Procedure Codes for Licensed Therapist/017

Local Code Description FAMILY THERAPY W/CHILD BY LICENSED PSYCHOLOGIST INCLUDING MDC015 X0097 REPORTS
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Local Code

Licensed Therapists

Max Alwd Max Amt Units

National MOD Code MOD 1 2

MOD 3

National Code Description FAMILY PSYCHOTHERAPY (WITH THE PATIENT PRESENT)

Max Alwd Max Amt Units

$90.00

13

90847

HP

$90.00

FAMILY THERAPY W/ CHILD BY MASTER''S LEVEL LICENSED CLINICIAN MDC015 X0098 INCLUDING REPORTS 45-60 MINUTES CHILD MENTAL HEALTH COUNSELOR/MARRIAGE AND FAMILY THERAPIST-INDIVIDUAL - MINIMUM 15MDC015 X0099 20 MINUTE VISIT FAMILY THERAPY W/O CHILD BY MASTER''S LEVEL LICENSED MDC015 X0100 CLINICIANS 45-60 MINUTES CHILD PSYCHIATRIST INITIAL DIAGNOSTIC INTERVIEW INCLUDING MDC015 X0101 REPORT- 60-90 MINUTES CHILD PSYCHIATRIST INDIVIDUAL THERAPY INCLUDING REPORT 45-60 MDC015 X0102 MINUTES CHILD PSYCHIATRIST INDIVIDUAL THERAPY WITH MED. MGT20-30 MDC015 X0103 MINUTES FAMILY THERAPY W/O CHILD BY LICENSED PSYCHOLOGIST INCLUDING MDC015 X0104 REPORTS 45-60 MINUTES CHILD PSYCHOLOGIST INITIAL DIAGNOSTIC INTERVIEW INCLUDING MDC015 X0105 REPORT 60-90 MINUTES CHILD PSYCHOLOGIST INDIVIDUAL THERAPY WITH REPORT 40-50 MDC015 X0106 MINUTES CHILD PSYCHOLOGIST INDIVIDUAL
MDC015 X0107 THERAPY WITH REPORT20-30 MINUTES

$75.00

13

H0004

HO

HR

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

$18.75

$22.00

To Be Eliminated BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION INCLUDING HISTORY, MENTAL STATUS, OR DISPOSITION (MAY INCLUDE COM PSYCHOTHERAPY, OFFICE/OUTPATIENT FACILITY, APPROXIMATELY 45 OR 50 MINUTES FACE-TO-FACE WITH THE PATIAENT COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES

$75.00

H0004

HO

HS

$18.75

$150.00

90801

$150.00

$95.00

90806

$95.00

$60.00

H2010

$30.00

$90.00

90846

HP

$125.00

90801

HP

$80.00

13

90806

HP

FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT) PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION INCLUDING HISTORY, MENTAL STATUS, OR DISPOSITION (MAY INCLUDE COM PSYCHOTHERAPY, OFFICE/OUTPATIENT FACILITY, APPROXIMATELY 45 OR 50 MINUTES FACE-TO-FACE WITH THE PATIAENT

$90.00

$125.00

$80.00

$60.00

To Be Eliminated BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

CHILD PSYCHOLOGIST GROUP

MDC015 X0108 THERAPY WITH REPORT60-90 MINUTES

$35.00

13

H0004

HQ

HP

$5.83

Procedure Codes for Licensed Therapist/017

Local Code Description CHILD MENTAL HEALTH SW,NP, MFT, LICENSED MENTAL HEALTH COUNSELOR, INDIVIDUAL DIAG. MDC015 X0109 INTERVIEW W/ REPORT 60-90 CHILD MENTAL HEALTH SW/NP,MFT,LICENSED MENTAL HEALTH COUNSELOR INDIVIDUAL THERAPY MDC015 X0110 W/REPORTS 45-60 MINS
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Local Code

Max Alwd Max Amt Units

National MOD Code MOD 1 2 HO or TD or AJ HO or TD or AJ

MOD 3

National Code Description

Max Alwd Max Amt Units

$100.00

H0031

MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN

$100.00

$65.00

13

H0004

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES HO or TD or AJ

$16.25

NURSE PRACTITIONER INDIVIDUAL

MDC015 X0111 THERAPY W/MED. MGT. 20-30 MINUTES

$35.00

H2010

TD

$17.50

CHILD MENTAL HEALTH SW,NP,MFT, LICENSED MENTAL HEALTH COUNSELOR GROUP THERAPY MDC015 X0112 W/REPORTS 60-90 MINUTES
MDC020 X0281 SEXUAL ABUSE EVALUATION

$30.00 $70.00

13 14

H0004 H0031*

HQ HO or HP

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

$5.00 $70.00

8 2

MDC020 X0282

MDC020 X0283 MDC020 X0284 MDC020 X0285

MDC010 X0500

SEXUAL ABUSE INDIVIDUAL AND FAMILY TREATMENT UNIT (50 MIN. SESSION) SEXUAL ABUSE INDIVIDUAL AND FAMILY TREATMENT UNIT (30 MIN. SESSION) SEXUAL ABUSE GROUP TREATMENT UNIT (50 MIN. SESSION) SEXUAL ABUSE GROUP TREATMENT UNIT (90 MIN. SESSION) DCYF-FAMILY THERAPY W/O CHILD BY MASTER''S LEVEL LICENSED CLINICIANS INCLUDING REPORTS, 4560 MINUTES

$70.00

H0004*

HR

HO or HP

$17.50

$35.00 $35.00 $70.00

3 3 3 H0004* HQ HO or HP

To Be Eliminated BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES Same as code above

$11.66

$75.00

H0004

HS

HO

DCYF - CHILD PSYCHIATRIST INITIAL DIAGNOSTIC INTERVIEW INCLUDING MDC010 X0501 REPORT 60-90 MINUTES DCYF - CHILD PSYCHIATRIST INDIVIDUAL THERAPY INCLUDING MDC010 X0502 REPORT 45-60 MINUTES DCYF- CHILD PSYCHIATRIST INDIVIDUAL THERAPY WITH MEDICATION MANAGEMENT 20-30 MDC010 X0503 MINUTES

$150.00

90801

$95.00

90806

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION INCLUDING HISTORY, MENTAL STATUS, OR DISPOSITION (MAY INCLUDE COM PSYCHOTHERAPY, OFFICE/OUTPATIENT FACILITY, APPROXIMATELY 45 OR 50 MINUTES FACE-TO-FACE WITH THE PATIAENT

$18.75

$150.00

$95.00

$60.00

H2010

COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES

$30.00

Procedure Codes for Licensed Therapist/017

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Local Code

Local Code Description

Max Alwd Max Amt Units

National MOD Code MOD 1 2

MOD 3

National Code Description

Max Alwd Max Amt Units

DCYF FAMILY THERAPY W/O CHILD BY LICENSED PSYCHOLOGIST INCLUDING MDC010 X0504 REPORTS 45-60 MINUTES DCYF - CHILD PSYCHOLOGIST INITIAL DIAGNOSTIC INTERVIEW INCLUDING MDC010 X0505 REPORT 60-90 MINUTES DCYF - CHILD PSYCHOLOGIST INDIVIDUAL THERAPY WITH REPORT 4560 MINUTES DCYF - CHILD PSYCHOLOGIST INDIVIDUAL THERAPY WITH REPORT 2030 MINUTES DCYF - CHILD PSYCHOLOGIST - GROUP THERAPY WITH REPORT 60-90 MINUTES DCYF-CHILD MENTAL HEALTH SW, NP,MFT,LICENSED MENTAL HEALTH COUNSELOR INITIAL DIAGNOSTIC INTERVIEW W/RPT 60-90 DCYF-CHILD MENTAL HEALTH SW, NP,MFT,LICENSED MENTAL HEALTH COUNSELOR INDIVIDUAL THERAPY W/RPTS 45-60 MIN DCYF - NURSE PRACTITIONER INDIVIDUAL THERAPY WITH MEDICATION MANAGEMENT 20-30 MINUTES

$90.00

90846

HP

$125.00

90801

HP

MDC010 X0506

$80.00

13

90806

HP

FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT) PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION INCLUDING HISTORY, MENTAL STATUS, OR DISPOSITION (MAY INCLUDE COM PSYCHOTHERAPY, OFFICE/OUTPATIENT FACILITY, APPROXIMATELY 45 OR 50 MINUTES FACE-TO-FACE WITH THE PATIAENT

$90.00

$125.00

$80.00

MDC010 X0507

$60.00

To Be Eliminated BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

MDC010 X0508

$35.00

13

H0004

HQ HO or TD or AJ HO or TD or AJ

HP

$5.83

MDC010 X0509

$100.00

H0031

MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN

$100.00

MDC010 X0510

$65.00

13

H0004

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

$16.25

MDC010 X0511

$35.00

H2010

TD

COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES

$17.50

DCYF- CHILD MENTAL HEALTH SW,NP, MFT,LICENSED MENTAL HEALTH COUNSELOR, GROUP THERAPY WITH MDC010 X0512 REPORTS 60-90 MINUTS DIAGNOSTIC ASSESSMENT SERVICES DCYF LICENSED MASTERS MENTAL HEALTH PROFESSIONAL PER HOURMDC010 X0513 REPORT INCLUDED DIAGNOSTIC ASSESSMENT SERVICESDCYF- PHD PSYCHOLOGIST PER HOURMDC010 X0514 REPORT INCLUDED

$30.00

13

H0004

HQ

HO or TD or AJ

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

$5.00

$70.00

13

H0031

HO

H9

MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN

$70.00

$80.00

H0031

HP

H9

MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN

$80.00

Procedure Codes for Licensed Therapist/017

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DCYF

Local Code Description DIAGNOSTIC ASSESSMENT SERVICESDCYF-PSYCHIATRIST PER HOURX0515 COURT ORDERED

Local Code

Max Alwd Max Amt Units

National MOD Code MOD 1 2

MOD 3

National Code Description

Max Alwd Max Amt Units

$100.00

To Be Eliminated

DCYF-FAMILY THERAPY WITH CHILD BY LICENSED PSYCHOLOGIST INCLUDING MDC010 X0597 REPORTS 45-60 MINUTES DCYF- FAMILY THERAPIST WITH CHILD BY MASTER''S LEVEL LICENSED CLINICIAN INCLUDING REPORTS 45-60 MDC010 X0598 MINUTES DCYF-CHILD MENTAL HEALTH COUNSELOR/MARRIAGE AND FAMILY THERAPIST - INDIVIDUAL, MINIMUM 15MDC010 X0599 20 MINUTE VISIT

$90.00

13

90847

HP

FAMILY PSYCHOTHERAPY (WITH THE PATIENT PRESENT)

$90.00

$75.00

13

H0004

HR

HO

BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES

$18.75

$22.00

To Be Eliminated *Must Use Diagnosis Code of 995.53 with these claims.

Modifiers AH AJ HO HP HQ HR HS H9 TD

Modifier Description Clinical Psychologists Clinical Social Worker Master's Level Doctoral Level Group Family/Couple with Client Present Family/Couple without Client Present Court Ordered Registered Nurse