| CPT Code | Type of Service | Description of Service | Time | Fee |
| 90791 | Diagnostic Evaluation | The assessment of client’s psychosocial history, current mental status, diagnosis and recommendations for treatment | event | 150.00 |
| Medicaid and most commercial plans accept this code. Medicaid requires this service be performed once every six months. Available for private pay. | ||||
| 90832 | Psychotherapy | Psychotherapy is a variety of treatment techniques that help a client identify, manage or alleviate any emotional or behavioral disturbances, encourage emotional growth through coping techniques and problem-solving skills. Family and other persons may attend and participate in a psychotherapy session but the client must be present for some or all of the session and treatment remains focused on the client. | 30 minutes | 60.00 |
| 90834 | Psychotherapy | 38 to 52 minutes | 90.00 | |
| 90837 | Psychotherapy | 53 to 60 minutes | 120.00 | |
| Medicaid and most commercial plans accept these three psychotherapy codes. Availably for private pay. | ||||
| 99354 | Prolonged Psychotherapy | Psychotherapy that extends beyond the first 60 minutes. Deleted and inactive as of 1/1/2023 | 30 to 60 minutes | 120.00 |
| H0001 | Alcohol and/or Drug Assessment | Event | 100.00 | |
| H0004 | Prolonged Psychotherapy | Psychotherapy on the same day as psychotherapy 90837 and limited to 8 units max per client per date of service. Medicaid only. Active as of 4/1/2023. | 15 minutes | 30.00 |
| 90785 | Interactive Complexity | The Interactive Complexity code is reported in addition to a primary psychiatric service when the client has certain factors that increase the complexity of the service such as a disruptive communication that complicates the delivery of treatment, caregiver behavioral or emotional interference, evidence of a sentinel event with disclosure to a third party or use of play equipment or translator to enable communication. | event/ one time per psychotherapy session | 20.00 |
| Interactive Complexity may be added to the first psychotherapy code and does not apply for prolonged codes or crisis codes. | ||||
| 90839 | Psychotherapy for Crisis | In person psychotherapy for a client with a life-threatening or highly complex psychiatric crisis. Crisis services include history, mental status examination, mobilization of resources and implementation of treatment. | first 30 t0 74 minutes | 150.00 |
| 90840 | Each additional 30 minutes for a Psychotherapy Crisis | for each additional 30 minutes/ up to 3 codes per session | 75.00 | |
| Medicaid covers Psychotherapy for Crisis codes. Coverage varies by commercial insurance plans. Available for private pay. | ||||
| 90846 | Family Psychotherapy without the client present | Family dynamics as they relate to the client are the main focus of a family therapy session. Therapy focuses on improving the interaction in the family for the improvement of the client’s condition and the impact on the family members. | 27 minutes and up to 50 minutes | 145.00 |
| 90847 | Family Psychotherapy with the client present | 27 minutes and up to 50 minutes | 145.00 | |
| Most plans will cover family psychotherapy but not when held on the same day as other services. Family therapy is available for private pay. | ||||
| 90849 | Multi-family Group Psychotherapy. | Family psychotherapy provided to a client and their family, as well as other clients and families in a group setting. | event | 75.00 |
| 90853 | Group Psychotherapy | Psychotherapy for a group of clients in one session. Group dynamics are explored to help each participant move toward emotional healing and modification of thought and behavior for improved social interaction. | event | 50.00 |
| Medicaid and most commercial plans provide coverage for group therapies . Available for private pay. | ||||
| 90887 | Collateral Services | Interpretation or explanation of results of psychiatric examinations and procedures to family or other responsible persons or advising them on how to assist the client. This service is often used with school or daycare personnel to guide in how to assist the client. It can also be used with other persons who have a responsible caregiver role with the clients. | event | 120.00 |
| Medicaid covers Collateral Services for children only. Commercial plans do not cover this service. Available for private pay. | ||||
| H0031 | Mental Health Assessment | An assessment performed to determine level of care or to identify and rule out a diagnosis. | event | 100.00 |
| This service is covered by Medicaid only and not billable the same day as other Medicaid funded services. | ||||
| H0032 | Mental Health Service Plan | Develop a treatment plan with client and any collaborating professionals. | event | 120.00 |
| This is covered by Medicaid and billable in conjunction with 90791 Diagnostic Evaluation when a treatment plan is developed. Rarely covered by a commercial plan. | ||||
| H0002 | Behavioral Health Screening | Screening is performed to determine if there is a mental health issue that would benefit from referral for treatment. Coverage varies by plan. | event | 100.00 |
| H2015 | Community Support Services | Assist with emotional regulation, coping with crisis, and enhancing interpersonal skills for maximum independence in the home, school and community. | 15 minutes | $18.75 |
| Covered by Medicaid only. Available for private pay. | ||||
| H2023 | Targeted Case Management Services | Organize mental health services and community resources to create a team approach to therapeutic care. Four contacts per month minimum. | monthly charge | 350.00 |
| Case Management is covered by Medicaid and some commercial plans by prior authorization. Available for private pay. | ||||
| 10003 | Collateral Services with the Legal System | Consultation, deposition, court attendance, testimony for a court of law. (Phone conversations with a representing attorney may be eligible to be charged as a 90887 Collateral Service.). Private pay only. | daily charge- Court attendance generally requires the provider to clear their schedule for court attendance. | 600.00 |
| 10002 | Letters and Form Completion | Providers may provide letters or complete forms at the client’s request. Private pay only. | event-per document | 75.00 |
| 10001 | Copies of Client Records | Client Progress Notes, Assessments, and Treatment Plans are part of the client’s Protected Healthcare Information and require a signed Authorization to Release Information indicating the client or guardian’s permission to share information with a designated third party. | There is no charge for the request for client records when the information is provided in an electronic format and sent by secure mail.
Paper copies will be charged per page and the hourly wage for making the copies. Fees will apply for postage, delivery and thumb drives. Notarized records may incur a fee. |
Fees will be provided upon request for the records and are the responsibility of the client. |
| 10000 | No Show for Scheduled Appointments. | 24 hours’ notice is required to cancel a scheduled appointment. The first missed appointment will be documented but not charged. The second or subsequent times a client fails to show for a scheduled appointment they will be charged the No Show fee. Insurance plans do not provide coverage. This is the client’s responsibility. | Charge applies to each missed scheduled session. The fee may apply to multiple sessions scheduled for the same day of service. | 45.00. |
| All services are available by a private pay arrangement. Commercial plans vary and may not cover some of these codes or only cover by a prior authorization. The amount paid toward a service by a commercial plan is determined by the details of the plan. Co-pays, co-insurance and deductibles are the responsibility of the client. Contact your insurance plan for these details. Medicaid will cover most services at 100 % under certain rules. Medicaid clients will not be charged for services unless they have entered into a private pay arrangement with Transformations. |
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office@transformationsllc.net
