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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