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TO:                  Mental Health Clinic Service Providers

           

FROM:            Kathleen P. Allyn, Deputy Administrator

 

In the past, Idaho has used local state-only codes to pay for and report services not covered in the national coding books (HCPCS or CPT).  Federal regulations associated with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require that transactions and codes be consistent throughout the nation.  Effective for dates of service on or after October 20, 2003, Idaho will be converting the following state-only codes to the appropriate HCPCS or CPT codes in the table below.  Please be aware that some codes will require a modifier to be attached when billing the appropriate code. 

 

 

State Code

Description

[old descriptor], new descriptor

HCPCS or CPT

Code

Modifier

0100M

[Medical Report on Past Record Rather Than New Exam] Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes

90885

*Continue to use appropriate mental health diagnosis*

0105M

[Narrative Report on Past Record vs New Exam]

This code will be terminated 10/20/03

 

0110M

[Medical Report Based on New Exam] Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers

90889

* Continue to use appropriate mental health diagnosis*

0601M

NOTE:  Use this code - M0601 was deleted

[Psychological Testing for Diagnosis and Evaluation] Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, eg, WAIS-R, Rorschach, MMPI) with interpretation and report, per hour

 

96100

 

Use U1 for physicians

8105A

[Individual Psychotherapy for Nursing Facility Recipient]

Behavioral Health Counseling and Therapy, per 15 minutes

H0004

 

U4 modifier required

Use U1 modifier if performed by physician

8106A

[Group Psychotherapy for Nursing Facility Recipient]

Group Psychotherapy (other than of a  multiple- family group)

90853

U4 modifier required

Use U1 modifier if performed by physician

8107A

[Family Psychotherapy for Nursing Facility Recipient]

Family Psychotherapy (conjoint psychotherapy)(with patient present)

90847

U4 modifier required

Use U1 modifier if performed by physician

8110A

[Individual Psychotherapy for Nursing Facility Recipient]

Behavioral Health Counseling and Therapy, per 15 minutes

H0004

 

U4 modifier required

Use U1 modifier if performed by physician

8111A

[Group Psychotherapy for Nursing Facility Recipient]

Group Psychotherapy (other than of a  multiple- family group)

 

 

90853

U4 modifier required

Use U1 modifier if performed by physician

8112A

[Family Psychotherapy for Nursing Facility Recipient]

Family Psychotherapy (conjoint psychotherapy)(with patient present)

 

 

90847

U4 modifier required

Use U1 modifier if performed by physician

8115A

[Individual Interactive Psychotherapy for Nursing Facility Recipient]

Unlisted Psychiatric Service or procedure

 

 

90899

U4 modifier required

Use U1 modifier if performed by physician

8116A

[Group Interactive Psychotherapy for Nursing Facility Recipient]

Interactive Group Psychotherapy

 

90857

U4 modifier required

Use U1 modifier if performed by physician

8117A

Individual Interactive Psychotherapy for Nursing Facility Recipient[

Unlisted Psychiatric Service or procedure

 

 

 

90899

U4 modifier required

Use U1 modifier if performed by physician

8118A

]Group Interactive Psychotherapy for Nursing Facility Recipient[

Interactive Group Psychotherapy

90857

U4 modifier required

Use U1 modifier if performed by physician

8193A

]Social History and Evaluation[ Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs

 

T1028

 

8225A

]Collateral Contact – per 15 minutes)

Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient

90887

 

8286A

[Mental Health Blood Drawing Fee]

Routine venipuncture for collection of specimen(s)

G0001

 

8287A

[Medication Injection – Mental Health Center]  Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular

90782

 

8288A

[Medication supplied – Mental Health Center] Unclassified Drugs

J3490

*NDC is also required to be submitted on the claim in the Comments field*

 

8290A

[Partial Care – Mental Health Only] Skills Training and Development

 

 

H2014

 

8296A

[Interpreter, Non-Certified]

Interpretive Services

NOTE: Since 8297A  & 8298A were combined, effective for dates of service on or after 8/01/03, the new rate will be $12.16 per one (1) hour unit

NOTE: Medicaid has combined the three previous interpreter codes into 8296A

 

8297A

[Interpreter, Partially Certified]

This code was terminated 7/31/03

 

8298A

[Interpreter, Certified]

This code was terminated 7/31/03

 

8299A

[Unlisted Service – Mental Health Clinics and A/CDC]

This code will be terminated 10/20/03

 

8300A

[Psychological Services Performed by PhD Psychologist]

This code will be terminated 10/20/03

 

9081M

[Pharmacologic Management including Medication and Minimum Psychotherapy]  Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

90862

 

9082M

[Interactive Medical Psychiatric, Diagnostic Interview Exam] Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication

90802

Use U1 for physicians

9083M

[Group Medical Psychotherapy – 15 minutes] Group psychotherapy (other than of a multiple-family group)

90853

Use U1 for physicians

9084M

[Individual Psychotherapy – 15 minute increments] Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient

90804

90806

90808

NOTE: code based on the length of service

90804 20-30 mins

90806  45-50 mins

90808  75-80 mins

9085M

[Interactive Individual Medical Psychotherapy] Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient

90810

90812

90814

NOTE: code based on the length of service

90810 20-30 mins

90812  45-50 mins

90814  75-80 mins

9086M

[Interactive Group Medical Psychotherapy, per 15 minutes]

Interactive group psychotherapy

90857

Use U1 for physicians

9087M

[Family Psychotherapy – 15 minute  units] Family psychotherapy (conjoint psychotherapy)(with patient present)

90847

Use U1 for physicians

9088M

[Hypnotherapy, 25-30 minutes] Hypnotherapy

90880

 

9089M

[Psychiatric Diagnostic Interview Exam – 15 minute units]  Psychiatric diagnostic interview examination

90801

 

 

 

Use U1 for physicians

H5200

[Nursing Service – Office Visit] Nursing assessment / evaluation

 

 

T1001

 

H5300

[Occupational Therapy – Individual] Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes

97535

 

 

 

Required Modifiers and Definitions

U1

Medicaid Level of Care 1,

Performed by a Physician

U4

Medicaid Level of Care 4,

Services provided to an individual living in  a Nursing Facility

 

If you have questions regarding the information contained in this release, please contact Carolyn Burt-Patterson (208) 364-1827.  Thank you for your continued participation in the Idaho Medicaid Program.