Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 0100 Inpatient Services Yes No Yes 0114 Room & Board - private psychiatric Yes No Yes 0124 Room & Board semi private two bed - psychiatric Yes No Yes 0126 Substance Abuse Inpatient Detox Yes No Yes 0134 Room & Board psychiatric semi private - 3 and 4 bed Yes No Yes 0144 Room & Board private deluxe psychiatric Yes No Yes 0154 Room & Board - ward psychiatric Yes No Yes 0169 Inpatient Psychiatric - Days Awaiting Placement (<21 years of age) Yes No Yes 0190 Residential Treatment (<21 years of age) - Non-Accredited Behavioral Health accommodation - psychiatric and substance abuse (or co-occuring) 0194 Sub-acute Residential Treatment services (<21 years of age) 0204 Inpatient Intensive care (ICU) psychiatric Yes No Yes 0459 Psychiatric Emergency Services Yes No Yes 0762 23 Hour Observation Bed - billed as outpatient hospital services for general hospitals with psych units 0901 Electorconvulsive Therapy, Single seizure Yes No Yes 0912 Partial Hospitalization less intensive 0913 Partial Hospitalization more intensive 0914 Hospital Outpatient - Individual Therapy 0915 Hospital Outpatient - Group Therapy 0916 Hospital outpatient Family Therapy 0919 Outpatient Services for IHS, FQHC and RHC only 0944 Ambulatory Detox - Drug rehabilitation (includes professional fees) Yes No Yes 0945 Ambulatory Detox - Alcohol rehabilitation (includes professional fees) Yes No Yes 1000 Hearing Impaired Group Home (<21 years of age) 1001 Residential Treatment (<21 years of age) - Accredited Behavioral Health accommodation - psychiatric (or co-occuring) 1002 Residential Treatment (<21 years of age) - Accredited Behavioral Health accommodation -substance abuse (or co-occuring) 1005 Group Homes (< 21 years of age) 0780 + Q3014 Telehealth originating site facility fee - In order for originating site to receive reimbursement for telehealth fee/services, revenue code 0919 must be billed in conjunction with HCPCS Code Q3014 and revenue code 0780 90801 Psychiatric diagnostic interview examination includes a history, mental status, and a disposition, and may include communication with family or other sources, ordering and medical interpretation of laboratory or other medical diagnostic studies. In certain circumstances other informants will be seen in lieu of the individual. 90802 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication. 90804 Individual Psychotherapy, Face-to-face, 20-30 minutes, interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling.
Procedure/ Revenue Code Service/Revenue Code Description 90805 Individual Psychotherapy, 20-30 minutes, is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90806 Individual Psychotherapy, Face-to-face, 45-50 minutes, interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. 90807 Individual Psychotherapy, 45-50 minutes, is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90808 Individual Psychotherapy, 75-80 minutes, face-to-face interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. 90809 Individual Psychotherapy, 75-80 minutes, treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90810 Individual Psychotherapy, 20-30 minutes, face-to-face interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. 90811 Individual Psychotherapy, 20-30 minutes, is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90812 Individual Psychotherapy, 45-50 minutes, face-to-face interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. Billing NPI Rendering NPI Attending/ Admitting NPI
Procedure/ Revenue Code Service/Revenue Code Description 90813 Individual Psychotherapy, 45-50 minutes, is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90814 Individual Psychotherapy, 75-80 minutes, face-to-face interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. 90815 Individual Psychotherapy, 75-80 minutes, is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 90816 Individual Psychotherapy, in an inpatient, partial hospital or residential setting, approximately 20-30 minutes. 90817 Individual Psychotherapy, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 20-30 minutes. 90818 Individual Psychotherapy, in an inpatient, partial hospital or residential setting, approximately 45-50 minutes. 90819 Individual Psychotherapy, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 45-50 minutes. 90821 Individual Psychotherapy, in an inpatient, partial hospital or residential setting, approximately 75-80 minutes. 90822 Individual Psychotherapy, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 75-80 minutes. 90823 Individual Psychotherapy, interactive, in an inpatient, partial hospital or residential setting, approximately 20-30 minutes. 90824 Individual Psychotherapy, interactive, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 20-30 minutes. 90826 Individual Psychotherapy, interactive, in an inpatient, partial hospital or residential setting, approximately 45-50 minutes. 90827 Individual Psychotherapy, interactive, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 45-50 minutes. 90828 Individual Psychotherapy, interactive, in an inpatient, partial hospital or residential setting, approximately 75-80 minutes. 90829 Individual Psychotherapy, interactive, with medical evaluation and management, in an inpatient, partial hospital or residential setting, approximately 75-80 minutes. Billing NPI Rendering NPI Attending/ Admitting NPI
Procedure/ Revenue Code Service/Revenue Code Description 90846 Family Psychotherapy (FFT) (family without the patient) directed toward an individual and family to address emotional, behavioral or cognitive problems, which may be causative/exacerbating of the primary mental disorder or have been triggered by the stress related to coping with mental and physical illness, alcohol and drug abuse, and psychosocial dysfunction. Personal trauma, family conflicts, family dysfunction, self-concept responses to medication, and other life adjustments reflect a few of the many issues that may be addressed. 90846 Family Psychotherapy (FFT) (family without the patient) directed toward an individual and family to address emotional, behavioral or cognitive problems, which may be causative/exacerbating of the primary mental disorder or have been triggered by the stress related to coping with mental and physical illness, alcohol and drug abuse, and psychosocial dysfunction. Personal trauma, family conflicts, family dysfunction, self-concept responses to medication, and other life adjustments reflect a few of the many issues that may be addressed. 90847 Family Psychotherapy (family with the patient) directed toward an individual and family to address emotional, behavioral or cognitive problems, which may be causative/exacerbating of the primary mental disorder or have been triggered by the stress related to coping with mental and physical illness, alcohol and drug abuse, and psychosocial dysfunction. Personal trauma, family conflicts, family dysfunction, self-concept responses to medication, and other life adjustments reflect a few of the many issues that may be addressed. 90849 Multiple Family Group Psychotherapy sessions for multiple families when similar dynamics are occurring due to a commonality of problems. Each family is treated as a unit and all services are billed under one admitted individual. 90853 Group Psychotherapy administered in a group with a trained group leader in charge of individuals. Personal and group dynamics are discussed and explored in a therapeutic setting when similar dynamics are occurring due to a commonality of problems. 90857 Interactive Group Psychotherapy in a group, using play equipment, physical devices, language interpretation or other mechanisms of communication, in a group setting with a trained group leader in charge of individuals. Personal and group dynamics are discussed and explored in a therapeutic setting when similar dynamics are occurring due to a commonality of problems. Billing NPI Rendering NPI Attending/ Admitting NPI 90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy. 90870 ECT Single Seizure 90889 Preparation of report patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers. 96101 Psychological Testing by Psych. Or MD, face to face and interpretation and report 96102 Psychological Testing by Technician 96103 Psychological Testing by computer, w/interpretation and report 96105 Assessment of aphasia with Interpetation and Report, per hour. 96110 Developmental Testing with Interpetation and Report 96111 Developmental Testing, Extended 96116 Neurobehavioral Status Exam
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 96118 Neuropsychological testing w/report, face to face, interpretation and report 96119 Neuropsychological testing w/report, by technician 96120 Neuropsychological testing by computer, w/interpretation and report 96150 Health and Behavioral Assessment each 15 min face to face 96151 Re-Assessment 99199 NA Traditional Healer 99201 Office or other outpatient visit for the evaluation and management of a new patient, approximately 10 minutes face-to-face with patient. 99202 Office or other outpatient visit for the evaluation and management of a new patient, approximately 20 minutes face-to-face with patient. 99203 Office or other outpatient visit for the evaluation and management of a new patient, approximately 30 minutes face-to-face with patient. 99204 Office or other outpatient visit for the evaluation and management of a new patient, approximately 45 minutes face-to-face with patient. 99205 Office or other outpatient visit for the evaluation and management of a new patient, approximately 60 minutes face-to-face with patient. 99211 Office or other other outpatient visit for the evaluation and management of an established patient, approximately 5 minutes. 99212 Office or other other outpatient visit for the evaluation and management of an established patient, approximately 10 minutes. 99213 Office or other other outpatient visit for the evaluation and management of an established patient, approximately 15 minutes. 99214 Office or other other outpatient visit for the evaluation and management of an established patient, approximately 25 minutes. 99215 Office or other other outpatient visit for the evaluation and management of an established patient, approximately 40 minutes. 99217 Observation care discharge day management (this code is to be utilized by the physician to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial day of "observation status"). 99218 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: 1) a detailed or comprehensive history; 2) a detaield or comprehensive examination; 3) medical decision -making of low complexity 99219 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: 1) a detailed or comprehensive history; 2) a detaield or comprehensive examination; 3) medical decision -making of moderate complexity 99220 Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: 1) a detailed or comprehensive history; 2) a detaield or comprehensive examination; 3) medical decision -making of high complexity 99221 Initial Hospital care, per day, for the evaluation and management of patient, approximately 30 minutes. 99222 Initial Hospital care, per day, for the evaluation and management of patient, approximately 50 minutes. 99223 Initial Hospital care, per day, for the evaluation and management of patient, approximately 70 minutes.
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 99231 Subsequent Hospital care, per day, for the evaluation and management of patient, approximately 15 minutes. 99232 Subsequent Hospital care, per day, for the evaluation and management of patient, approximately 25 minutes. 99233 Subsequent Hospital care, per day, for the evaluation and management of patient, approximately 35 minutes. 99234 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, low severity problem. 99235 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, moderate severity problem. 99236 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, high severity problem. 99238 Hospital discharge day management, 30 minutes or less 99239 Hospital discharge day management, more than 30 minutes 99241 Office consultation for a new or established patient, approximately 15 minutes. 99242 Office consultation for a new or established patient, approximately 30 minutes. 99243 Office consultation for a new or established patient, approximately 40 minutes. 99244 Office consultation for a new or established patient, approximately 60 minutes. 99245 Office consultation for a new or established patient, approximately 80 minutes. 99251 Initial inpatient consultation for a new or established patient, approximately 20 minutes. 99252 Initial inpatient consultation for a new or established patient, approximately 40 minutes. 99253 Initial inpatient consultation for a new or established patient, approximately 55 minutes. 99254 Initial inpatient consultation for a new or established patient, approximately 80 minutes. 99255 Initial inpatient consultation for a new or established patient, approximately 110 minutes. 99354 Prolonged physician service in the office or other outpatient setting requiring direct patient contact beyond the usual service - 1 hour 99355 Prolonged physician service in the office or other outpatient setting requiring direct patient contact beyond the usual service - 30 minutes 99356 Prolonged physician service in the inpatient setting requiring unit/floor time beyond the usual service; first hour 99357 Prolonged physician service in the inpatient setting requiring unit/floor time beyond the usual service; each additional 30 minutes 99499 Forensic Evaluation - Felony - Can be running report but only billable one per incident H0002 Behavioral Health/Alcohol and Drug Screening for admission to treatment program H0003 Alcohol/Drug Screen - Lab
Procedure/ Revenue Code H0010 H0015 Service/Revenue Code Description Residential detoxification (sometimes referred to as social setting detoxification ) services include 24-hour supervision, observation, and support for individuals who are intoxicated or experiencing withdrawal. Residential detoxification is delivered by appropriately trained staff, is characterized by its emphasis on peer and social support, and provides care to individuals whose intoxication/withdrawal signs and symptoms are sufficiently severe to require 24-hour structure and support. Intensive Outpatient Treatment Program (IOP) provides a time limited, multifaceted approach to treatment service for individuals who require structure and support to achieve and sustain recovery. Intensive outpatient treatment programs generally provide a minimum of 9 treatment hours per week delivered during the day, evenings and/or weekends. A multi-disciplinary team must provide this service. The treatment program consists of, but is not limited to, individual, group and family counseling; relapse prevention and education; withdrawal management; and drug refusal skills. The amount of weekly services per individual is directly related to the goals and objectives specified in the individual s treatment plan; however, a minimum of 3 hours per day, 3 days a week is required. Billing NPI Rendering NPI Attending/ Admitting NPI H0017 H0018 H0019 Residential Treatment (<21 years of age) Accredited; Behavioral health accommodation psychiatric (or co-occurring) Short-term residential treatment program offering 24-hour intensive residential treatment, and rehabilitative services for up to 30 days in a highly structured, community-oriented environment. Appropriate for individuals who need concentrated therapeutic services prior to community residence. The focus of services is to stabilize the individual and provide a safe and supportive living environment during detox and/or recovery from addiction Residential program offering 24-hour supervised voluntary residential treatment, and rehabilitative services in a structured, community oriented environment (typically longer than 30 days), without room and board. Transitional living services (TLS) include organized rehabilitation services as well as assistance in obtaining appropriate long-term living arrangements. Also called transitional living, the services are designed for individuals who have the potential and motivation to ameliorate some skills deficits through a moderately structured rehabilitative program H0020 Methadone Maintenance/Opioid Replacement Therapy H0031 Assessment and Initial Treatment Plan H0039 Assertive Community Treatment-collateral encounter - Collaterals are members of the recipient s family or household, or significant others (e.g. landlord, criminal justice staff, and employer) who regularly interact with the recipient and are directly affected by or have the capability of affecting his or her condition, and are identified in the service plan as having a role in treatment. A collateral contact does not include contacts with other mental health service providers or individuals who are providing a paid service that would ordinarily be provided by the ACT team (e.g. meeting with a shelter staff who is assisting an ACT recipient in locating housing). H0041 Foster Care Non-Therapeutic H0048 Alcohol/Drug Testing - Court Ordered H2010 Medication Monitoring H2011 Crisis Intervention Services
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI H2012 Behavior Health Day Treatment (<21 years of age) H2014 Behavior Management Services H2014 Adaptive Skill Building Services w/diagnosis of Autism Disorder (AD) (<5 years of age) H2015 Comprehensive Community Support Services (CCSS) is to coordinate and provide services and resources to individuals/families necessary to promote recovery, rehabilitation and resiliency. CCSS identifies and addresses the barriers that impede the development of skills necessary for independent functioning in the community; as well as strengths, which may aid the individual or family in the recovery or resiliency process. Community support activities address goals specifically in the following areas: independent living; learning; working; socializing and recreation. H2016 MH Comprehensive community support services (CCSS), per diem H2017 Psychosocial Intervention (group or intergrated classroom) H2023 Supported Employment H2032 Activity Therapy H2033 Multi-systemic therapy (MST) provides an intensive home/family and community-based treatment for individuals (Juveniles) who are at risk of out-of-home placement or are returning home from placement. The MST model is based on empirical data and evidence-based interventions that target specific behaviors with individualized behavioral interventions. Services include an initial assessment to identify the focus of the MST interventions to be used with the individual and family. Specialized therapeutic and rehabilitative interventions are available to address specific areas of need such as substance abuse, delinquency, violent behavior etc. Services are primarily provided in the home, but workers also intervene at school and in other community settings H2034 Halfway House H2036 Substance Abuse Residential (Men) (Civigenics/CEC Only) H2036 Substance Abuse Residential (Women) (Civigenics/CEC Only) M0064 Brief Office Visit for the Monitoring/Changing of Psychotropic medications. Q3014 S5145 S9446 Telehealth originating site facility fee - In order for originating site to receive reimbursement for telehealth fee/services, revenue code 0919 must be billed in conjunction with HCPCS Code Q3014 and revenue code 0780. Telehealth services are inclusive in the outpatient reimbursement. Treatment foster care services provided to children or adolescents (up to age 21) who are placed with licensed and professionally trained families who provide 24-hour skilled, therapeutic care. Treatment Foster Care I services incorporate behavioral, psychological, and psychosocial approaches to clinical treatment services. Services must include clinical interventions by the specialized therapeutic foster care parent(s) and a clinical staff person. Services included in individualized treatment plans are designed to assist the child/adolescent to develop skills necessary for successful reintegration into the natural family or transition into the community. The family living experience is the core treatment service. Treatment Foster Care II (TFC II) allows for a step-down from TFC I when the child improves and no longer requires the level of intensity provided in TFC I (< 21 years of age) Patient Education, not otherwise classified, non physician provider, group, per session
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI S9482 Family Stabilization Services (intensive Home based services) S9986 Safehouse Interviews and Family Advocacy - one per year per client, any exceptions must be clinically approved T1005 Respite Care (licensed PhD practitioners must have perscriptive authority) - Reimbursement must not exceed $80.00 per day T1007 Service/Treatment Plan development and/or modification T1016 School Based Services T1024 Resource Management T1027 Infant Mental Health Services (Early Intervention Therapy - individual) T1502 Administration of Oral/intramuscular/Subcutaneous Medication
Definitions: a) Billing NPI - NPI number associated to the 'Pay To' provider on the claim b) Rendering NPI = NPI number associated to the 'Servicing Provider' on the claim (HCFA/CMS 1500/837P claims) c) Attending/Admitting NPI = NPI number associated to the ' Provider who is overseeing care' on the claim (UB04/UB92/837I claims)