Overview
There have been no changes with the psych outpatient CPT codes since the 2021 updates. Click this link to jump to the MDM chart cheat sheet.
99213
MDM: 1 stable chronic illness with Rx management (stable ADHD, MDD in remission)
Time = 20-29 minutes – Document total time or start/stop time
99214
MDM: 1 or more chronic illness that is worsening, progressing or with side effects + Rx management
2 chronic stable diagnoses, + Rx management
1 undiagnosed new problem (rule out)
Time = 30-39 minutes – Document total time or start/stop time
99215
MDM:1 or more chronic illness with severe exacerbation, progression or side effects of tx
1 acute or chronic illness that poses a threat to life or bodily function
– Recommendation/discussion to admit to higher level of care can be counted whether patient accepted admission or not.
Time = 40-54 minutes – Document total time or start/stop time
Social Determinants of Health
If a clinician documents a patient’s social determinant of health and how it impacts their illness, the clinician may count this as a moderate risk in medical decision making.
NewPatient E&M based on time (Document total time)
99203 - 30 - 44 min
99204 - 45 - 59 min
99205 - 60 - 74 min
75 or more - 99417
Prolonged Care 99417
New patient: 60 minutes 99205 + each additional 15 minutes (99417 x qty)-minimum 75 minutes
Established patient: 40 minutes 99215 + each additional 15 minutes (99417 x qty)-minimum 55 minutes
Psychotherapy with E/M 992xx + 9083x
E/M must be documented and billed based on Medical Decision Making – MDM
Psychotherapy must be billed based on time
90833-30 minutes (16 -37 minutes of therapy)
· Used in addition to E/M service
90836-45 minutes (38 - 52 minutes of therapy)-we are not using this code
· Used in addition to E/M service
90838-60 minutes (minimum 53 minutes of therapy)-we are not using this code
· Used in addition to E/M service
One note is acceptable but must be able to identify the 2 distinct services
MDM chart cheat sheet
Updated