Medicaid Procedure Code Changes in Psychological Services August 2019

Medicaid introduced new procedure codes for psychological services effective August 1, 2019. The changes include telehealth availability for specific codes, such as 96130, 96131, 96136, and 96137. Units for codes like 90832, 90834, 90837, 90846, 90847, and 90853 have also been increased to 20 per calendar year. Billing guidelines and examples are provided for better understanding.

• Medicaid
• Procedure Codes
• Psychological Services
• Telehealth
• Billing

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1. Cha p ter 5 38 Sc ho o l -Ba sed Hea l th Servi c es Psychological Services August 2019

2. M edi c a i d p ro c edure c o de c ha nges E ffec ti ve August 1, 2 0 19 90791 Telehealth is now available for this code. Must use a GT modifier when billing, if telehealth was used. 96101 was replaced The new codes are : 96130, 96131, 96136, and 96137 96130 Psychological testing 2 units per calendar year, 60- minute unit 96131 Psychological Testing; additional hour 4 units per calendar year, 60- minute units. * Can only be used if billed with 96130* 96136 Test Administration and scoring - 1 unit per calendar year, 30- minute units. 96137 Test Administration and scoring; additional 30 minutes- 4 units per calendar year, 30-minute units. 2

3. M edi c a i d p ro c edure c o de c ha nges c o nti nued Example of how the new codes could be used: 96130 - 1 unit (60 minutes) 96131 - 2 units (120 minutes) 96136 - 1 unit (30 minutes, can only use once, 1 unit max) 96137 - 2 units (60 minutes) However this is ONLY a suggestion. If you need more time on 96130 or 96131, the units are there to use. Also if additional time was used on scoring, 96137 has a max of 4 units. 3

4. M edi c a i d p ro c edure c o de c ha nges c o nti nued 90832 Units increased to 20 per calendar year 90834 Units increased to 20 per calendar year 90837 units increased to 20 per calendar year 90846 units increased to 20 per calendar year 90847 units increased to 20 per calendar year 90853 units increased to 20 per calendar year All of these codes are also available as Telehealth. If billing telehealth, you must use the GT modifier on your billing to signify it was completed via telehealth. 4

5. Bi l l i ng F Bi l l i ng F o rm o rm Medicaid Number Last Name First Name WVEIS Number Date of Birth Provider Name County School Month/Year 5

6. Bi l l i ng F Bi l l i ng F o rm o rm Medicaid Number Last Name First Name 03900000003 Doe Aubrey WVEIS Number Date of Birth Provider Name Suzanne Smith 999999999 3-8-2008 County School Month/Year 59 501 Sept/2019 6

7. Di a gno si s Co des Enter the Psychological specific ICD 10 Diagnosis Codes on the form starting with box number one. Enter the codes that are directly associated with the therapy sessions and/or assessments. 7

8. I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1. 2. 3. 4. 5. 6. 8

9. I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1. F90.0 2. F91.1 3. 4. 5. 6. 9

10. School Based Psychological Services P ro c edure c o des Procedure Psychiatric Diagnostic Evaluation (No Medical Services) An integrated bio-psychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. Psychological Testing, Administration and Scoring Psychological Testing Includes Integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment of planning and report and interactive feedback to the patient, family member (s) or caregiver(s); First Hour Code Service Unit 90791 2 events per calendar year Event= Completed evaluation 2 units per calendar year 60-minute unit 96130 96131 Psychological Testing: Testing and evaluation by professional; Additional Hour 4 units per calendar year 60-minute unit * MUST USE 96130 to be able to bill for 96131 1 unit per calendar year 30- minute unit 4 units per calendar year 30-minute unit 2 events per calendar year. 96136 Test Administration and Scoring: First 30 minutes Test Administration and Scoring: Additional 30 minutes Developmental Testing: Limited to developmental testing with interpretation and report 96137 96110 Psychotherapy Services Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 1 unit per 16-37 minutes 20 units per calendar year 90832 Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 1 unit per 38-52 minutes 20 units per calendar year 90834 Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. 1 unit per 53 or more minutes 20 units per calendar year 90837 Family Psychotherapy 90846 Family Psychotherapy (without the patent present) Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development 1 unit per 45-50 minutes 20 units per calendar year 90847 Family Psychotherapy (with the patient present) Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development 1 unit per 45-50 minutes 20 units per calendar year Group Psychotherapy 90853 Group psychotherapy is treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patters of behavior, and encourage personality growth and development. 1 unit per 60 minutes 20 units per calendar year Maximum limit of 12 individuals in a group setting Psychotherapy for Crisis 90839 Psychotherapy for Crisis 1 unit per 60 minutes 4 per calendar year 1 unit per 30 minutes after the initial 60 minutes from 90839 4 per calendar year Additional 30 Minutes of psychotherapy for crisis, used in conjunction with 90839 90840 10

11. E nter Cl a i m Do c um enta ti o n Use the procedure codes and caps to complete the claim documentation section of the billing form. In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.) Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2) Column three - enter the CPT code including a GT modifier if being provided by telehealth. Columns four and five - enter the start and end time. In the last column enter the total number of units or event(s). 11

12. Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 12

13. Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 9-4-2019 9-4-2019 9-5-2019 9-5-2019 9-12-2019 1 1 1 1 2 96130 96131 96136 96137 90583 9:00 10:00 1:30 2:00 1:00 10:00 12:00 2:00 3:00 2:00 1 2 1 2 1 13

14. Si gna ture a nd Credenti a l s _____________________ Signature/Credentials Date ______________ 14

15. Kel l ey J o hnso n Co o rdi na to r Offi c e o f Sp ec i a l E duc a ti o n kel l ey. j o hnso n@ k12 . wv. us 30 4 - 5 5 8 - 2 6 96 ext 5 35 39 W VDE M edi c a i d W eb si te: http s: / / wvde. us/ sp ec i a l - educ a ti o n/ M edi c a i d/