Updated CPT Codes for Behavioral Health Screenings and Assessments

The primary steps in diagnosing patients with behavioral health problems involve conducting health screenings and assessments. There is a variety of current procedural terminology (CPT) codes to use for such assessments and screenings that pediatricians use for behavioral health, including many which have recently been updated.

Here’s a guide to existing and updated CPT codes.

Preventative Health

The following codes can be used with a preventative health or a regular office visit. Offices usually establish protocols for certain age groups to say which assessments should be completed at a visit. All scoring and documentation is performed with standardized instruments.

• 96110 Developmental screening with scoring and documentation.

Examples: developmental milestone survey, speech and language delay screen.

• 96127 Brief emotional and behavioral assessment with scoring and documentation.

Examples: depression inventory, attention-deficit/hyperactivity disorder (ADHD) scale).

• 96150 Initial health and behavior assessment that includes 15 minutes of face-to-face time with the patient.

Health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires.

• 96151 Health and behavior re-assessment that includes 15 minutes face-to-face with the patient.

Health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires.

• 96160 Administration of patient-focused health risk assessment instrument with scoring and documentation.

Health hazard appraisal.

ADHD

Treatment for ADHD often requires more time and/or visits than other diagnoses. Reporting your E/M based on time for these visits can help to capture that extra effort. You must document what you discussed with the patient, such as medication, side effects, symptoms and signs. You are also required to document the total time of the visit and that more than 50% was spent counseling. For example:

• 99214 Total time spent was 25 minutes, of which 20 minutes were spent counseling.
• 99203 Total time spent was 30 minutes, of which 20 minutes were spent counseling.

Obesity Counseling and other Preventative Counseling

Codes for obesity, family issues, and preventive work for behavior issues that can lead to health problems are billed by a physician or other qualified healthcare professional. These codes can not be billed with other preventive medicine codes (99381-99387 and 99391-99397).

The following codes are based on time. In order to bill for each, you must meet or exceed the time noted.

• 99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.
• 99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes.
• 99403 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes.
• 99404 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes.

Always check first with your local payers to make sure these codes are separately payable. .

Smoking Cessation and Alcohol/Substance Abuse Counseling and Screening

These in-person services are usually performed during a preventive visit or an office visit while counseling the patient on a risky lifestyle choice that may lead to a health problem. The codes, which can be billed with other preventive medicine codes, are provided by a physician or qualified healthcare professional.

Because the following codes are based on time, the midpoint amount of time should be met.

• 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes and up to 10 minutes.
• 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.
• 99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes.
• 99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes.

Utilizing Social Workers

These services can be provided by a healthcare professional with training in health and behavior interventions. These may include physicians, psychologists, advanced practice nurses, or clinical social workers.

Some  offices now have social workers on-site to provide valuable counseling and intervention services for individual patients or group. In many instances, a social worker can be credentialed and contracted with insurance companies directly. He or she would then bill  services separately, based on time.

The following codes are based on time and can be billed with multiple units.

• 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual/
• 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (two or more patients).
• 96154 Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present).
• 96155 Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present).

Example: 30 minutes spent with patient. 96152 – 2 units.

New CPT codes

Four new Medicare Part B billing codes became available in 2018 to report BHI services, from care management to psychiatric collaborative care. The codes may be used to bill for services outlined by the Psychiatric Collaborative Care Model (CoCM). In areas where a psychiatric consultant is required, he or she does not have to be participating with Medicare. Medicare makes payment to the billing practitioner directly for the service, so third-party contractors do not have to be Medicare participants.

These codes are not limited to Medicare beneficiaries, and may be used to treat patient with any behavioral, mental, or psychiatric condition being treated by the billing practitioner. This may include substance use disorders. For more information, visit cms.gov. Check with your commercial Payers to determine whether or not they are covering these codes.

• 99484 This code is used to bill services rendered using other BHI models of care. These include care management services for behavioral health conditions, as directed by a physician or other qualified health care professional, requiring at least 20 minutes of clinical staff time per calendar month.

Required elements of this care include an initial assessment or follow-up monitoring (including the use of applicable validated rating scales); behavioral health care planning in relation to behavioral/psychiatric health problems (including revision for patients who become stagnant or whose status changes); facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team.

• 99492 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.

Required elements of this care: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry (with appropriate documentation and participation in weekly caseload consultation with the psychiatric consultant); and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.

• 99493 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant and directed by the treating physician or other qualified healthcare professional.

Required elements of this care: tracking patient follow-up and progress using the registry (with appropriate documentation); participation in weekly caseload consultations with the psychiatric consultant; ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment (including medications) based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.

• 99494 Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional. List separately in addition to code for primary procedure.