BHAC, ERMHS and FC MFT/LCSW Fee Table Basic Language
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1 BHAC, ERMHS and FC MFT/LCSW Fee Table Language Fee Diagnostic Evaluation (No Medical) MFT/LCSW Psychotherapy (16-37) min MFT/LCSW Psychotherapy (38-52) min MFT/LCSW Family Therapy, w/out PT MFT/LCSW Family Therapy, w/pt MFT/LCSW Group Psychotherapy, Per Person, Per Session MFT/LCSW Home Visit for Ind, Fam, Mar, Non MD MFT/LCSW H2015 Comp Com, Sup Svcs, Non MD, per 15min MFT/LCSW H2015AP MH Plan Development (per 15 Minutes) (ERMHS ONLY) MFT/LCSW H2015AS MH Assessment (per 15 Minutes) (ERMHS ONLY) MFT/LCSW T1017 Case Management (per 15 minutes) (ERMHS ONLY) MFT/LCSW BHAC: Behavorial Health Access Center ERMHS: Educationally Related Mental Health Services FC: Foster care Language Rate: Contact PPN Administration for Certification Criteria
2 BHAC,ERMHS and FC PhD Fee Table Language Fee Diagnostic Evaluation (No Medical) Phd Psychotherapy (16-37) min Phd Psychotherapy (38-52) min Phd Family Therapy, w/out PT Phd Family Therapy, w/pt Phd Group Psychotherapy, Per Person, Per Session Phd Test Admin, Scoring, Rpt, Per Hr* Phd Home Visit for Ind, Fam, Mar, Non MD Phd H2015 Comp Com, Sup Svcs, Non MD, per 15min Phd H2015AP MH Plan Development (per 15 Minutes) (ERMHS ONLY) Phd H2015AS MH Assessment (per 15 Minutes) (ERMHS ONLY) Phd T1017 Case Management (per 15 minutes) (ERMHS ONLY) Phd *96101 Test Admin, Scoring, Rpt, Per Hr Replaces BHAC Behavorial Health Access Center ERMHS Educationally Related Mental Health Services FC FosterCare Language Rate: Contact PPN Administration for Certification Criteria
3 BHAC/FC MD Outpatient Fee Table Child/Family Interactive Complexity Add on Code Psychiatrists $ Diagnostic Evaluation (No Medical) Psychiatrists $ Diagnostic Evaluation with Medical Psychiatrists $ Psychotherapy (16-37) min Psychiatrists $ Psychotherapy (30) min Add-On Code Psychiatrists $ Psychotherapy (38-52) min Psychiatrists $ Psychotherapy (45) min Add-On Code Psychiatrists $ Psychotherapy (53+) min (Office only) Psychiatrists $ Family Therapy, w/out PT Psychiatrists $ Family Therapy, w/pt Psychiatrists $ Group Psychotherapy, Per Person, Per Session Psychiatrists $ ECT Single Seizure Psychiatrists $ E/M Med Support NEW Client - Level 2 Psychiatrists $ E/M Med Support NEW Client - Level 3 Psychiatrists $ E/M Med Support EST Client - Level 1 Psychiatrists $ E/M Med Support Est Client - Level 2 Psychiatrists $ E/M Med Support Est Client - Level 3 Psychiatrists $ * Medical Conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more Psychiatrists $54.07 *99367 Replaces CPT codes and 99362
4 IP/ER MD Fee Table IP Psychiatric Unit, Intial Hosp. Care - (30 min) Psychiatrists $ IP Psychiatric Unit, Initial Hospital Care - (50 min) Psychiatrists $ IP Psychiatric Unit, Int. Hosp. Care - (70 min) Psychiatrists $ IP Psychiatric Unit, Subsequent Hosp. Care - (15 min) Psychiatrists $ IP Psychiatric Unit, Subsequent Hosp. Care - (25 min) Psychiatrists $ IP Psychiatric Unit, Subsequent Hosp. Care - (35 min) Psychiatrists $ Hospital Discharge Service - (30 min or less) Psychiatrists $ Hospital Discharge Service - (30 min or more) Psychiatrists $ Emergency Dept. - (Minor) Psychiatrists $ Emergency Dept. - (Lo-Moderate) Psychiatrists $ Emergency Dept. - (Moderate) Psychiatrists $ Emergency Dept. - (High) Psychiatrists $ Emergency Dept. - (High w Immediate threat) Psychiatrists $ IP/ER Inpatient including Emegency Room
5 IMD/Nursing Facility MD Fee Table Initial E/M Nursing Facility Care (Low Severity) Psychiatrists $ Initial E/M Nursing Facility Care (Moderate) Psychiatrists $ Initial E/M Nursing Facility Care (High) Psychiatrists $ Subsequent Nursing Facility Care - 10 min FTF Psychiatrists $ Subsequent Nursing Facility Care - 15 min FTF Psychiatrists $ Subsequent Nursing Facility Care- 25 min FTF Psychiatrists $ Subsequent Nursing Facility Care- 35 min FTF Psychiatrists $ Nursing Facility Discharge 30 min or less FTF Psychiatrists $ Nursing Facility Discharge 30 min or more FTF Psychiatrists $ Eval & Mgmt in Nursing Facility or Annual LPS Exam Psychiatrists $87.21
6 RCF MD Fee Table Dom. Rest Home New Patient - (20 min) Psychiatrists $ Dom. Rest Home New Patient - (30 min) Psychiatrists $ Dom. Rest Home New Patient - (45 min) Psychiatrists $ Dom. Rest Home New Patient - (60 min) Psychiatrists $ Dom. Rest Home New Patient - (75 min) Psychiatrists $ Dom. Rest Home Est. Patient - (15 min) Psychiatrists $ Dom. Rest Home Est. Patient - (25 min) Psychiatrists $ Dom. Rest Home Est. Patient - (40 min) Psychiatrists $ Dom. Rest Home Est. Patient - (60 min) Psychiatrists $ RCF Residential Care Facility
7 for Family Mosaic Project FMP MFT/LCSW Fee Table Language Fee Diagnostic Evaluation (No Medical) MFT/LCSW Psychotherapy (16-37) min MFT/LCSW Psychotherapy (38-52) min MFT/LCSW Psychotherapy 53 or more minutes MFT/LCSW Family Therapy, w/out PT MFT/LCSW Family Therapy, w/pt MFT/LCSW Group Psychotherapy, Per Person, Per Session MFT/LCSW Home Visit for Ind, Fam, Mar, Non MD MFT/LCSW H0036 Fam,Ind,Grp Svc- Field/Home/OthLoc 15min MFT/LCSW H0046 Collateral Service (per 15 Minutes) MFT/LCSW H2015 Comp Com, Sup Svcs, Non MD, per 15min MFT/LCSW H2015AP MH Plan Development (per 15 Minutes) MFT/LCSW H2015AS MH Assessment (per 15 Minutes) MFT/LCSW T1017 Case Management (per 15 minutes) MFT/LCSW
LCSW, RN Ther, LCPC. PHD Psych CRNP - PMH APRN - PMH
non-facili facili On- Off- OTHER PROFESSIONAL SERVICES FOR IOP, PHP & CRS 90791 iatric diagnostic evaluation 157.80 110.29 128.49 112.50 180.74 90791 C&A iatric diagnostic evaluation 157.80 110.29 128.49
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