Public Mental Health System Rates Effective July 1, 2016
Procedure
E&M
Service Description
MD
non-facility
MD/NPP
facility
NPP
PHD
Psych
POS
21,22,31,32,
51,52
OTHER PROFESSIONAL SERVICES FOR IOP, PHP & CRS
90791
Psychiatric diagnostic evaluation
90791
C&A Psychiatric diagnostic evaluation
90792
Psychiatric diagnostic evaluation with medical services
C&A Psychiatric diagnostic evaluation with medical
90792
services
Evaluation and Management, including Rx -Minimal, new
99201
patient
Evaluation and Management, including Rx -Straight
99202
forward, new
patient
Evaluation
and
Management, including Rx -Low complexity,
99203
99204
99205
99211
new patient
Evaluation and Management, including Rx -Moderately
complex, new patient
Evaluation and Management, including Rx -Highly complex,
new patient
Evaluation and Management, including Rx -Minimal
Evaluation and Management, including Rx -Straight forward
99212
125.97
125.97
LCSW,
RN Ther,
LCPC
OMHC
110.29
110.29
177.20
197.91
177.20
On-Site
154.71
154.71
154.71
108.13
108.13
108.13
154.71
108.13
197.91
43.41
26.07
43.41
43.41
73.84
49.27
73.84
73.84
106.80
75.37
106.80
106.80
162.35
127.30
162.35
162.35
203.38
19.82
165.44
8.98
203.38
19.82
203.38
19.82
43.03
24.60
43.03
43.03
71.91
49.86
71.91
71.91
105.75
76.48
105.75
105.75
142.34
44.66
83.95
108.37
142.34
44.66
83.95
142.34
45.55
85.63
Evaluation and Management, including Rx -Low complexity
99213
99214
Evaluation and Management, including Rx -Moderately
complex
Evaluation and Management, including Rx -Highly complex
99215
90832
Individual psychotherapy (30 min) MD Only
90834
Individual psychotherapy (45 min) MD Only
OUTPATIENT/OFFICE PROFESSIONAL SERVICES
90791
Psychiatric diagnostic evaluation
90791
C&A Psychiatric diagnostic evaluation
90792
Psychiatric diagnostic evaluation with medical services
C&A Psychiatric diagnostic evaluation with medical
90792
services
90832
Individual psychotherapy (30 min)-Outpatient
90832
C&A Individual psychotherapy (30 min)-Outpatient
90833
Y 30 min Psychotherapy add on
90833
Y C&A 30 min Psychotherapy add on
90834
Individual psychotherapy (45 min)-Outpatient
90834
C&A Individual psychotherapy (45 min)-Outpatient
90836
Y 45 min Psychotherapy add on
90836
Y C&A 45 min Psychotherapy add on
90837
Individual psychotherapy (60 min)
90837
C&A Individual psychotherapy (60 min)
90838
Y 60 min Psychotherapy add on
90838
Y C&A 60 min Psychotherapy add on
90839
Psychotherapy for crisis, first 60 min
90839
C&A Psychotherapy for crisis, first 60 min
90840
Psychotherapy for crisis--additional 30 min
90840
C&A Psychotherapy for crisis-- additional 30 min
90846
Family psychotherapy without patient present
90846
C&A Family psychotherapy without patient present
90847
Family psychotherapy with patient present (45-60 min)
90847
C&A Fam psychoth with patient present (45-60 min)
90847-52
C&A Family psychotherapy with patient present--Abbrev
90849
Multiple family group psychotherapy 45 - 60 minutes
C&A Multiple family group psychotherapy 45 - 60 minutes
90849
90849-52
Multiple family group psychotherapy--Abbrev
90849-52
C&A Multiple family group psychotherapy--Abbrev
H2027
Family psycho-education with consumer present
Family psycho-education without
154.71
154.71
154.71
108.13
108.13
108.13
154.71
51.05
51.05
51.05
51.05
92.76
92.76
92.76
92.76
108.13
35.68
35.68
35.68
35.68
65.05
65.05
65.05
65.05
86.72
86.72
96.60
96.60
59.82
54.89
54.89
66.95
66.95
41.99
125.97
125.97
110.29
110.29
41.71
41.71
36.39
36.39
75.58
75.58
66.35
66.35
72.79
72.79
79.50
79.50
48.72
55.99
55.99
68.29
68.29
42.83
177.20
197.91
177.20
197.91
52.07
61.58
52.07
61.58
94.62
109.45
94.62
109.45
94.62
109.45
94.62
109.45
104.14
123.15
56.34
64.27
93.78
108.33
98.53
111.97
61.02
41.44
43.68
37.20
40.11
55.99
55.99
Off-Site
On/Off Site FQHC
CM
Mobile Tx
Traumat Freestandin
Resident.
Brain Part. Hosp.
Crisis
Injury
Program
Facility Facility
Public Mental Health System Rates Effective July 1, 2016
Procedure
E&M
Service Description
MD
non-facility
MD/NPP
facility
NPP
PHD
Psych
POS
21,22,31,32,
51,52
90853
90853
90853-21
90853-21
99201
99201
99202
99202
99203
99203
99204
99204
99205
99205
99211
Group psychotherapy (not multi-family.) 45-60 minutes
C&A Group psychotherapy (not multi-family.) 45-60
minutes.
Group psychotherapy prolonged (More than 75 minutes)
C&A Group psychotherapy prolonged (More than 75
minutes)
Evaluation and Management, including Rx -Minimal, new
patient
C & A Evaluation and Management, including Rx -Minimal,
new patient
Evaluation and Management, including Rx -Straight
forward, new patient
C & A Evaluation and Management, including Rx -Straight
forward, new patient
Evaluation and Management, including Rx -Low complexity,
new patient
C & A Evaluation and Management, including Rx -Low
complexity, new patient
Evaluation and Management, including Rx -Moderately
complex, new patient
C & A Evaluation and Management, including Rx Moderately complex, new patient
Evaluation and Management, including Rx -Highly complex,
new patient
C & A Evaluation and Management, including Rx -Highly
complex, new patient
Evaluation and Management, including Rx -Minimal
C&A Evaluation and Management, including Rx -Minimal
99211
LCSW,
RN Ther,
LCPC
OMHC
On-Site
25.25
25.25
25.76
25.76
40.30
25.25
25.25
25.76
25.76
42.55
52.62
Off-Site
On/Off Site FQHC
CM
Mobile Tx
Traumat Freestandin
Resident.
Brain Part. Hosp.
Crisis
Injury
Program
Facility Facility
52.62
43.41
26.07
43.41
43.41
43.41
26.07
43.41
43.41
73.84
49.27
73.84
73.84
73.84
49.27
73.84
73.84
106.80
75.37
106.80
106.80
106.80
75.37
106.80
106.80
162.35
127.30
162.35
162.35
162.35
127.30
162.35
162.35
203.38
165.44
203.38
203.38
203.38
19.82
165.44
8.98
203.38
19.82
203.38
19.82
19.82
8.98
19.82
19.82
43.03
24.60
43.03
43.03
43.03
24.60
43.03
43.03
71.91
49.86
71.91
71.91
71.91
49.86
71.91
71.91
105.75
76.48
105.75
105.75
105.75
76.48
105.75
105.75
142.34
108.37
142.34
142.34
142.34
51.05
108.37
142.34
35.68
41.71
36.39
65.05
75.58
66.35
Evaluation and Management, including Rx -Straight forward
99212
99212
C&A Evaluation and Management, including Rx -Straight
forward
Evaluation and Management, including Rx -Low complexity
99213
99213
99214
99214
C&A Evaluation and Management, including Rx -Low
complexity
Evaluation and Management, including Rx -Moderately
complex
C&A Evaluation and Management, including Rx Moderately complex
Evaluation and Management, including Rx -Highly complex
99215
99215
90875
90876
90889
0929
96101
96102
C&A Evaluation and Management, including Rx -Highly
complex
Indiv psychophysio therapy incl biofdbk (20-30 min)
Indiv psychophysio therapy incl biofdbk (45-50 min)
92.76
Discharge OMS (HCFA)
Discharge OMS (UB)
Psych testing, per hour, Ph.D. Lic-Maximum 8 hours per
service
Psychological Testing Computer (Flat rate)
Office Consultation - also used for H&P for PHP (15 Min)
99241
103.02
28.66
46.97
31.79
46.97
88.02
66.70
88.02
Office Consultation - also used for H&P for PHP (40 min)
99243
94.62
22.40
22.40
Office Consultation - also used for H&P for PHP (30 min)
99242
142.34
52.07
120.39
93.29
120.39
99244
Office Consultation - also used for H&P for PHP (60 min)
179.59
149.96
179.59
99245
Office Consultation - also used for H&P for PHP (80 min)
218.71
185.46
218.71
103.02
28.66
Public Mental Health System Rates Effective July 1, 2016
Procedure
E&M
Service Description
MD
non-facility
MD/NPP
facility
NPP
POS
21,22,31,32,
51,52
99354
LCSW,
RN Ther,
LCPC
Prolonged phy svc req face-to-face pat contact beyond the
usual service
Each additional 30 minutes of a prolonged phy svc
99355
INPATIENT HOSPITAL SERVICES
99221
Initial hospital care (30 min) (MD only)
99221
C&A Initial hospital care (30 min) (MD only)
99222
Initial hospital care (50 min) (MD only)
99222
C&A Initial hospital care (50 min) (MD only)
99223
Initial hospital care (70 min) (MD only)
99223
C&A Initial hospital care (70 min) (MD only)
99231
Subsequent IP care (15 min) (MD only)
99231
C&A Subsequent IP care (15 min) (MD only)
99232
Subsequent IP care (25 min) (MD only)
99232
C&A Subsequent IP care (25 min) (MD only)
99233
Subsequent IP care (35 min) (MD only)
99233
C&A Subsequent IP care (35 min) (MD only)
99238
Hospital
discharge
day mgmt
(30 min
less)
(MD only)
C&A
Hospital
discharge
day mgmt
(30ormin
or less)
(MD
99238
only)
99239
Hospital discharge day mgmt (>30 min) (MD only)
99239
C&A Hospital discharge day mgmt (>30 min) (MD only)
99251
Initial inpatient consultation (20 min) (MD only)
99252
Initial inpatient consultation (40 min) (MD only)
99253
Initial inpatient consultation (55 min) (MD only)
99254
Initial inpatient consultation (80 min) (MD only)
99255
Initial inpatient consultation (110 min) (MD only)
99281
ER Visit
99282
ER Visit
99283
ER Visit
99284
ER Visit
99285
ER Visit
MISCELLANEOUS
00104
Anesthesia for ECT
90870
ECT single seizure w/ monitoring (Physician only)
T1015
36415
96372
PHD
Psych
Off-Site
On/Off Site FQHC
CM
Mobile Tx
Traumat Freestandin
Resident.
Brain Part. Hosp.
Crisis
Injury
Program
Facility Facility
95.03
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
99.19
99.19
133.70
133.70
197.73
197.73
38.42
38.42
70.22
70.22
101.39
101.39
70.82
70.82
104.83
104.83
47.59
72.84
111.90
162.70
196.16
20.69
40.35
60.30
114.36
168.77
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
100.24
100.36
Ind.
Rate
15.54
15.54
SPECIAL SERVICES
S0201
Mental health partial hosp, tx <24 hours
S0201-52
Intensive outpatient program (IOP)
S9480
Intensive OP psych svcs, per diem (clinic model)
S9480
C&A Intensive OP psych svcs, per diem (clinic model)
H0032
Interdisciplinary team tx plng w/patient present
H0046
Therapeutic Nursery
MENTAL HEALTH CASE
Case MANAGEMENT
Management Annual Assessment (only if approved
H0031
by program)
T1016
Mental health case management (Daily rate)
On-Site
97.95
Clinic visit/encounter, all inclusive rate per day
Collection of blood by venipuncture
Therapeutic injection
OCCUPATIONAL THERAPY
97003
Occupational therapy evaluation, per 15 min
97004
Occupational therapy re-evaluation, per 15 min
97150
Therapeutic procedure(s) group (2 or more)
97530
Therapeutic activities, direct patient contact, per 15 min.
97532
Development of cognitive skills, direct contact per 15 min.
97535
Self-care/home mgmt
trng, pertrng,
15 min.
Community/work
reintegration
direct contact, per 15
97537
min.
OMHC
211.91
115.33
134.93
160.40
86.22
43.90
15.68
15.68
19.04
12.31
12.31
12.31
12.31
113.00
113.00
Public Mental Health System Rates Effective July 1, 2016
Procedure
E&M
Service Description
MD
non-facility
MD/NPP
facility
POS
21,22,31,32,
51,52
T1017
NPP
PHD
Psych
LCSW,
RN Ther,
LCPC
OMHC
On-Site
Off-Site
On/Off Site FQHC
Traumat Freestandin
Resident.
Brain Part. Hosp.
Crisis
Injury
Program
Facility Facility
$20.59/
15 mins.
MOBILE TREATMENT
H0040-21
Assertive Community Treatment (ACT) EBP for Medicare
H0040-U9
consumers
H0040
Mobil treatment Non-EBP
H0040-52
Mobil treatment Non-EBP for Medicare consumers
1,231.67
1,091.71
873.36
669.58
PSYCHIATRIC REHABILITATION-RESIDENTIAL REHABILITATION PROGRAM
H0002
Rehabilitation Assessment
H2016
Encounter (only bill w/POS 15 (off-site) or 52 (on-site)
S9445
Any combination of on/off-site PRP svcs for client in a
supported employment program. (Must use POS 52 or 15
& min 2 encounters) (Monthly rate)
H2018-U2
Any combination of on/off-site PRP svcs for Community
client (i.e. child or adult under supv of guardian/parent).
(Must use POS 49 & min 3 encounters) (Monthly rate)
H2018-U2
On-site PRP svcs only for Community client. (Must use
POS 52 & min 2 encounters) (Monthly rate)
H2018-U2
Off-site PRP svcs only for Community client. (Must use
POS 15 & min 2 encounters) (Monthly rate)
H2018-U3
Any combination of on/off-site PRP svcs for Supported
Living client (i.e. adult living independently). (Must use
POS
49PRP
& min
6 encounters)
(MonthlyLiving
rate) client. (Must
On-site
svcs
only for Supported
H2018-U3
Mobile Tx
$20.59/
15 mins.
Targeted Case Management (Children and Youth)
T1017-HG
H2018-U3
CM
On-site PRP svcs only to Adult in General Level RRP bed.
(Must use POS 52 & min 4 encounters) (Monthly rate)
H2018-U4
Off-site PRP svcs only to Adult in General Level RRP bed.
(Must use POS 15 & min 13 encounters) (Monthly rate)
H2018-U5
On-site PRP svcs only to Adult in Intensive Level RRP bed.
(Must use POS 52 & min 4 encounters) (Monthly rate)
H2018-U5
Off-site PRP svcs only to Adult in Intensive Level RRP bed.
(Must use POS 15 & min 19 encounters) (Monthly rate)
64.11
111.97
111.97
111.97
444.24
190.62
253.61
791.62
use POS 52 & min 3 encounters) (Monthly rate)
Off-site PRP svcs only for Supported Living client. (Must
use POS 15 & min 5 encounters) (Monthly rate)
H2018-U4
64.11
269.85
521.77
465.78
1,250.69
465.78
3,249.34
H2018-U6
Any combination of on/off-site PRP svcs for adult in
General Level RRP bed. (Must use POS 49 & min 17
encounters) (Monthly rate)
H2018-U7
Any combination of on/off-site PRP svcs for adult in
Intensivel Level RRP bed. (Must use POS 49 & min 23
encounters) (Monthly rate)
T1023
Transitional PRP. Any combination of on/off-site PRP
services to adult or TAY consumer transitioning to an RRP
or an inpt. Facility. (Must use POS 49 and min 4 encounters
for at least 60 min each)
HOUSING SERVICES
T2048
Residential room and board (per day)
S5150
Enhanced support (per hour) (10 hour maximum)
H0019
Crisis Bed hold (per day)
RESPITE CARE
H0045
H0045
T1005
1,716.49
3,715.14
465.78
13.10
13.43
13.10
Adult Respite care, not in home, per diem
C&A Respite care, not in home, per diem
In home respite care
RESIDENTIAL CRISIS SERVICES
S9485
Residential crisis services (also bill as T2048)
S5145
Residential crisis, treatment foster care
13.10
13.10
78.66
181.39
$3.63/15
min.
$3.63/
15min.
262.54
168.81
Public Mental Health System Rates Effective July 1, 2016
Procedure
E&M
Service Description
MD
non-facility
MD/NPP
facility
POS
21,22,31,32,
51,52
SUPPORTED EMPLOYMENT
Supported employment (intensive job coaching), per 15
H2023
minutes (Auth'd by CSA w/lifetime benefit of $2,750)
Supported employment (Pre-placement phase) (Auth'd by
H2024
CSA and has a maximum number of 3 units/year)
Supported employment (Job placement phase) (Auth'd by
H2024-21
CSA and has a maximum number of 3 units/year)
H2026
Ongoing support to maintain employment, per month
H2026-21
Ongoing support to maintain employment, per month - EBP
S9445-52
Clinic coordination - EBP
OMHC
On-Site
Off-Site
On/Off Site FQHC
CM
Mobile Tx
Traumat Freestandin
Resident.
Brain Part. Hosp.
Crisis
Injury
Program
Facility Facility
1,118.57
363.91
447.88
111.97
200.55
265.55
367.37
51.78
90.32
127.07
30.72
51.78
127.07
25.11
$109.80
($27.45/
mins)
15
Reassessment and development of new Behavior Plan for $103.24
TBS (licensed TBS Providers only) (to be billed in 15
($25.81/ 15
minute increments)
mins)
EPSDT Health & behavior intervention (must be a
$22.44/hr
96152
designated provider of Therapeutic Behavioral Services) (to ($5.61/
15
be billed in 15 minute increments)
minutes)
* Reimbursable using POS 12 for follow-up visits by an OMHC M.D. in a Crisis Bed
** If value of field is 'Y', can charge one E&M Code between 99201 and 99215
96151
LCSW,
RN Ther,
LCPC
447.88
THERAPEUTIC BEHAVIORAL SERVICES
Initial Assessment & Development of Behavioral Plan for
TBS (to be billed in 15 minute increments)
PHD
Psych
7.70
TRAUMATIC BRAIN INJURY
W0037
Residential habilitation Level 1 (per day)
W0038
Residential habilitation Level 2 (per day)
W0039
Residential habilitation Level 3 (per day)
W0054
Day habilitation Level 1 (per day)
W0055
Day habilitation Level 2 (per day)
W0056
Day habilitation Level 3 (per day)
W0057
Supported employment Level 1 (per day)
W0058
Supported employment Level 2 (per day)
W0059
Supported employment Level 3 (per day)
W0060
Individual Support Services (ISS) (rate per hour)
96150
NPP