AH-Clinical Psych            

SA-Nurse Pract.                 HO-Master's Level

$104.94 $53.74   $54.43     $50.25     $37.30

90834

Individual Psychotherapy

45 min

1 Encounter

-

 per day

AF-Physician                             AM-Phys. Assist             

AH-Clinical Psych            

SA-Nurse Pract.                 HO-Master's Level

$209.88   $107.48   $108.86    $100.50    $74.60

90837

Individual Psychotherapy

60 min or more

1 Encounter

-

per day

AF-Physician                             AM-Phys. Assist             

AH-Clinical Psych           

SA-Nurse Pract.                 HO-Master's Level

$314.82    $161.22    $163.29    $150.75    $111.90

 

 

These 3 codes have separate session times for each encounter.

 

·         90832 – 20-30 minute encounter

·         90834 – 45-50 minute encounter

·         90837 – 60 minute or more encounter

Reimbursements for each encounter type are based on actual face to face contact with the beneficiary.  Appointments that are scheduled for 30 minutes that involve actual face to face encounter time for 20-25 minutes should be billed as a 90832.  Appointments scheduled for 60 minutes that involve actual face to face encounter time of 45-50 minutes should be billed as 90834.  Appointments that involved face to face encounter time beyond 60 minutes should be billed as 90837.  Psychotherapy of less than 16 minutes is not a billable service. Please note that for clinical service note completion, documentation of the encounter must include start and end times.  

Effective with dates of service on or after February 1, 2013, SCDHHS will change the following procedure codes from units to encounters as listed below.  

 

2012 Codes

Description

Unit

Frequency

Modifiers

2013  Codes

Description

Unit

Frequency

Modifiers

Rates

90846

Family Psychotherapy (without Patient present)

30 minutes

 -

6 per day

AF

HP                            AM

AH             SA                 HO

90846

Family Psychotherapy (without Patient present)

1 Encounter

 -

per day

 

HP-Physician                                      

AH-Clinical Psych                              HO-Master's Level

$301.17           $156.18           $107.04                  

90847

Family Psychotherapy (with Patient present)

30 minutes

 -

6 per day

AF

HP                            AM

AH             SA                 HO

90847

Family Psychotherapy (with Patient present)

1 Encounter

per day

 

HP-Physician                                           

AH-Clinical Psych                              HO-Master's Level

$301.17          

$156.18

$107.04

 

 

90853

Group Psychotherapy

30 minutes

 -

6 per day

AF

HP                            AM

AH             SA                 HO

90853

Group Psychotherapy

1 Encounter

-

per day

 

AH-Clinical Psych                                                            HO-Master's Level

$24.30

$16.65

 

 

 

 

99366

Service Plan Development/ Team Conference w/Patient/Family

30 minutes

 -

6 per day

AF

HP                            AM

AH             SA                 HO

99366

Service Plan Development/ Team Conference w/Patient/Family

1 Encounter

 -

per day

 

No Modifier

$39.54                     

99367

Service Plan Development/ Team Conference without Patient/Family

30 minutes

 -

6 per day

AF

HP                            AM

AH             SA                 HO

99367

Service Plan Development/ Team Conference without Patient/Family

1 Encounter

per day

 

No Modifier

$39.54          

 

 

 

If you should have questions regarding program policy, please contact Behavioral Health at 803-898-2565. Questions about claims resolution may be directed to the Provider Service Center (PSC) at 1-888-289-0709. Thank you for your continued support of the South Carolina Medicaid Program.

Report Fraud