ALERT!!
MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, May 21st at 6:00am (EST) until Sunday, May 22nd at 11:59pm (EST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.
Medicine
Chapter 7
Section 3.13
Psychotropic Pharmacologic
Management
Issue Date: December 5, 1984
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT).
All Rights Reserved.
Revision: C-13, November 15, 2017
1.0 DESCRIPTION
Pharmacologic management, including prescription
and review of medication, when performed with or without psychotherapy
services.
2.0 POLICY
2.1 In
2013, the American Medical Association (AMA) made significant revisions
to the Current Procedural Terminology (CPT) codes regarding behavioral
health services. Beginning January 1, 2013, psychotropic
pharmacologic management services can be billed in one of two ways
depending on the type of provider and the services being rendered:
2.1.1 Physicians
and certified psychiatric nurse specialists permitted to utilize
Evaluation and Management (E/M) codes providing psychotropic pharmacologic
management with or without psychotherapy services should use the
appropriate E/M code as described in the current CPT
manual.
2.1.2 Prescribing psychologists providing psychotropic
pharmacologic management in conjunction with psychotherapy services
(when the psychologist is authorized to prescribe in their state;
for example, New Mexico and Louisiana) should use CPT code 90863
as an add-on code to the primary psychotherapy service as described
in the current CPT manual. Other providers (i.e., physicians or
Certified Psychiatric Nurse Specialists [CPNSs]) should not utilize
this CPT code. See also
32 CFR 199.2 and
Chapter 11, Section 3.7, regarding TRICARE’s
definition of CPNS.
2.2 The allowable charge for psychotropic
pharmacologic management shall be based on the CHAMPUS Maximum Allowable
Charge (CMAC) methodology.
3.0 EFFECTIVE
DATE
S3.1 January
1, 2013.
3.2 Removal
of quantitative limits on mental health care, October 3, 2016.
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