90791(Psychiatric diagnostic evaluation): This code is used to bill mental diagnostic assessments when medical services are not provided. The assessment includes the client’s history, mental status assessment, as well as recommendations. In Pennsylvania, Medicaid provides reimbursement even if the assessment was performed by non-psychiatrists (American Medical Association, 2017). Reimbursement Rates for PMHNP in Pennsylvania
90834 (Provision of psychotherapy for the patient for 45 minutes): This code is used to bill individual psychotherapy provided to the client, and this may be along with a family member. In addition, the time range for billing using this code is 38-52 minutes (Puente, 2018).
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90837 (Provision of psychotherapy to the patient for 60 minutes): This code is used in billing for psychotherapy provided to an individual and can include behavior modification. Psychotherapy can be provided to the client, in presence of a family member. The time range for billing provided psychotherapy using this code is 53 minutes and above (American Medical Association, 2017).
90847 (Family Psychotherapy in presence of the patient): The code is used to bill for psychotherapy provided to the patient as well as the members of the family. This code is also used to bill for psychotherapy provided to couples. There is a low likelihood of this billing being challenged by insurance due to the patient’s presence during therapy provision (American Medical Association, 2017).
90853 (Group Psychotherapy): This code is used to bill psychotherapy provided during a group therapy and pathology of every individual in the group is examined. Moreover, group dynamics are identified and utilized in behavior and attitude modification of the group members. This code is utilized in billing per-session services for each and every member of the group (O’Donnell et al, 2014). Reimbursement Rates for PMHNP in Pennsylvania
American Medical Association (2017). Fee Schedule For Community/Private Mental Health Centers, Effective July 1, 2018. Chicago: American Medical Association.
MH Procedure CPT or HCPC Codes and Rates 2018. American Medical Association.
O’Donnell A, Mark W & Amy K. (2014). Overcoming Roadblocks: Current and Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care. J Gen Intern Med. 28(12): 1667–1672.
Puente A. (2018). Coding, Billing & Documenting Professional Psychological Services. University Of North Carolina Wilmington
Reimbursement Rates for PMHNP in Pennsylvania
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