MH and SUD Services for Cost Study.xlsx
XLSX spreadsheet 2 MB Posted
- Attached to
- RFP 2021-08 Behavioral Health Plan Cost Study
- Solicitation number
- S-X26083-00001463
- Issued by
- Multnomah County, Oregon
About this file
This document is a fee schedule for Mental Health (MH) and Substance Use Disorder (SUD) Services provided to Health Share of Oregon members by CareOregon. The fee schedule includes detailed information on the various MH and SUD services, including the permissible staff, time/unit, mode of delivery, limitations, and service criteria/guidelines. The services range from anesthesia for electroconvulsive therapy to online digital evaluation and management, psychotherapy, case management, and various levels of residential and outpatient treatment.
Additionally, this document is related to a state and local contract opportunity in Oregon, specifically for a cost study of the behavioral health services provided within the CareOregon Coordinated Care Organizations in Multnomah County and the City of Portland. CareOregon is seeking proposals to perform this cost study, which will analyze the costs associated with providing various behavioral health services in their networks.
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MH Services CareOregon Fee Schedule A for Mental Health Services Provided to Health Share of Oregon Members
| Code | Service | Permissible Staff^ | Time/ | ||
| Units | Mode Limitations | Service Criteria/Tips and Guidelines | |||
| 00104 | Anesthesia for ECT | N/A | Per Occurrence | Face-to-face | |
| 0362T | ABA - Behavior identification supporting assessment administered by physician or other QHP with the assistance of two or more technicians | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 0373T | ABA - Adaptive behavior treatment with protocol modification administered by physician or QHP with the assistance of two or more technicians | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |||
| 90785 | Interactive complexity (List separately in addition to the code for primary procedure) | LMP | Same as service provided | Face-to-face | |
| 90791 | Psychiatric Diagnostic Evaluation | Licensed QMHP | |||
| QMHP | Per Occurrence | Face-to-face |
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
90792 Psychiatric Diagnostic Evaluation with Medical Services PMHNP
PA
ND Per Occurrence Face-to-face
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
| 90792 AF | See 90792 | DO | |
| MD | Per Occurrence | Face-to-face | See 90792 |
| 90832 | Psychotherapy, 30 minutes with patient | Licensed QMHP | |
| QMHP | 30 minutes Rounding time: 16-37 minutes | Face-to-face | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
| 90833 | Psychotherapy, 30 minutes with patient when performed with an E/M service (List separately in addition to the code for primary procedure) | PMHNP |
PA
ND
DO
| MD | 30 minutes | Face-to-face | |
| 90834 | Psychotherapy, 45 minutes with patient | Licensed QMHP | |
| QMHP | 45 minutes Rounding time: 38 - 52 minutes | Face-to-face | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
| 90836 | Psychotherapy, 45 minutes with patient when performed with an E/M service (List separately in addition to the code for primary procedure) | PMHNP |
PA
ND
DO
| MD | 45 minutes | ||
| Rounding time: 38 - 52 minutes | Face-to-face | ||
| 90837 | Psychotherapy, 60 minutes with patient | Licensed QMHP | |
| QMHP | 60 minutes Rounding time: 53+ minutes | Face-to-face | |
| 90838 | Psychotherapy, 60 minutes with patient when performed with an E/M service (List separately in addition to the code for primary procedure) | PMHNP |
PA
ND
DO
| MD | 60 minutes Rounding time: 53+ minutes | Face-to-face | |
| 90839 | Psychotherapy for crisis, first 60 minutes | QMHP |
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
| MD | 60 minutes | ||
| Rounding time 30 to 74 minutes | Face-to-face | ||
| 90840 | Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) | QMHP |
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
| MD | Per Occurrence | Face-to-face | |
| 90846 | Family psychotherapy (without the patient present) | QMHP |
Licensed QMHP Mental Health Intern Per Occurrence Face-to-face or Telephone # If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant.
90847 Family psychotherapy (with patient present) QMHP Licensed QMHP
| Mental Health Intern | Per Occurrence | Face-to-face | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
| 90849 | Multiple-family group psychotherapy | QMHP |
Licensed QMHP
| Mental Health Intern | Per Occurrence | Face-to-face | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
| 90849 22 | Multiple-family group psychotherapy: Incredible Years | QMHP |
Mental Health Intern Licensed QMHP QMHA Per Occurrence Face-to-face # Code restricted to Incredible Years parenting sessions.
90853 Group psychotherapy (other than of a multiple-family group) QMHP Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
| MD | Per Occurrence | Face-to-face | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
| 90853 22 | Group psychotherapy: Family Sexual Abuse Treatment | QMHP |
Licensed QMHP Mental Health Intern Per Occurrence Face-to-face # Family Sexual Abuse Treatment group only. May be used for both parent only and children only groups.
90867 Initial Therapeutic repetitive Transcranial Magnetic Stimulation (TMS) treatment DO
MD
| PMHNP | Per Occurrence | Face-to-face | |
| 90868 | Therapeutic repetitive TMS treatment; subsequent delivery and management | DO |
MD
| PMHNP | Per Occurrence | Face-to-face | |
| 90869 | Transcranial magnetic stimulation treatment (stimulates nerve cells in brain to improve symptoms of depression) | LMP |
LPC
LMFT
LCSW
Psychologist
QMHP
| QMHA | Per Occurrence | Face-to-face | |
| 90870 | Electroconvulsive therapy - Facility | DO | |
| MD | Per Occurrence | Face-to-face | Covers all relevant facility charges |
| 90870 | Electroconvulsive therapy - Professional fees | DO | |
| MD | Per Occurrence | Face-to-face | Covers all relevant professional fees |
| 90882 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers or institutions | QMHP |
Mental Health Intern Licensed QMHP
OT
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per Occurrence Face-to-face or Telephone
If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant.
Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
| 90882 HN | See 90882 | QMHA | Per Occurrence | Face-to-face or Telephone | See 90882 |
| 90887 | 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 | QMHP |
Mental Health Intern Licensed QMHP
OT
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per Occurrence Face-to-face or Telephone If 2 or more distinct services are provided on the same day, bill one line and 2 or more units - NOT 2 or more lines, 1 unit each. May be used for check-ins with parents about child behavior unless family counseling is more appropriate.
Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
| 96130 | Psychological testing evaluation services, first hour | Psychologist | 60 Minutes | Face to Face |
| 96131 | Psychological testing evaluation services, each additional hour | Psychologist | 60 Minutes | Face to Face |
| 96136 | Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes | Psychologist | 30 Minutes | Face to Face |
| 96137 | Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes | Psychologist | 30 Minutes | Face to Face |
| 97151 | Behavior identification assessment and plan of care, physician /QHP each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 97152 | Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
BCBA
| Technician | 15 Minutes | Face to Face | |
| 97153 | Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
BCBA
| Technician | 15 Minutes | Face to Face | |
| 97154 | Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
BCBA
| Technician | 15 Minutes | Face to Face | |
| 97155 | Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with one patient, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 97156 | Family adaptive behavior treatment guidance, administered by physician/QHP (with or without the patient present), face-to-face with guardian/caregiver, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 97157 | Multiple-family group adaptive behavior treatment guidance, administered by physician/QHP (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 97158 | ABA - Group adaptive behavior treatment with protocol modification administered by physician or other QHP | Physician |
Psychologist Licensed Behavior Analyst
| BCBA | 15 Minutes | Face to Face | |
| 98966 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | PMHNP |
PA
| ND | 5-10 minutes | Telephone | |
| 98967 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | PMHNP |
PA
| ND | 11-20 minutes | Telephone | |
| 98968 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion | PMHNP |
PA
| ND | 21-30 minutes | Telephone | |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
| ND | 20 minutes | ||
| Rounding time 16-25 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99202 AF | See 99202 | DO | |
| MD | See 99202 | Face-to-face | |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
ND 30 minutes Rounding time
| 26-38 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99203 AF | See 99203 | DO | |
| MD | See 99203 | Face-to-face | |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
ND 45 minutes Rounding time
| 39-53 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99204 AF | See 99204 | DO | |
| MD | See 99204 | Face-to-face | |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and 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. | PMHNP |
PA
ND 60 minutes Rounding time
| 54 + minutes | Face-to-face | New description effective 1/1/2021 | |
| 99205 AF | See 99205 | DO | |
| MD | See 99205 | Face-to-face | |
| 99212 | 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. | PMHNP |
PA
ND 10 minutes Rounding time
| 8-13 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99212 AF | See 99212 | DO | |
| MD | See 99212 | Face-to-face | |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
ND 15 minutes Rounding time
| 14-20 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99213 AF | See 99213 | DO | |
| MD | See 99213 | Face-to-face | |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
ND 25 minutes Rounding time
| 21-33 minutes | Face-to-face | New description effective 1/1/2021 | |
| 99214 AF | See 99214 | DO | |
| MD | See 99214 | Face-to-face | |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. | PMHNP |
PA
ND 40 minutes Rounding time
| 34+ minutes | Face-to-face | New description effective 1/1/2021 | |
| 99215 AF | See 99215 | DO | |
| MD | See 99215 | Face-to-face | |
| 99251 AF | Initial Inpatient Consult - 20 minute duration | DO | |
| MD | 20 minutes | ||
| Rounding time 16-25 minutes | Face-to-face | ||
| 99252 AF | Initial Inpatient Consult - 40 minute duration | DO | |
| MD | 40 minutes Rounding time 36-45 minutes | Face-to-face | |
| 99253 AF | Initial Inpatient Consult - 55 minute duration | DO | |
| MD | 55 minutes | ||
| Rounding time 51-30 minutes | Face-to-face | ||
| 99324 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A problem focused history;
- A problem focused examination; and
- Medical decision making of straight-forward complexity OR 20 minute duration PMHNP
PA
| ND | 20 minutes | ||
| Rounding time 16 to 25 minutes | Face-to-face | ||
| 99324 AF | See 99324 | DO | |
| MD | See 99324 | Face-to-face | |
| 99325 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of a new patient, which requires these 3 key components: |
- An expanded problem focused history;
- An expanded problem focused examination; and
- Medical decision making of low complexity OR 30 minute duration PMHNP
PA
ND 30 minutes Rounding time
| 26-38 minutes | Face-to-face | ||
| 99325 AF | See 99325 | DO | |
| MD | See 99325 | Face-to-face | |
| 99326 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A detailed history;
- A detailed examination; and
- Medical decision making of moderate complexity OR 45 minute duration PMHNP
PA
ND 45 minutes Rounding time: 39 - 53 minutes Face-to-face
| 99326 AF | See 99326 | DO | |
| MD | See 99326 | Face-to-face | |
| 99327 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate complexity OR 60 minute duration PMHNP
PA
| ND | 60 minutes | ||
| Rounding time 54-68 minutes | Face-to-face | ||
| 99327 AF | See 99327 | DO | |
| MD | See 99327 | Face-to-face | |
| 99328 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of high complexity OR 75 minute duration PMHNP
PA
| ND | 75 minutes |
| Rounding time 69+ minutes | Face-to-face |
| 99328 AF | See 99328 | DO | |
| MD | See 99328 | Face-to-face | |
| 99334 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A problem-focused history;
- A problem-focused examination; and
- Medical decision making of straight-forward complexity OR 15 minute duration PMHNP
PA
| ND | 15 minutes | ||
| Rounding time 14-20 minutes | Face-to-face | ||
| 99334 AF | See 99334 | DO | |
| MD | See 99334 | Face-to-face |
99335 Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:
- An expanded problem-focused history;
- An expanded problem-focused examination; and
- Medical decision making of low complexity OR 25 minute duration PMHNP
PA
ND 25 minutes Rounding time
| 21-33 minutes | Face-to-face | ||
| 99335 AF | See 99335 | DO | |
| MD | See 99335 | Face-to-face | |
| 99336 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A detailed history;
- A detailed examination; and
- Medical decision making of moderate complexity OR 40 minute duration PMHNP
PA
| ND | 40 minutes | ||
| Rounding time 34-49 minutes | Face-to-face | ||
| 99336 AF | See 99336 | DO | |
| MD | See 99336 | Face-to-face | |
| 99337 | Domiciliary, Rest Home or Custodial Care Services visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate to high complexity OR 60 minute duration PMHNP
PA
| ND | 60 minutes | ||
| Rounding time 50+ minutes | Face-to-face | ||
| 99337 AF | See 99337 | DO | |
| MD | See 99337 | Face-to-face | |
| 99341 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A problem focused history;
- A problem focused examination; and
- Medical decision making of straight-forward complexity OR 20 minute duration PMHNP
PA
| ND | 20 minutes | ||
| Rounding time 16 to 25 minutes | Face-to-face | ||
| 99341 AF | See 99341 | DO | |
| MD | See 99341 | Face-to-face | |
| 99342 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: |
- An expanded problem-focused history;
- An expanded problem-focused examination; and
- Medical decision making of low complexity OR 30 minute duration PMHNP
PA
ND 30 minutes Rounding time 26-38 minutes Face-to-face
| 99342 AF | See 99342 | DO | |
| MD | See 99342 | Face-to-face | |
| 99343 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A detailed history;
- A detailed examination; and
- Medical decision making of moderate complexity OR 45 minute duration PMHNP
PA
| ND | 45 minutes | ||
| Rounding time 39-53 minutes | Face-to-face | ||
| 99343 AF | See 99343 | DO | |
| MD | See 99343 | Face-to-face | |
| 99344 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate complexity OR 60 minute duration PMHNP
PA
| ND | 60 minutes | ||
| Rounding time 54-68 minutes | Face-to-face | ||
| 99344 AF | See 99344 | DO | |
| MD | See 99344 | Face-to-face | |
| 99345 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of high complexity OR 75 minute duration PMHNP
PA
| ND | 75 minutes | ||
| Rounding time 69+ minutes | Face-to-face | ||
| 99345 AF | See 99345 | DO | |
| MD | See 99345 | Face-to-face | |
| 99347 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A problem-focused history;
- A problem-focused examination; and
- Medical decision making of straight-forward complexity OR 15 minute duration PMHNP
PA
| ND | 15 minutes | ||
| Rounding time 14-20 minutes | Face-to-face | ||
| 99347 AF | See 99347 | DO | |
| MD | See 99347 | Face-to-face | |
| 99348 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- An expanded problem-focused history;
- An expanded problem-focused examination; and
- Medical decision making of low complexity OR 25 minute duration PMHNP
PA
ND 25 minutes Rounding time
| 21-33 minutes | Face-to-face | ||
| 99348 AF | See 99348 | DO | |
| MD | See 99348 | Face-to-face | |
| 99349 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A detailed history;
- A detailed examination; and
- Medical decision making of moderate complexity OR 40 minute duration PMHNP
PA
| ND | 40 minutes |
| Rounding time 34-49 minutes | Face-to-face |
| 99349 AF | See 99349 | DO | |
| MD | See 99349 | Face-to-face | |
| 99350 | Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: |
- A comprehensive history;
- A comprehensive examination; and
- Medical decision making of moderate to high complexity OR 60 minute duration PMHNP
PA
| ND | 60 minutes | ||
| Rounding time 50+ minutes | Face-to-face | ||
| 99350 AF | See 99350 | DO | |
| MD | See 99350 | Face-to-face | |
| 99354 | Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to eligible codes). | DO |
MD
ND
PA
PMHNP 60 Minutes Rounding 30-74 minutes Face-to-face 99354 can be used in conjunction with 90837, 90847, 99241-99245, 99324-99337, 99341-99350, 99483.
99355 Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to 99354). DO
MD
ND
PA
| PMHNP | 30 minutes | ||
| Rounding 15-30 minutes | Face-to-face | ||
| 99356 | Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient or observation Evaluation and Management service) | DO |
MD
ND
PA
| PMHNP | 60 Minutes Rounding 30-74 minutes | Face-to-face | 99356 can be used in conjunction with 90837, 90847, 99218-99220, 99221-99223, 99224-99226, 99231-99233, 99234-99236, 99251-99255, 99304-99310 |
| 99357 | Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to 99356) | DO |
MD
ND
PA
PMHNP
| 30 minutes | |||
| Rounding 15-30 minutes | Face-to-face | ||
| 99366 | Medical team conference with patient and/or family, and nonphysician health care professionals, 30 minutes or more | LMP | |
| Psychologist | 30 Minutes | Face-to-face | |
| 99368 | Medical team conference with nonphysician health care professionals, 30 minutes or more | LMP | |
| Psychologist | 30 Minutes | Face-to-face | |
| 99407 | Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes | QMHA |
QMHP
Mental Health Intern Licensed QMHP
| CADC | Per Occurrence | Face-to-face | |
| 99415 | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour | PMHNP |
PA
| ND | 60 Minutes Rounding 30-74 minutes | Face-to-face | |
| 99416 | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to 99415) | PMHNP |
PA
| ND | 30 Minutes Rounding 15-30 minutes | Face-to-face | |
| 99417 | Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215) | DO |
MD
ND
PA
| PMHNP | 15 Minutes | ||
| Face-to-face | New code effective 1/1/2021 | ||
| 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes | PMHNP |
PA
| ND | 5-10 minutes | Telehealth | |
| 99421 AF | See 99421 | DO | |
| MD | 5-10 minutes | Telehealth | |
| 99422 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes | PMHNP |
PA
| ND | 11-20 minutes | Telehealth | |
| 99422 AF | See 99422 | DO | |
| MD | 11-20 minutes | Telehealth | |
| 99423 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes | PMHNP |
PA
| ND | 21 + minutes | Telehealth | |
| 99423 AF | See 99423 | DO | |
| MD | 21 + minutes | Telehealth | |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional to an established patient, parent or guardian, 5-10 minutes of medical discussion | PMHNP |
PA
| ND | Per Occurrence | Telephone | |
| 99441 AF | See 99441 | DO | |
| MD | Per Occurrence | Telephone | |
| 99442 | See 99441 for details; 11-20 minutes of medical discussion | PMHNP |
PA
| ND | Per Occurrence | Telephone | |
| 99442 AF | See 99442 | DO | |
| MD | Per Occurrence | Telephone | |
| 99443 | See 99441 for details; 21-30 minutes of medical discussion | PMHNP |
PA
| ND | Per Occurrence | Telephone | |
| 99443 AF | See 99443 | DO | |
| MD | Per Occurrence | Telephone | |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | Licensed QMHP |
Mental Health Intern
QMHP
| QMHA | Per Occurrence | Face-to-face | |||
| G0176 HQ | Activity therapy, Group | See G0176 | See G0176 | Face-to-face | |
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | Licensed QMHP |
Mental Health Intern
QMHP
QMHA
| Peer Support Specialist | Per Occurrence | Face-to-face | |||
| G0177 HQ | Training and educational services, Group | See G0177 | See G0177 | Face-to-face | |
| G2012 | Brief communication technology-based service, e.g., virtual check-in, by a physician/QHP who can report E/M services, provided to an established patient, 5-10 minutes of medical discussion | Licensed QMHP |
QMHP
Mental Health Intern
| (RN- see Tips and Guidelines) | 5-10 minutes | Telehealth | # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing. |
| G2012 AF | See G2012 | DP | |
| MD | 5-10 minutes | Telehealth | |
| G2012 AS | See G2012 | PMHNP |
PA
| ND | 5-10 minutes | Telehealth | |
| H0004 | Behavioral Health Counseling and Therapy | QMHP |
Licensed QMHP Mental Health Intern
| (RN - See Tips and Guidelines) | Per 15 minutes | Face-to-face or Telephone | # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be deliv+I3ered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing. |
| H0004 AF | See H0004 | DO | |
| MD | Per 15 minutes | Face-to-face or Telephone | See H0004 |
| H0004 AS | See H0004 | PMHNP |
PA
| ND | Per 15 minutes | Face-to-face or Telephone | See H0004 | |||
| H0004 HN | See H0004 | QMHA | Per 15 minutes | Face-to-face or Telephone | Incredible Years parenting programs only. For follow-up telephone counseling delivered by the QMHA as part of the fidelity model. QMHAs use 90849 22 when they are the second staff member in a multi-family psychotherapy group. | |
| H0019 | Behavioral Health, Long Term, Residential Services (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | N/A | Per Diem | Face-to-face | ||
| H0031 | Mental Health Assessment, by non-physician | QMHP | ||||
| Mental Health Intern | Per Occurrence | Face-to-face |
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
| H0031 GO | See H0031 | OT | Per Occurrence | Face-to-face | See H0031 |
| H0032 | Mental health service plan development by non-physician | Licensed QMHP |
QMHP
Mental Health Intern
| Per Occurrence | Face-to-face | |
| H0034 | Medication Training and Support | Licensed QMHP |
QMHP
Mental Health Intern
QMHA
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face or Telephone # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
| H0035 | Partial Hospitalization | N/A | Per diem | Face-to-face |
| H0036 | Community Psychiatric Supportive Treatment | Licensed QMHP |
QMHP
Mental Health Intern
| QMHA | Per 15 minutes | Face-to-face | ||||
| H0037 | Community psychiatric supportive treatment program, per diem | NA | Per diem | Face-to-face | ||
| H0038 | Self-help/peer services, Individual | Peer Support Specialist | Per 15 minutes | Face-to-face or Telephone | # |
| H0038 HQ | Self-help/peer services, Group | See H0038 | Per Occurrence | Face-to-face | |
| H0045 | Respite care services, not in the home, per diem | N/A | Per diem | Face-to-face | |
| H2000 | Comprehensive multidisciplinary evaluation with | ||||
| Child and Adolescent Needs Survey (CANS) | QMHA |
QMHP
Mental Health Intern Licensed QMHP Per Occurrence Face-to-face or Telephone* (*Telephone allowed for 0-12 months only)
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
| H2000 TG | Comprehensive multidisciplinary evaluation with | |
| Child and Adolescent Needs Survey (CANS) by non-physician | QMHP |
Mental Health Intern
| Licensed QMHP | Per Occurrence | Face-to-face | |
| H2010 | Comprehensive Medication Services | QMHP |
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face or Telephone
Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
H2011 Crisis intervention services QMHP Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face or Telephone # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
| H2011 HN | See H2011 | QMHA | Per 15 minutes | Face-to-face or Telephone | See H2011 |
| H2012 | Behavioral health day treatment, per hour | N/A | Per hour to a maximum of four per day | Face-to-face | Agency NPI may be noted as the provider on H2012 claims. |
| H2013 | Psychiatric health facility service, per diem | N/A | Per diem | Face-to-face |
| H2014 | Skills Training and Development, Individual | QMHA |
QMHP
Mental Health Intern Licensed QMHP Peer Support Specialist Per 15 minutes Face-to-face or Telephone #
| H2014 HQ | Skills Training and Development, Group | See H2014 | Per 15 minutes | Face-to-face or Telephone | # |
| H2021 | Community based wraparound services | QMHA |
QMHP
Mental Health Intern
| Licensed QMHP | Per 15 minutes | Face-to-face or Telephone | # |
| H2023 | Supported employment | QMHA |
QMHP
Mental Health Intern
| Licensed QMHP | Per 15 minutes | Face-to-face or Telephone | |
| H2027 | Psychoeducational Services, INDIVIDUAL | QMHA |
QMHP
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face or Telephone # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
H2027 HQ Psychoeducational Services, GROUP QMHA
QMHP
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
H2032 Activity therapy, Individual Licensed QMHP Mental Health Intern
QMHP
| QMHA | Per 15 minutes | Face-to-face | ||||
| H2032 HQ | Activity therapy, Group | See H2032 | See H2032 | See H2032 | ||
| Inpatient | Acute inpatient psychiatric care, all-inclusive | N/A | Per diem | Face to face | ||
| Q3014 | Telehealth originating site facility fee | All | per occurance | Face-to-Face | Facility provides in-person assistance accessing telehealth services | |
| S9453 | Smoking cessation classes, non-physician provider | QMHA |
QMHP
Mental Health Intern Licensed QMHP
| CADC | Per Occurrence | Face-to-face | |||
| S9480 | Intensive Outpatient | N/A | Per diem | Face-to-face | |
| T1005 | Respite Care Services | QMHA |
QMHP
Mental Health Intern
| Licensed QMHP | Per 15 minutes | Face-to-face | Travel time is factored into the rate and may not be billed under a separate code. |
| T1016 | Case Management | QMHP |
Mental Health Intern Licensed QMHP
PMHNP
PA
ND
DO
MD
(RN - See Tips and Guidelines) Per 15 minutes Face-to-face or Telephone
Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
| T1016 HN | See T1016 | QMHA | |
| Peer Support Specialist | Per 15 minutes | See T1016 | See T1016 |
| T1023 | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol | QMHP | |
| Mental Health Intern | Per Occurrence | Face-to-face |
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
T1023 HN Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter QMHA Per Occurrence Face-to-face
DOES NOT REQUIRE ABOVE THE LINE DIAGNOSIS.
| Non-Billable 90899 Code | ||
| 90899 15 | Unlisted Service and Procedure | |
| Extended Outreach Support | All | Per Occurrence |
15 or more Minutes No Limitation Non-billable code for submission as encounter only and should be used for medically necessary purposes. This code is not intended to track or measure staff productivity. Use this code only when a billable code is not available. This code is not paired with the Prioritized List and is to be used only by clinical staff (i.e. QMHA, QMHP, Licensed QMHP, CADC, OT, RN, PMHNP, PA, MD, and Peer Support Specialists). A corresponding service note for each billed encounter must be present from each person participating in the service. At a minimum, a provisional diagnosis must be given to be able to bill these codes. State approved paired diagnosis and those found on the State's diagnostic workup file are eligible for use.
This code should be used when more than one provider is present for a service OR when you have travelled to see a client in the community and they are not there. Examples would include a QMHP attending a psychiatric appointment with client, or when more than one staff provides a service for safety reasons.
Clinical documentation must demonstrate total duration of service/travel time.
PH TECH Note: Code not to be sent to state for encounter purposes.
90899 30 Per Occurrence 30 or more Minutes
90899 60 Per Occurrence 60 or more Minutes
| PLACE OF SERVICE CODES | MODIFIERS | ||
| 02 | Telehealth | 33 | 22 - Approved Evidence Based Practice Rate |
| 03 | School | 34 | AF - MD |
| 04 | Homeless Shelter | 50 | AS - Psychiatric Mental Health Nurse Practitioner OR Physician Assistant |
| 11 | Office | 51 | CC - Client Coordination non-billable service |
| 12 | Home | 52 | GT - Via interactive simultaneous audio and telecommunications systems |
| 15 | Mobile Unit | 53 | H9 - Court Ordered (for services related to court ordered diversion) |
| 16 | Temporary Lodging | 54 | HE - Mental Health Program |
| 20 | Urgent Care Facility | 55 | HN - QMHA: A bachelor's degree in a behavioral sciences field OR a combination of at least three years relevant work, education, training or experience |
| 21 | Inpatient Hospital | 56 | HQ - Group Service |
| 22 | Outpatient Hospital | 61 | UB - Services Provided in a School Based Health Center (Informational Modifier) |
| 23 | Emergency Room-Hospital | 62 | TG - Complex/High Tech Level of Care |
| 31 | Skilled Nursing Facility | 71 | ^ = Mental Health Intern approved provider type for agencies holding a current Certificate of Approval. Please use Taxonomy Code: 390200000X: Student in an Organized Health Care Education/Training Program when submitting encounters. |
| 32 | Nursing Facility | 99 | # = Service may be provided to a client's family member or care giver when the client is not present. |
| NCCI NOTE: The following modifiers are valid NCCI modifiers where relevant: XP/XE (XE is for FQHC providers), 25 and 59. | |||
| TPL NOTE: The following codes do not require Medicare to be billed first - all H-codes, all T-codes, 90849 22, 90853 22, 90882, 90882 HN, 90887, 99441, 99442, 99443, G0176, G0176 GO, G0176 HQ, G0177, G0177 HQ , S9480 and S9453. | |||
| MEDICAID ENROLLMENT/DMAP NOTE: All clinicians providing MH services must be enrolled in Oregon Medicaid as a MH Provider Type in order to be reimbursed for MH services rendered. | |||
| DMAP NOTE RE: RN / LPN: Per DMAP, RNs and LPNs who also hold a relevant behavioral health credential (QMHA, QMHP, CADC, LPC, LCSW or other behavioral health (BH) credential) can be enrolled in Oregon Medicaid as a Mental Health Provider (Type 33) or Alcohol & Drug Provider (Type 03) and should appear as the rendering provider on claims for services provided under their BH credential. For RNs and LPNs without a BH DMAP enrollment, all BH services performed must be done so under the supervision and direction of a licensed clinician. In this circumstance, the licensed clinician is responsible for the services being rendered and thus must appear on the claim as the rendering provider. |
https://www.encoderpro.com/epro/i9v3Handler.do?_k=104*15&_a=view SUD Services CareOregon Fee Schedule for Substance Use Disorder Services Provided to Health Share of Oregon Members
| Code | Service | Permissible Staff (as specified by applicable OARs) within an AMH Substance Use Disorder Certified/Licensed Program | Time/ | |
| Units | Mode Limitations | CareOregon Service Criteria/Tips and Guidelines | ||
| G2012 HF/HG + AS | See G2012 | PMHNP |
PA
| ND | 5-10 minutes | Telehealth | |
| G2012 HF/HG | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. | Licensed QMHP |
QMHP
Mental Health Intern
| (RN- see Tips and Guidelines) | 5-10 minutes | Telehealth | # Services delivered by an RN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing. |
| 90849 HF/HG | Multiple-family group psychotherapy | CADC Candidate | |
| CADC | Per Occurrence | Face-to-face with client or family | If two distinct services are provided on the same day, bill two lines with one unit each and required NCCI modifiers when relevant. |
Contracted rate effective 10/1/21 90887 HF/HG Explanation of psychiatric, medical examinations, procedures, and data to other than patient. CADC CADC Candidate
LMP**
(RN and LPN - See Tips and Guidelines) Per Occurrence Face-to-face or Telephone If two or more distinct services are provided on the same day, bill one line and 2 or more units - NOT two or more lines, 1 unit each.
Services delivered by an RN or LPN credentialed staff without a BH DMAP enrollment must be delivered under the supervision of the licensed clinician who is responsible for the service. Additionally, the supervising clinician's NPI must be used for billing.
Contracted rate effective 10/1/21
| 97810 HF/HG | Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient. | LICENSED ACUPUNCTURIST | Per 15 Minutes | Face-to-face |
| 97811 HF/HG | Acupuncture, 1 or more needles; without electrical stimulation, additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of the needle(s). | LICENSED ACUPUNCTURIST | Per 15 Minutes | Face-to-face |
| 97813 HF/HG | Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient. | LICENSED ACUPUNCTURIST | Per 15 Minutes | Face-to-face |
| 97814 HF/HG | Acupuncture, 1 or more needles; with electrical stimulation, additional 15 minutes of personal one-on-one contact with the patient, with reinsertion of the needle(s). | LICENSED ACUPUNCTURIST | Per 15 Minutes | Face-to-face |
| 98966 HF/HG | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | PA** |
NP**
| ND | 5-10 minutes | Telephone | Contracted rate effective 10/1/21 |
| 98967 HF/HG | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | PA** |
NP**
| ND | 11-20 minutes | Telephone | Contracted rate effective 10/1/21 |
| 98968 HF/HG | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion | PA** |
NP**
| ND | 21-30 minutes | Telephone | Contracted rate effective 10/1/21 |
| 99202 HF/HG | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. | PA** |
NP**
ND 20 minutes (Rounding time 16-25 minutes) Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99202 HF/HG + AF | See 99202 HF/HG | MD** | |
| DO** | See 99202 HF/HG | Face-to-face, Telehealth | Contracted rate effective 10/1/21 |
| 99203 HF/HG | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. | PA** |
NP**
| ND | 30 minutes (Rounding time | |
| 26-38 minutes) | Face-to-face, Telehealth | New description effective 1/1/2021 |
Contracted rate effective 10/1/21
| 99203 HF/HG + AF | See 99203 HF/HG | MD** | |
| DO** | See 99203 HF/HG | See 99203 HF/HG | Contracted rate effective 10/1/21 |
| 99204 HF/HG | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. | PA** |
NP**
| ND | 45 minutes (Rounding time | |
| 39-53 minutes) | Face-to-face, Telehealth | New description effective 1/1/2021 |
Contracted rate effective 10/1/21
| 99204 HF/HG + AF | See 99204 HF/HG | MD** | |
| DO** | See 99204 HF/HG | See 99204 HF/HG | |
| 99205 HF/HG | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and 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. | PA** |
NP**
| ND | 60 minutes (Rounding time | |
| 54 + minutes) | Face-to-Face, Telehealth | New description effective 1/1/2021 |
Contracted rate effective 10/1/21
| 99205 HF/HG + AF | See 99205 HF/HG | MD** | |
| DO** | See 99205 HF/HG | See 99205 HF/HG | Contracted rate effective 10/1/21 |
| 99211 HF/HG | 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. | PA** |
NP**
ND 5 minutes Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99211 HF/HG + AF | See 99211 HF/HG | MD** | |
| DO** | See 99211 HF/HG | See 99211 HF/HG | Contracted rate effective 10/1/21 |
| 99212 HF/HG | 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. | PA** |
NP**
ND 10 minutes (Rounding time 8-13 minutes) Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99212 HF/HG + AF | See 99212 HF/HG | MD** | |
| DO** | See 99212 HF/HG | See 99212 HF/HG | Contracted rate effective 10/1/21 |
| 99213 HF/HG | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. | PA** |
NP**
ND 15 minutes (Rounding time 14-20 minutes) Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99213 HF/HG + AF | See 99213 HF/HG | MD** | |
| DO** | See 99213 HF/HG | See 99213 HF/HG | Contracted rate effective 10/1/21 |
| 99214 HF/HG | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. | PA** |
NP**
ND 25 minutes (Rounding time 21-33 minutes) Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99214 HF/HG + AF | See 99214 HF/HG | MD** | |
| DO** | See 99214 HF/HG | See 99214 HF/HG | Contracted rate effective 10/1/21 |
| 99215 HF/HG | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. | PA** |
NP**
ND 40 minutes (Rounding time 34+ minutes) Face-to-face, Telehealth New description effective 1/1/2021
Contracted rate effective 10/1/21
| 99215 HF/HG + AF | See 99215 HF/HG | MD** | |
| DO** | See 99215 HF/HG | See 99215 HF/HG | Contracted rate effective 10/1/21 |
| 99415 HF/HG | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour | PA** |
NP**
| ND | 60 Minutes (Rounding 30-74 minutes) | Face-to-Face, Telehealth | Contracted rate effective 10/1/21 |
| 99416 HF/HG | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to 99415) | PA** |
NP**
| ND | 30 Minutes (Rounding 15-30 minutes) | Face-to-Face, Telehealth | Contracted rate effective 10/1/21 |
| 99417 HF/HG | Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215) |
DO**
MD**
PA**
NP**
ND 15 Minutes Face-to-Face, Telehealth New code effective 1/1/2021
Contracted rate effective 10/1/21 99421 HF/HG Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes PA**
NP**
| ND | 5-10 minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99421 HF/HG + AF | See 99421 | MD** | |
| DO** | 5-10 minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99422 HF/HG | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes | PA** |
NP**
| ND | 11-20 minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99422 HF/HG + AF | See 99422 | MD** | |
| DO** | 11-20 minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99423 HF/HG | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes | PA** |
NP**
| ND | 21 + minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99423 HF/HG + AF | See 99423 | MD** | |
| DO** | 21 + minutes | Telehealth | Contracted rate effective 10/1/21 |
| 99441 HF/HG | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | PA** |
NP**
| ND | 5-10 minutes | Telephone | Contracted rate effective 10/1/21 |
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