Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 99214 UG-Doctoral Level (Child Psychiatrist) Evaluation and Management for an Established Patient, 30-39 minutes $143.98 MH and SA OP Services 99214 U6-Doctoral Level (MD / DO) Evaluation and Management for an Established Patient, 30-39 minutes $118.51 MH and SA OP Services 99214 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Evaluation and Management for an Established Patient, 30-39 minutes $100.73 MH and SA OP Services 99215 UG-Doctoral Level (Child Psychiatrist) Evaluation and Management for an Established Patient, 40-54 minutes $166.57 MH and SA OP Services 99215 U6-Doctoral Level (MD / DO) Evaluation and Management for an Established Patient, 40-54 minutes $166.57 MH and SA OP Services 99215 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Evaluation and Management for an Established Patient, 40-54 minutes $141.58 MH and SA OP Services 99231 UG-Doctoral Level (Child Psychiatrist) Subsequent Hospital Care for Eval and Management, 15 minutes $ 78.07 MH and SA OP Services 99231 U6-Doctoral Level (MD / DO) Subsequent Hospital Care for Eval and Management, 15 minutes $ 59.27 MH and SA OP Services 99231 AH-Doctoral Level (PhD, PsyD, EdD) Subsequent Hospital Care for Eval and Management, 15 minutes $ 56.89 MH and SA OP Services 99231 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Subsequent Hospital Care for Eval and Management, 15 minutes $ 47.47 MH and SA OP Services 99232 UG-Doctoral Level (Child Psychiatrist) Subsequent Hospital Care for Eval and Management, 25 minutes $ 117.11 MH and SA OP Services 99232 U6-Doctoral Level (MD / DO) Subsequent Hospital Care for Eval and Management, 25 minutes $ 88.19 MH and SA OP Services 99232 AH-Doctoral Level (PhD, PsyD, EdD) Subsequent Hospital Care for Eval and Management, 25 minutes $ 84.66 MH and SA OP Services 99232 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Subsequent Hospital Care for Eval and Management, 25 minutes $ 70.63 MH and SA OP Services 99233 UG-Doctoral Level (Child Psychiatrist) Subsequent Hospital Care for Eval and Management, 35 minutes $ 156.16 MH and SA OP Services 99233 U6-Doctoral Level (MD / DO) Subsequent Hospital Care for Eval and Management, 35 minutes $ 117.59 MH and SA OP Services 99233 AH-Doctoral Level (PhD, PsyD, EdD) Subsequent Hospital Care for Eval and Management, 35 minutes $ 112.88 MH and SA OP Services 99233 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Subsequent Hospital Care for Eval and Management, 35 minutes $...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 90847 U3-Intern (PhD, PsyD, EdD) / or MAT Family Psychotherapy (conjoint psychotherapy) (with patient present) $ 50.23 MH and SA OP Services 90847 U4-Intern (Master's) Family Psychotherapy (conjoint psychotherapy) (with patient present) $ 48.77 MH and SA OP Services 90849 UG-Doctor Level (Child Psychiatrist) Multi-family group psychotherapy $ 46.29 MH and SA OP Services 90849 U6-Doctor Level (MD/DO) Multi-family group psychotherapy $ 38.84 MH and SA OP Services 90849 AH-Doctoral Level (PhD, PsyD, EdD) Multi-family group psychotherapy $ 35.86 MH and SA OP Services 90849 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Multi-family group psychotherapy $ 33.00 MH and SA OP Services 90849 HO-Master's Level (Independently Licensed Clinicians, Licensed Alcohol and Drug Counselor 1, and Supervised Master's Level Clinicians) Multi-family group psychotherapy $ 27.69 MH and SA OP Services 90849 U3-Intern (PhD, PsyD, EdD) / or MAT Multi-family group psychotherapy $ 17.96 MH and SA OP Services 90849 U4-Intern (Master's) Multi-family group psychotherapy $ 16.50 MH and SA OP Services 90853 UG-Doctoral Level (Child Psychiatrist) Group psychotherapy (other than of a multiple-family group) $ 46.29 MH and SA OP Services 90853 U6-Doctoral Level (MD / DO) Group psychotherapy (other than of a multiple-family group) $ 38.84 MH and SA OP Services 90853 AH-Doctoral Level (PhD, PsyD, EdD) Group psychotherapy (other than of a multiple-family group) $ 35.86 MH and SA OP Services 90853 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Group psychotherapy (other than of a multiple-family group) $ 33.12 MH and SA OP Services 90853 HO-Master's Level (Independently Licensed Clinicians, Licensed Alcohol and Drug Counselor 1, and Supervised Master's Level Clinicians) Group psychotherapy (other than of a multiple-family group) $ 33.12 MH and SA OP Services 90853 U3-Intern (PhD, PsyD, EdD) / or MAT Group psychotherapy (other than of a multiple-family group) $ 17.96 MH and SA OP Services 90853 U4-Intern (Master's) Group psychotherapy (other than of a multiple-family group) $ 16.50 MH and SA OP Services 90882 UG-Doctoral Level (Child Psychiatrist) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 51.11 MH and SA OP Services 90882 U6-Doctoral Level (MD / DO) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 90832 AH-Doctoral Level (PhD, PsyD, EdD) Individual Psychotherapy, approximately 20-30 minutes $ 59.16 MH and SA OP Services 90832 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Individual Psychotherapy, approximately 20-30 minutes $ 59.16 MH and SA OP Services 90832 HO-Master's Level (Independently Licensed Clinicians, Licensed Alcohol and Drug Counselor 1, and Supervised Master's Level Clinicians) Individual Psychotherapy, approximately 20-30 minutes $ 52.20 MH and SA OP Services 90832 U7-Certified Addiction Counselor / Certified Alcohol & Drug Abuse Counselor Individual Psychotherapy, approximately 20-30 minutes $ 52.20 MH and SA OP Services 90832 U3-Intern (PhD, PsyD, EdD) / or MAT Individual Psychotherapy, approximately 20-30 minutes $ 35.49 MH and SA OP Services 90832 U4-Intern (Master's) Individual Psychotherapy, approximately 20-30 minutes $ 31.32 MH and SA OP Services 90833 U6-Doctoral Level (MD / DO) Add-On Code; Psychotherapy, 30 minutes, when Performed with an Evaluation and Management Service $ 63.83 MH and SA OP Services 90833 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Add-On Code; Psychotherapy, 30 minutes, when Performed with an Evaluation and Management Service $ 54.25 MH and SA OP Services 90834 UG-Doctoral Level (Child Psychiatrist) Individual Psychotherapy, approximately 45 minutes $ 115.70 MH and SA OP Services 90834 U6-Doctoral Level (MD / DO) Individual Psychotherapy, approximately 45 minutes $ 101.66 MH and SA OP Services 90834 AH-Doctoral Level (PhD, PsyD, EdD) Individual Psychotherapy, approximately 45 minutes $ 95.89 MH and SA OP Services 90834 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Individual Psychotherapy, approximately 45 minutes $ 95.46 MH and SA OP Services 90834 HO-Master's Level (Independently Licensed Clinicians, Licensed Alcohol and Drug Counselor 1, and Supervised Master's Level Clinicians) Individual Psychotherapy, approximately 45 minutes $ 95.46 MH and SA OP Services 90834 U3-Intern (PhD, PsyD, EdD) / or MAT Individual Psychotherapy, approximately 45 minutes $ 47.98 MH and SA OP Services 90834 U4-Intern (Master's) Individual Psychotherapy, approximately 45 minutes $ 47.26 MH and SA OP Services 90836 U6-Doctoral Level (MD / DO) Add-On Code; Psychotherapy, 45 minutes, when Performed with an Evaluation and Management Service $ 82.90 MH and SA OP Services 90836 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Add-On Code; Psychotherapy, 45 minutes, when Perf...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 90853 U4-Intern (Master's) Group psychotherapy (other than of a multiple-family group) $ 16.50 MH and SA OP Services 90882 UG-Doctoral Level (Child Psychiatrist) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 51.11 MH and SA OP Services 90882 U6-Doctoral Level (MD / DO) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 44.33 MH and SA OP Services 90882 AH-Doctoral Level (PhD, PsyD, EdD) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 23.97 MH and SA OP Services 90882 SA-Nurse Practitioner/Board Certified RNCS and APRN-BC Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 38.36 MH and SA OP Services 90882 HO-Master's Level (Independently Licensed Clinicians, Licensed Alcohol and Drug Counselor 1, and Supervised Master's Level Clinicians) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 23.63 MH and SA OP Services 90882 U3-Intern (PhD, PsyD, EdD) / or MAT Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 12.00 MH and SA OP Services 90882 U4-Intern (Master's) Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions. $ 11.81 MH and SA OP Services 90887 UG-Doctoral Level (Child Psychiatrist) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 79.19 MH and SA OP Services 90887 U6-Doctoral Level (MD / DO) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 79.19 MH and SA OP Services 90887 AH-Doctoral Level (PhD, PsyD, EdD) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 67.32 MH and SA OP...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost patient, which requires a medically appropriate history and/or examination and a high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. MH and SA OP Services 99205 Nurse Practitioner/Board Certified RNCS and APRN- BC Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and a high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. $ 150.39 MH and SA OP Services 99211 Doctoral Level (Child Psychiatrist) Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. $ 19.88 MH and SA OP Services 99211 Doctoral Level (MD / DO) Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. $ 17.24 MH and SA OP Services 99211 Nurse Practitioner/Board Certified RNCS and APRN- BC Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. $ 15.71 MH and SA OP Services 99212 Doctoral Level (Child Psychiatrist) Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. $ 40.99 MH and SA OP Services 99212 Doctoral Level (MD / DO) Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. $ 35.55 MH and SA OP Services 99212 Nurse Practitioner/Board Certified RNCS and APRN- BC Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropr...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 90887 Nurse Practitioner/Board Certified RNCS and APRN- BC Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 34.87 MH and SA OP Services (Behavioral Health Urgent Care) 90887 Nurse Practitioner/Board Certified RNCS and APRN- BC; GJ-Behavioral Health Urgent Care Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 40.10 MH and SA OP Services 90887 Master's Level Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 21.48 MH and SA OP Services (Behavioral Health Urgent Care) 90887 Master's Level; GJ- Behavioral Health Urgent Care Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 24.70 MH and SA OP Services 90887 Intern (PhD, PsyD, EdD) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 10.91 MH and SA OP Services (Behavioral Health Urgent Care) 90887 Intern (PhD, PsyD, EdD); GJ-Behavioral Health Urgent Care Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 12.55 MH and SA OP Services 90887 Intern (Master's) Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 10.74 MH and SA OP Services (Behavioral Health Urgent Care) 90887 Intern (Master's); GJ- Behavioral Health Urgent Care Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient $ 12.35 MH and SA OP Services 96372 Doctoral Level (MD / DO) Therapeutic, Prophylactic or Diag...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. MH and SA OP Services 99253 Nurse Practitioner/Board Certified RNCS and APRN- BC Initial Inpatient Consultation, 55 minutes $ 114.86 MH and SA OP Services 99254 Doctoral Level (Child Psychiatrist) Initial Inpatient Consultation, 80 minutes $ 255.41 MH and SA OP Services 99254 Doctoral Level (MD / DO) Initial Inpatient Consultation, 80 minutes $ 191.80 MH and SA OP Services 99254 Nurse Practitioner/Board Certified RNCS and APRN- BC Initial Inpatient Consultation, 80 minutes $ 153.64 MH and SA OP Services 99255 Doctoral Level (Child Psychiatrist) Initial Inpatient Consultation - Comprehensive, 110 minutes $ 336.47 MH and SA OP Services 99255 Doctoral Level (MD / DO) Initial Inpatient Consultation - Comprehensive, 110 minutes $ 252.34 MH and SA OP Services 99255 Nurse Practitioner/Board Certified RNCS and APRN- BC Initial Inpatient Consultation - Comprehensive, 110 minutes $ 202.12 MH and SA OP Services 99402 Doctoral Level (PhD, PsyD, EdD) Preventative Medicine Counseling, 30 minutes (Psychological Testing) $ 40.98 MH and SA OP Services 99402 Intern (PhD, PsyD, EdD) Preventative Medicine Counseling, 30 minutes (Psychological Testing) $ 20.50 MH and SA OP Services 99404 Doctor (Child / Adolescent MD / DO) Preventative Medicine Counseling, 60 minutes (Counseling and/or Risk Factor Reduction Intervention) $ 153.27 MH and SA OP Services 99404 Doctoral Level (MD / DO) Preventative Medicine Counseling, 60 minutes (Counseling and/or Risk Factor Reduction Intervention) $ 177.11 MH and SA OP Services 99404 Nurse Practitioner/Board Certified RNCS and APRN- BC Preventative Medicine Counseling, 60 minutes (Counseling and/or Risk Factor Reduction Intervention) $ 153.27 MH and SA OP Services 99417 Doctoral Level (MD / DO) Prolonged office or other outpatient evaluation and management service, requiring total time with or without direct patient contact beyond usual service, on the date of the primary service (e.g., billed with 99205 or 99215), each 15 minutes $ 26.08 MH and SA OP Services 99417 Nurse Practitioner/Board Certified RNCS and APRN- BC Prolonged office or other outpatient evaluation and management service, requiring total time with or without direct patient contact beyond usual service, on the date of the primary service (e.g., billed with99205 or 99215), each 15 minutes $ 26.08
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. Diversionary Services H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan) including assessment, counseling; crisis intervention, and activity therapies or education. (Enhanced Structured Outpatient Addiction Program - SOAP with Motivational Interviewing Counseling) $ 80.30 Diversionary Services H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan) including assessment, counseling; crisis intervention, and activity therapies or education. (Structured Outpatient Addiction Program (SOAP) with Motivational Interviewing) $ 71.59 Diversionary Services H0037 Community Psychiatric Supportive Treatment Program, per diem $ 654.13 Diversionary Services H2012 + Behavioral Health Day Treatment, per hour (Psychiatric Day Treatment) 101 CMR 307 Diversionary Services H0038 HF Recovery Coaching – A non-clinical service provided (in 15 minutes increments) by a trained recovery advocate who provides guidance and coaching for individuals to meet their recovery goals 101 CMR 346 Diversionary Services H2012 Behavioral Health Day Treatment, per hour (Enhanced Psychiatric Day Treatment) 101 CMR 307 Diversionary Services H2015 + Comprehensive community support services, per 15 minutes (Community Support Program) $ 13.97 Diversionary Services H2015 HF Recovery Support Navigator – Self-help/peer service by a recovery advocate trained in Recovery Coaching. Rate is in 15-minutes increments. 101 CMR 444 Diversionary Services H2016 HE When directed by EOHHS, Comprehensive community support services, per diem (Community Support Program (CSP) for members residing in DHCD-funded new temporary shelters) $ 17.30 Diversionary Services H2016 HH Effective on the later of October 1, 2021 or the date on which CMS approves these services, comprehensive community support program, per diem (Enrolled Client Day) (behavioral health service by a navigator trained to support members with justice involvement) (CSP-JI) $ 17.23 Diversionary Services H2016 HM Comprehensive community support program, per diem (Enrolled Client Day) (recovery support service by a recovery advocate trained in Recovery Coaching) 101 CMR 346 Diversionary Services H2020 + Therapeutic behavioral services, per diem (Dialectical Behavior Therapy) $ 26.50 Diversionary Servi...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. Other Outpatient 90870 + Electroconvulsive therapy (includes necessary monitoring) $ 630.95 Other Outpatient 96112 Doctoral Level (PhD, PsyD, EdD) Developmental Testing administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour (Learning Disorders) $ 180.72 Other Outpatient 96113 Doctoral Level (PhD, PsyD, EdD) Each additional 30 minutes (List separately in addition to code for primary procedure) (Developmental/Behavioral Screening and Testing) $ 90.36 Other Outpatient 96130 Doctoral Level (PhD, PsyD, EdD) Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour $ 91.39 Other Outpatient 96131 Doctoral Level (PhD, PsyD, EdD) Each additional hour (List separately in addition to code for primary procedure) $ 91.39 Other Outpatient 96132 Doctoral Level (PhD, PsyD, EdD) Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour $ 91.39 Other Outpatient 96133 Doctoral Level (PhD, PsyD, EdD) Each additional hour (List separately in addition to code for primary procedure) $ 91.39 Other Outpatient 96136 Doctoral Level (PhD, PsyD, EdD) Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes (Test administration and scoring by professional) $ 45.70 Other Outpatient 96137 Doctoral Level (PhD, PsyD, EdD) Each additional 30 minutes (List separately in addition to code for primary procedure) (Test administration and scoring by professional) $ 45.70 Other Outpatient 96138 Technician/Intern (Master's) Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minut...
Category of Service Procedure Code Modifier Group Procedure Description Unit Cost. Other Outpatient H0046 Doctoral Level (MD/DO) Mental health services, not otherwise specified (Collateral Contact) $ 40.30 Other Outpatient H0046 Doctoral Level (PhD, PsyD, EdD) Mental health services, not otherwise specified (Collateral Contact) $ 21.79 Other Outpatient H0046 Nurse Practitioner/Board Certified RNCS and APRN- BC Mental health services, not otherwise specified (Collateral Contact) $ 34.87 Other Outpatient H0046 Master's Level Mental health services, not otherwise specified (Collateral Contact) $ 21.48 Other Outpatient H0046 Addiction Counselor Mental health services, not otherwise specified (Collateral Contact) $ 21.48 Other Outpatient H0046 Intern (PhD, PsyD, EdD) Mental health services, not otherwise specified (Collateral Contact) $ 10.91 Other Outpatient H0046 Intern (Master's) Mental health services, not otherwise specified (Collateral Contact) $ 10.74
