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
Important: If a patient has already completed an initial psychiatric evaluation (CPT 99205) with any Rula psychiatric clinician within the past 3 years, the clinician must bill using a follow-up code (e.g., 99215), even if this is their first session with that specific prescriber.
The Clinician may still use the initial evaluation charting template, but should not bill 99205 again within the 3-year timeframe.
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