Description:
This policy provides information on reimbursement for Psychiatric Collaborative Care.
Definitions:
Psychiatric Collaborative Care Services are provided under the direction of a treating physician or other qualified health care professional.
99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. Please refer to the CPT® manual for the required elements.
- Total duration of collaborative care management over the calendar month is 36-85 minutes. Time less than 36 minutes is not reported separately.
- This code can be billed one time per month for all the work done in that month.
- Time spent on activities for services reported separately are not included in the time applied to 99492.
99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. Please refer to the CPT® manual for the required elements.
- Total duration of collaborative care management over the calendar month is 31-75 minutes. Time less than 31 minutes is not reported separately.
- This code can be billed one time per month for all the work done in that month.
- Do not report 99492 and 99493 in the same calendar month.
- Time spent on activities for services reported separately are not included in the time applied to 99493.
+99494: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional. (List separately in addition to code for primary procedure.)
- Refer to the time requirement in the CPT® manual for total duration of collaborative care management over the calendar month.
- This code can be billed one time per month with units reflecting the number of additional 30-minute increments of work done in that month.
- This is an add-on code to 99492 and 99493.
- Time spent on activities for services reported separately are not included in the time applied to 99494.
99483: Assessment of and care planning for a patient with cognitive impartment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home. Please refer to the CPT® manual for the required elements.
- Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.
- Do not report 99483 in conjunction with Evaluation and Management (E&M) services, psychiatric diagnostic procedures, psychological testing, neuropsychological testing, brief emotional/behavioral assessment, and medication therapy management services.
- A single physician or other qualified healthcare professional should not report 99483 more than once every 180 days.
99484: Care-management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month. Please refer to the CPT® manual for the required elements.
- General behavioral health integration care management services (99484) are reported by the supervising physician or other qualified healthcare professional.
- This code can be billed one time per month.
- Behavioral Health integration care management (99484) and psychiatric collaborative care management (99492, 99493, 99494) may not be reported by the same professional in the same month.
Policy:
Blue Cross Blue Shield of North Dakota (BCBSND) will reimburse professional Psychiatric Collaborative Care Management Services when submitted on the CMS-1500 Claim Form with CPT® Codes 99483 – 99494. When CPT® Codes 99483 – 99494 are billed on the UB-04 the claims will be returned to the provider for correction. The required elements described in the CPT® book must be met to bill the CPT® codes.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
- Group or Individual benefit
- Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
- Mandated or legislative required criteria will always supersede.
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
Cross Reference:
CPT® Guidelines
Date
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Updates
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4/9/2020
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Update policy number and added limitations and exclusions.
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12/1/2020
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Archived policy
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