Behavioral and Substance Abuse Codes

Claims and billing for mental health, substance abuse and psychiatric services are complicated and often require special attention, which is best handled by a specialist. Below you’ll find a convenient list of the 2017 Mental Health CPT, behavioral and substance abuse codes.

Intake Code

90791 – Psychiatric Diagnostic Evaluation

Cannot be used within a 6 month period by same provider.

Can use 90785 add-on code for complex sessions (90791 + 90785)

90792 – Psychiatric Diagnostic Evaluation with Medical Services
Cannot be used within a 6 month period by same provider.

Can use 90785 add-on code for complex sessions. (90792 + 90785)

Therapy Codes

90834 – Standard Therapy Session, 45 min.

UBH uses a HJ modifier to indicate EAP

Can use 90785 for complex sessions. (90834 + 90785)

90837 – Standard Therapy Session, 53 mins.

Not all insurance will allow this code without an authorization.

99354 add-on for 90 minute session (90837 + 99354)

99355 add-on for each additional 30 minutes (90837 + 99354 + 99355)

90785 add-on for complex sessions, can be used with extended sessions too.

99404 – EAP code for standard 45 min session; Cigna and MHN

90839 – Is defined for the use of psychotherapy with a patient in crisis. In order to be identified as Psychotherapy for Crisis service the presenting problem is typically life threatening, or complicated and requires immediate attention to resolve a highly stressful situation. Service for a crisis may often include the following:

Risk assessment and evaluation of crisis state

Mental Status Exam

Brief Psychotherapy

Mobilization of Resources to defuse crisis

Implementation of psychotherapeutic IP/OP intervention plan.

Disposition/outcome follow up

The Psychotherapy for Crisis Code can be used:

It is used for the first 30-74 minutes of the crisis intervention.

Must be face-to face intervention with the patient and/or family member/parent or guardian responsible for making care decisions.

The provider must devote full attention to the patients needs during the reported time.

90840 – Defined for use of psychotherapy with a patient in crisis; an add-on code used for intervention that goes beyond the (90839) 74 minute period.

It is used to report each additional 30 minutes of crisis intervention, with each additional 30 minutes billed with an incremental unit (1-1/2 hr = 3 unites).

Crisis codes cannot be used with:

90791, 90792 – Initial Intake Diagnostic Evaluation

90832 thru 90838 – Routine Psychotherapy

90785 – Interactive Complexity

90846 – Group Therapy, Patient not Present.

90847 – Group therapy, patient present.

90853 – Group Therapy, other than family.

 99354 – Prolonged Service

In the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient EM service)

Used after 74 minutes of therapy.

Can be used with 90837, 99213, 99214 and 99215.

99355 – Prolonged Service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes.

Used after 2 hours for additional 30 mins, up to 4 time 90837 + 99354 + 99355.

Interactive Complexity Code

90785 – Interactive Complexity is an add-on code, which may be used in conjunction with other psychotherapy services when the patient interaction is complicated by limitations of the patient to communicate, or by involvement of people other than the patient.

It can be reported with any of the following codes:

90791, 90792 – Initial intake Diagnostic Evaluation

90832 thru 90838 – Routine Psychotherapy

90853 – Group Therapy

EM Codes (99201 – 99255; 99304-99377; 99341-99350)

An add-on code, is defined for use when specific communication factors complicate the delivery pf psychiatric service. Common factors include:

Discordant or emotional family interactions

Young and verbally undeveloped child

Impaired patient or participant

Involves others legal responsible for care.

Involves multiple others in treatment process.

Involves other third party representation

The Interactive Complexity code can be reported when at least one of the following is present:

The need to manage maladaptive communication

A Caregiver’s emotion or behavior interferes with ability to assist in treatment plan.

Evident / Disclosure is made of a sentinel event, including mandated report to state agency and intervention.

Use of play equipment, other physical devices, interpreter, or translator is needed for communication with the patient.

E/M Codes:

99213 –Established Office Visit 15 mins.
Presenting problems low to moderate severity

90833 for 30 mins of therapy (99213 + 90833)

90836 for 45 mins of therapy (99213 + 90836)

90838 for 60 mins of therapy (99213 + 90838)

90785 for complex therapy session. (99213 + 9083* +90785)

99214 – Established Office Visit 25 mins.
Presenting problems moderate to high severity

90833 for 30 mins of therapy (99214 + 90833)

90836 for 45 mins of therapy (99214 + 90836)

90838 for 60 mins of therapy (99214 + 90838)

90785 for complex therapy session. (99214 + 9083* +90785)

99215 – Established Office Visit 45 mins.
Highest level of Care for established patients.

90833 for 30 mins of therapy (99215 + 90833)

90836 for 45 mins of therapy (99215 + 90836)

90838 for 60 mins of therapy (99215 + 90838)

90785 for complex therapy session. (99215 + 9083* +90785)

Prolonged Clinical Staff Services

99415 – Prolonged Clinical Staff, 1st Hr. (44-74 mins.)
Used when a prolonged E/M service is provided in office that involves prolonged clinical staff face to face time beyond the normal time of the E/M service.

Use in conjunction with 99213, 99214, 99215 (99213 + 99415)

Used with clinical staff observation in conjunction with physician.

Testing Codes

96101 – Psychological Testing

96118 – Neuropsychological Testing

Report Codes

90885 – Psychiatric evaluation of records
Description:
CPT code 90885 is used when a provider is asked to do a review of records for psychiatric evaluation without direct patient contact. This may be accomplished at the request of an agency or peer review organization. It may also be employed as part of an overall evaluation of a patient’s psychiatric illness or suspected psychiatric illness, to aid in the diagnosis and/or treatment plan.

90887 – Interpretation with Family
Description:
CPT code 90887 is used when the treatment of the patient may require explanations to the family, employers or other involved persons for their support in the therapy process. This may include reporting of examinations, procedures, and other accumulated data.

90889 – Preparation of Report
Description:
CPT code 90889 is defined as 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

99449 – Interprofessional Telephone/Internet Consultation

Interprofessional telephone/internet assessment and management service, including verbal and written report.

90899 – Unlisted Psychiatric Service