LCD for Psychiatry and Psychology Services (L1593)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L1593 

 

LCD Title 

Psychiatry and Psychology Services 

 

Contractor's Determination Number 

1593 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.
 

 

Primary Geographic Jurisdiction 

Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
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Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 12/27/1996  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 01/01/2006  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

Psychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases.

Information in this part of the policy had been divided into six (6) sections. These sections address each individual CPT/HCPCS procedure code.

I. General Clinical Psychiatric Diagnostic or Evaluative Interview Procedures

II. Special Clinical Psychiatric Diagnostic or Evaluative Procedures

III. Psychiatric Therapeutic Services

IV. Psychiatric Somatotherapy

V. Other Psychiatric Disorders

VI. Central Nervous System Assessments/Tests (e.g., Neuro-Cognitive, Mental Status, Speech Testing)


Section I: General Clinical Psychiatric Diagnostic or Evaluative Interview Procedures:

Description: Procedure 90801 is described as the elicitation of a complete medical (including past, family, social) and psychiatric history, establishment of tentative diagnosis, and an evaluation of the patient’s ability and willingness to work to solve the patient’s mental problem. It includes a complete mental status exam. Information may be obtained from the patient, other physicians and/or family. There may be overlapping of the medical and psychiatric history depending on the problem. An evaluation and management (E&M) service may be substituted for the initial interview procedure, including consultation codes (CPT99241-99263), provided required elements of the E&M service billed are fulfilled. Consultation services require, in addition to the interview and examination, providing a written opinion and/or advice. They do not include psychiatric treatment.

Documentation: The medical record must reflect the elements outlined in the above description.

Comments: This service may be covered once, at the onset of an illness or suspected illness. It may be utilized again for the same patient after a hiatus, or on admission, or re-admission, to inpatient status due to complications of the underlying condition.


Section II: Special Clinical Psychiatric Diagnostic or Evaluative Interview examination

Description: Procedure 90802 is described as being used principally by child psychiatrists, psychologists and clinical social workers when they initially evaluate children who do not have the ability to interact with ordinary verbal communication. This code may also be applied to the initial evaluation of adult patients with organic mental deficits, or who are catatonic or mute.

The CPT Assistant states that the Interactive Medical Psychiatric Diagnostic Interview Examination (90802) includes the same components as the Psychiatric Diagnosis Interview Examination which includes history, mental status, disposition, and other components as indicated. However, in the interactive examination, the physician uses inanimate objects, such as toys and dolls for a child or an interpreter for a deaf person or one who does no speak English.

Documentation: The medical record must indicate that the person being evaluated does not have the ability to interact through normal verbal communicative channels. If the patient is capable of communication by any means this code may not be billed.

Comments: Procedure code 90802 is covered for the interactive evaluations of children who are 16 years of age or younger, and of adults, who have one of the following conditions, as classified in the ICD-9-CM (2005):


295.21-295.24 Schizophrenic disorders; catatonic type

299.00 Psychoses with origin specific to childhood; infantile autism, current or active state

299.80 Psychoses with origin specific to childhood; other specified childhood psychoses ; current or active state



Other catatonic states may be covered if documentation is submitted with the claim. Coverage also includes interactive examinations of patients with primary psychiatric diagnosis (e.g., Axis I DSM-III-R or DSM IV diagnoses), excluding the dementias (ICD-9-CM codes 290.0-290.9) and one of the following conditions, as classified in the ICD-9-CM (2005):


315.31 Development speech or language disorder

315.39 Developmental speech or language disorder, other

389.00-389.08 Conductive hearing loss, unspecified/combined types

389.10-389.18 Sensorineural hearing loss, unspecified/combined types

389.2 Mixed conductive and sensorineural hearing loss

389.7 Deaf mutism, not elsewhere classifiable

784.3 Aphasia

784.41 Voice disturbance, aphonia

784.5 Other speech disturbance


For the latter group of diagnoses, both the primary and secondary diagnoses must be submitted with the claim.


Section III: Psychiatric Therapeutic Procedures

Description: Procedure code 90865 is used for the administrative of sedative or tranquilizer, using intravenously, to relax the patient and remove inhibitions for discussion of subjects difficult for the patient to discuss freely in the fully conscious state.

Documentation: The medical records should document the medical necessity of this procedure, i.e., the patient had difficulty verbalizing about psychiatric problems without the aide of the drug. The record should also document the specific pharmacological agent dosage administered, and whether the technique was effective or non-effective.

Description: Procedure 90804 through 90809 (Psychotherapy) is defined as "the treatment for mental illness and behavior disturbances in which the physician establishes a professional contract with the patient and through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior and encourage personality growth and development."


Documentation: The medical records must indicate the time spent in the psychotherapy encounter and that, cognitive skills, such as behavior modification, supportive interactions, and discussion of reality were applied to produce therapeutic change.

Comments: While a variety of psychotherapeutic techniques are recognized for coverage under these codes, the services must be performed by a person licensed by the state to perform psychotherapy services. Medicare coverage of procedure codes 90804-90809 does not include teaching grooming skills, monitoring activities of daily living, recreational therapy (dance, art, play) or social interaction, therefore procedure codes 90804-90809 should not be used to bill for ADL training and/or social interaction skills.

*Note: Procedure codes 90805, 90807, and 90809 include drug management and continuing medical diagnostic evaluation as well as psychotherapy. Therefore, drug management and continuing diagnostic evaluation may not be billed separately on the same day.

Guidelines for Procedure Codes 90804-90809



1. Individual psychotherapy codes should be used only when the focus of treatment involves individual therapy and/or continuing medical diagnostic evaluation. Psychotherapy codes should not be used as generic psychiatric service codes when another code, such as E&M or pharmacologic management code, would be more appropriate.

2. Prolonged treatment (in excess of twenty sessions per episode of illness) may be subject to medical review. Documentation must be present in the medical record indicating the necessity for continued treatments.

4. Procedure codes 90808/90809 (approximately 75-80 minutes) should not be routinely used. They are reserved for exceptional circumstances. The provider of service must document in the patient’s medical record the medical necessity of this service and define the exceptional circumstances.

5. Medicare will not accept psychiatric therapy procedure codes 90804-90809 being billed on the same date of service as an evaluation and management (E&M) service, by the same provider or mental health profession group. The single exception is that a consultation may be billed at the initial visit and psychotherapy may be billed on the same date of service, if it is medically indicated.

6. Psychotherapy services are not covered when documentation indicates that Dementia (ICD-9 codes, 290.0, 290.20-290.9, 331.0-331.2) has produced a severe enough cognitive defect to prevent establishment of a relationship with the therapist which would allow insight-oriented therapy to be effective. Profound mental retardation (ICD-9 code 318.2) is never covered for psychotherapy services. In such cases, evaluation and management codes or pharmacologic management codes should be reported.

7. For psychotherapy sessions lasting longer than 90 minutes (or if an additional code is billed in conjunction with codes 90808/90809), reimbursement will only be made if a report is submitted with the claim, documenting the face-to-face time spent with the patient and the medical necessity for the extended time.



Description: Procedure code 90845 is the practice of psychoanalysis which uses a special technique to gain insight into a patient’s unconscious motivations and conflicts and is a different therapeutic modality than psychotherapy.

Documentation: The medical record must indicate that psychoanalytic techniques were used.

Comments: The physician using this technique must be trained and credentialed in its use. It is not time related, but the code is billed once for each daily session regardless of the time involved. The Relative Value Units assigned to this code are based on a 45-60 minute session. Psychoanalysis is generally considered unsuitable for psychoses.

Medicare coverage includes the following diagnosis codes:


296.20-296.25
Major depressive disorders, single episodes ; unspecified to in partial or unspecified remission

296.30-296.35
Major depressive disorders, recurrent episodes; unspecified to in partial or unspecified remission

300.01 Panic disorder

300.02 Generalized anxiety disorder

300.20-300.29 Phobias, unspecified to other isolated or simple phobias

300.3 Obsessive-compulsive disorder

300.4 Neurotic depression

309.1 Prolonged depressive reaction

309.21 Separation anxiety disorder

309.22
Emancipation disorder of adolescence or early adult life

309.23 Specific academic or work inhibition




Description: Procedure codes 90846, 90847, 90849 are used to describe family participation in the treatment process of the patient. Code 90846 is used when the patient is not present. Code 90847 is used when the patient is present. Code 90849 is intended for group therapy sessions for multiple families when similar dynamics are occurring due to a commonality of problems in the family members under treatment.

Documentation: The medical record must document the conditions described under Description and Comments paragraphs relative to codes 90846, 90847, and 90849.

Comments: The Medicare National Coverage Determination Manual, 1.1.§70.1 states that family counseling services are covered only where the primary purpose of such counseling is the treatment of the patient’s condition. Examples are as follows:


1. When there is a need to observe the patient’s interaction with family members (CPT 90847).

2. Where there is a need to assess the capability of, and assist the family members in, the management of the patient (90846 or 90847).

3. These codes may also apply when the patient is comatose or withdrawn and uncommunicative due to a mental disorder.



Code 90849 has restrictive coverage by Medicare and would generally be non-covered. Such group therapy is directed to the effects of the patients’ condition on the family, and does not meet Medicare’s standards of being part of the physician's personal services to the patient. If such is not the case, individual consideration may be given if documentation is submitted.


Description: Psychotherapy administered in a group setting (90853) with a trained group leader in charge of several patients. Personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction and support.

Documentation: The record must indicate that the guidelines under Description and Comments were followed.

Comments: Group therapy, since it involves psychotherapy, must be led by a person who is authorized by state statute to perform this service. This will usually mean a psychiatrist, psychologist, or clinical social worker and, in some states, certified nurse practitioners, clinical nurse specialists, or qualified mental health personnel. For Medicare Part B coverage, group therapy does not include socialization, music therapy, recreational activities, art classes, excursions, sensory stimulation or eating together, cognitive stimulation, motion therapy, etc.


Description: As with code 90802, and 90857 are used when the patient, or patients in the group setting, does not have the ability to interact by ordinary verbal communication therefore non-verbal communication skills are employed, or an interpreter may be necessary. Code 90855 is comparable in time to 90806/90807 (45-50 minutes). The guidelines in the Documentation section under CPT 90802 apply to code 90857.

Documentation: Documentation in the medical record must include the need for interactive therapy. The guidelines in the Documentation section under code 90802 apply to code 90847.

Comments: Code 90857 should not be billed on the same date of service as 90853.


Section IV: Psychiatric Somatotherapy

Description: Code 90862 is intended for use by the physician who is prescribing pharmacologic therapy for a patient with an organic brain syndrome or whose diagnosis is in the ICD-9 range of 290.0-319, and is being managed primarily by psychotropic drugs. It may also be used for the patient whose psychotherapy is being managed by another health professional and the billing physician is managing the psychotropic medication. The service includes prescribing, monitoring the effect of medication and adjusting the dosage. Any psychotherapy provided is minimal and is usually supportive only.

Documentation: The record must document that the guidelines under Description and Comments are followed.

Comments: If the physician supplies other services in addition to pharmacologic management at the visit then an E&M code may be used. However, the E&M service will include pharmacologic management and therefore 90862 should not be billed in addition to the E&M service. Based on physician work relative value units, the physician work component of the code is similar to Code 99214 (equivalent to 25-30 minutes).

If the patient receives psychotherapy and drug management at the same visit, the drug management is included, as part of that service by definition and 90862 should not be billed in addition to the psychotherapy code.

This code is not intended to be used for the actual administration of medication, nor is it intended to be used for observation of the patient taking an oral medication. Administration and supply of oral medication is a non-covered service.

Codes 90862 and M0064 describe a physician service and cannot be billed by a non-physician’s service, with the exception that nurse practitioners whose scope of license in their states permit them to prescribe may use this code if they perform these services.

Code 90862 is not intended to refer to a brief evaluation of the patient's state or simple dosage adjustment of long term medication. The code refers to the in-depth management of psychopharmacologic agents, which are potent medications with frequent serious side effects, and represents a very skilled aspect of patient care.

HCPCS' code M0064 should be used for the lesser level of drug monitoring such as simple dosage adjustment. M0064 is defined as a brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental, psychoneurotic and personality disorders. Based on the assignment of RVUs, the work involved in M0064 is similar to code 99212. Time spent is generally less than ten minutes'

Medicare covers the following diagnosis codes for codes 90862 or M0064:


290.0-305.00 Senile dementia, uncomplicated to alcohol abuse, unspecified

305.20-319 Nondependent abuse of drugs; cannabis abuse, unspecified to unspecified mental retardation




Description: Codes 90870 and 90871 are described as the application of electric current to the brain, through scalp electrodes to produce a single (90870) or multiple (90871) seizures.

Documentation and Comment: When the psychiatrist administers the anesthesia for the seizure therapy, no separate payment may be made for that service.


Section V: Other Psychiatric Therapy

Description: Code 90880 is described as medical hypnotherapy. Hypnotherapy is an artificially induced alteration of consciousness in which the patient is in a state of increased suggestibility.

Documentation: Claims must be submitted with a covered diagnosis.

Comments: Hypnosis may be used for diagnostic or therapeutic purposes. When used therapeutically to enhance psychotherapy or provided in conjunction with psychotherapy in the same session, only code 90880 should be reported.

Medicare will cover hypnotherapy for the following diagnoses:


300.11 Conversion disorders

300.12 Psychogenic amnesia

300.13 Psychogenic fugue

300.14 Multiple personality

300.15 Dissociative disorder or reaction, unspecified

300.20-300.29 Phobias, unspecified to other isolated or simple phobias

307.80 Psychogenic pain, site unspecified

308.0-309.9 Predominant disturbance of emotions to unspecified adjustment reaction



Code 90882, environmental intervention for medical management purposes on a psychiatric patient’s behalf with agencies, employers, or institutions is NON COVERED by Medicare.


Description: Code 90889 involves preparation of reports for insurance companies, agencies, courts, etc. Medicare does not cover this service.


Section VI: Central Nervous System Assessments/Tests (e.g., Neuro-Cognitive, Mental Status, Speech Testing)

Description: Code 96101, 96102, 96103 includes the administration, interpretation and scoring of the tests mentioned in the CPT description and other medically accepted tests for evaluation of intellectual strengths, psychopathology, psychodynamics, mental health risks, insight, motivation and other factor influencing treatment and prognosis.

Documentation: The medical record must indicate the presence of mental illness or signs of mental illness for which psychological testing is indicated as an aid in the diagnosis and therapeutic planning. The record must show the tests performed, scoring and interpretation, as well as the time involved.

Comments: These are not psychotherapeutic modalities, but are diagnosis aids, Use of such tests when mental illness is not suspected would be a screening procedure and is not covered by Medicare. Each test performed must be medically necessary and therefore standardized batteries of tests are not acceptable. The Folstein Mini-Mental Exam (or similar test) is not separately reimbursable by Medicare and is included in the clinical interview or E&M service.

Changes in mental illness may require psychological testing to determine new diagnoses of the need for changes in therapeutic measure. Repeat testing not required for a diagnosis or continued treatment would be considered medically unnecessary. Nonspecific behaviors, which do not indicate the presence of, or change n, a mental illness would not be an acceptable indication for testing. psychological or psychiatric evaluations that can be accomplished through the clinical interview alone (e.g., response to medication) would not require psychological testing, and such testing might be considered as medically unnecessary. Adjustment reactions or dysphoria associated with moving to a nursing facility do not constitute medical necessity for psychological testing.

Code 96101 should not be reported by the treating psychiatrist for reading the report of the results of psychological testing by the psychiatrist and the reading of the report is therefore included in the office, or floor time in the hospital, for that day, and would be included in the E&N service code for that day.


Description: Codes 96101,96102, 96103, 96105, 96110, 96111, and 96116 are clearly delineated in the CPT definition. Codes 96118, 96119, 96120 describe testing which is intended to describe and diagnose the neurocognitive effects of medical disorders that impinge directly or indirectly on the brain. Examples of problems, which might lead to neuropsychological testing, are:


1. Detection of neurologic diseases based on quantitative assessment of neurocognitive abilities (e.g., mild head injury, anoxic injuries, AIDS dementia)

2. Differential diagnosis between psychogenic and neurogenic syndromes (e.g., depression vs. dementia)

3. Delineation of the neurocognitive effects of CNS disorders

4. Neurocognitive monitoring of recovery or progression of CNS disorders; and

5. Assessment of neurocognitive functions for the formulation of rehabilitation and/or management strategies among individuals with neurologic disorders.



Documentation: The medical record must document that the guidelines outlined in the Description and Comments were followed.

Comments (96118, 96119, 96120): The content of Neuropsychological Testing procedures differs in a large part from that of Psychological Testing (96101 96102, 96103) in that Neuropsychological testing consists primarily of individually administered ability tests that comprehensively sample ability domains that are known to be sensitive to the functional integrity of the brain (e.g., abstraction, memory and learning, attention, language, problem solving, sensorimotor functions, constructional praxis, etc.). These procedures are objective and quantitative in nature and require that patient to directly demonstrate their level of competence in a particular cognitive domain. Neuropsychological Testing does not rely on self-report questionnaires such as the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), rating scales such as the Hamilton Depression Rating Scale, or projective techniques such as the Rorschach or Thematic Appreciation Test (TAT). These procedures are intended for psychological testing and should be covered under 96110. Brief screening measures such as the Folstein Mini Mental Status Exam or use of other mental status exams in isolation should not be classified separately as Neuropsychological Testing (96118, 96119, 96120) since they are typically part of a more general clinical exam or interview.

Typically, the test battery will require from 5-7 hours to perform, including administration, scoring and interpretation. If the testing is done over several days, the testing time should be combined and reported all on the last date of service. If the testing time exceeds 11 hours, a report must be submitted indicating the medical necessity for this extended testing.

Indications: Neuropsychological conditions, which fall under the Descriptions and Comments sections preceeding. ICD-9 codes which are descriptive of those conditions will be covered for code 96118, 96119, 96120.
 

 

Coverage Topic 

Mental Health Care (Outpatient)
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

091X

Psychiatric/psychological services-general classification

 

 

CPT/HCPCS Codes 

Medicine, Psychiatry/Central Nervous System Assessments/Tests (e.g., Neuro-Cognitive, Mental Status, Speech Testing)

90801

PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION

90802

INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF COMMUNICATION

90804

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;

90805

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; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES

90806

INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT;

90807

INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES

90808

INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT;

90809

INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES

90810

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;

90815

INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES

90823

INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN INPATIENT HOSPITAL, PARTIAL HOSPITAL OR RESIDENTIAL CARE SETTING, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT;

90829

INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN INPATIENT HOSPITAL, PARTIAL HOSPITAL OR RESIDENTIAL CARE SETTING, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH MEDICAL EVALUATION AND MANAGEMENT SERVICES

90845

PSYCHOANALYSIS

90846

FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT)

90847

FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT)

90849

MULTIPLE-FAMILY GROUP PSYCHOTHERAPY

90853

GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)

90857

INTERACTIVE GROUP PSYCHOTHERAPY

90862

PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION WITH NO MORE THAN MINIMAL MEDICAL PSYCHOTHERAPY

90865

NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM AMOBARBITAL (AMYTAL) INTERVIEW)

90870

ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING)

90880

HYPNOTHERAPY

90882

ENVIRONMENTAL INTERVENTION FOR MEDICAL MANAGEMENT PURPOSES ON A PSYCHIATRIC PATIENT’S BEHALF WITH AGENCIES, EMPLOYERS, OR INSTITUTIONS

90889

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

90899

UNLISTED PSYCHIATRIC SERVICE OR PROCEDURE

96101

PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI, RORSCHACH, WAIS), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT

96102

PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI AND WAIS), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, ADMINISTERED BY TECHNICIAN, PER HOUR OF TECHNICIAN TIME, FACE-TO-FACE

96103

PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI), ADMINISTERED BY A COMPUTER, WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT

96105

ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT, PER HOUR

96110

DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SCREEN), WITH INTERPRETATION AND REPORT

96111

DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/OR COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS) WITH INTERPRETATION AND REPORT

96116

NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG, ACQUIRED KNOWLEDGE, ATTENTION, LANGUAGE, MEMORY, PLANNING AND PROBLEM SOLVING, AND VISUAL SPATIAL ABILITIES), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME WITH THE PATIENT AND TIME INTERPRETING TEST RESULTS AND PREPARING THE REPORT

96118

NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), PER HOUR OF THE PSYCHOLOGIST’S OR PHYSICIAN’S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT

96119

NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, ADMINISTERED BY TECHNICIAN, PER HOUR OF TECHNICIAN TIME, FACE-TO-FACE

96120

NEUROPSYCHOLOGICAL TESTING (EG, WISCONSIN CARD SORTING TEST), ADMINISTERED BY A COMPUTER, WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT

M0064

BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG PRESCRIPTIONS USED IN THE TREATMENT OF MENTAL PSYCHONEUROTIC AND PERSONALITY DISORDERS

 

 

ICD-9 Codes that Support Medical Necessity 

The following list of covered ICD-9 and DSM III R diagnosis codes must be linked to the appropriate procedure before consideration for Medicare payment may be made. Refer to individual CPT code(s) coverage found in the Coverage and Limitations section of this policy.

290.0 - 305.03

SENILE DEMENTIA UNCOMPLICATED - NONDEPENDENT ALCOHOL ABUSE IN REMISSION

305.20 - 319

NONDEPENDENT CANNABIS ABUSE UNSPECIFIED USE - UNSPECIFIED MENTAL RETARDATION

389.00 - 389.08

CONDUCTIVE HEARING LOSS UNSPECIFIED - CONDUCTIVE HEARING LOSS OF COMBINED TYPES

389.10 - 389.18

SENSORINEURAL HEARING LOSS UNSPECIFIED - SENSORINEURAL HEARING LOSS, BILATERAL

389.20

MIXED HEARING LOSS, UNSPECIFIED

389.21

MIXED HEARING LOSS, UNILATERAL

389.22

MIXED HEARING LOSS, BILATERAL

389.7

DEAF, NONSPEAKING, NOT ELSEWHERE CLASSIFIABLE

784.3

APHASIA

784.41

APHONIA

784.5

OTHER SPEECH DISTURBANCE

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

Any ICD-9 CMD diagnosis code not listed in this policy or any DSM-III-R or DSM IV mental health diagnosis code that is not cited in this policy.

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

1. There should be documentation of the patient’s capacity to participate in and benefit from psychotherapy if psychotherapy is the chosen treatment. The estimated duration of treatment in terms of number of sessions should be specified. For an acute problem there should be documentation in the medical record that the treatment is expected to improve the health status or function of the patient. For chronic problems there must be documentation indicating that stabilization or maintenance of health status or function is expected.

2. The medical record should document the target symptoms, the goals of therapy and methods of monitoring outcome. It should also document why the chosen therapy is the appropriate treatment modality either in lieu of or in addition to another form of psychiatric treatment.

3. If medical records are requested, submit:

 

  • Psychiatric records including date of onset and diagnosis
  • Treatment plan with start of care date
  • Physician's orders and progress notes
  • Therapists' notes
  • Note of M.D. visit before or during dates of service
  • Itemized list of charges

 

 

Appendices 

LINK TO QUESTIONS AND ANSWERS (COMMENTS) ABOUT THIS
POLICY:

Frequently Asked Questions


 

 

Utilization Guidelines 

 

 

Sources of Information and Basis for Decision 

CPT Handbook for Psychiatrists

CPT Assistant

State and National Psychiatry/Psychology Professional Associations

Board Certified Psychiatry Consultants

Carrier Medical Directors Psychology/Psychiatry Clinical Workgroup

Other carrier local medical review policies

Medicare National Coverage Determination Manual 

 

Advisory Committee Meeting Notes 

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives. 

 

Start Date of Comment Period 

 

 

End Date of Comment Period 

 

 

Start Date of Notice Period 

11/27/1996 

 

Revision History Number 

1593b 

 

Revision History Explanation 

07/24/2002 Formatted

04/03/2002 Deleted obsolete codes from 11/28/01 revision

11/28/2001 Updated ICD-9 codes [2002 Code Book]

11/07/2004 - The description for CPT/HCPCS code 96111 was changed in group 1

08/05/2005 Replaced obsolete HCPCS codes 90841-90844 with codes 90804-90809

This LCD was converted from an LMRP on 8/5/2005

09/04/2005 - This policy was updated by the ICD-9 2005-2006 Annual Update.

11/26/2005 - The description for CPT/HCPCS code 90870 was changed in group 1

11/26/2005 - CPT/HCPCS code 96100 was deleted from group 1
11/26/2005 - CPT/HCPCS code 96115 was deleted from group 1
11/26/2005 - CPT/HCPCS code 96117 was deleted from group 1
2/20/2006 - CPT/HCPCS codes 96101, 96102, 96103, 96116, 96118, 96119, 96120 added to Group 1. Limitations and Indications, Section VI edited text to reflect deletion and addition of codes.


09/04/2006 - This policy was updated by the ICD-9 2006-2007 Annual Update.

11/18/2006 - The description for CPT/HCPCS code 96101 was changed in group 1
11/18/2006 - The description for CPT/HCPCS code 96119 was changed in group 1

09/03/2007 - This policy was updated by the ICD-9 2007-2008 Annual Update.

09/27/2007 - Frequently Asked Questions restored to Appendices.

11/10/2007 - The description for CPT/HCPCS code 96101 was changed in group 1
11/10/2007 - The description for CPT/HCPCS code 96118 was changed in group 1 

 

Reason for Change