4.1 Maximum duration of psychotherapy
sessions for care provided on or after January 1, 2013:
4.1.1 Inpatient or outpatient individual
psychotherapy (Current Procedural Terminology (CPT) codes):
• 90832 and 90833 - 30 minutes;
• 90834 and 90836 - 45 to 50
minutes; or
• 90837 and 90838 - 60 minutes.
4.1.2 Inpatient or outpatient group,
conjoint or family psychotherapy (CPT codes):
90846 - FAMILY PSYTX W/O PATIENT
90847 - FAMILY PSYTX W/ PATIENT
90849 - MULTIPLE FAMILY GROUP
PSYTX
90853
- GROUP PSYCHOTHERAPY
4.1.3 Crisis
intervention (CPT codes):
90839
- PSYTX FOR CRISIS, FIRST 60 MIN
90840 - PSYTX FOR CRISIS, EACH
ADDL 30 MIN
4.2 Frequency
of psychotherapy sessions.
4.2.1 Multiple
sessions the same day: If the multiple sessions are of the same
type, payment may be made only if the circumstances represent crisis
intervention and only according to the restrictions applicable to
crisis intervention. A collateral session not involving the identified
patient on the same day the patient receives a therapy session does
not require review. Patients who require multiple sessions on the
same day may require a higher level of care such as IOP or PHP.
4.2.2 Collateral visits (CPT code
90887). Collateral visits are payable when medically or psychologically necessary
for treatment of the identified patient. A collateral visit is considered
to be a psychotherapy session for purposes of reviewing the duration
or frequency of psychotherapy.
4.2.3 Psychoanalysis
(CPT code 90845). Psychoanalysis is covered when provided by a graduate
or candidate of a psychoanalytic training institution recognized
by the American Psychoanalytic Association and when preauthorized
by the contractor.
4.2.4 Play therapy. Play therapy
is a form of individual psychotherapy which is utilized in the diagnosis
and treatment of children with mental health disorders. Play therapy
is a benefit, subject to the regular points of review applicable
to individual psychotherapy.
4.2.5 Marathon therapy. Marathon
therapy is a form of group therapy in which the therapy sessions
last for an extended period of time, usually one or more days. Marathon
therapy is not covered since it is not medically necessary or appropriate.
4.2.6 Inpatient psychotherapy and
medical care. The allowable charge for inpatient psychotherapy includes medical
management of the patient. A separate charge for hospital visits
rendered by the provider on the same day as he or she is rendering
psychotherapy is not covered. Payment is authorized only for medically
necessary hospital visits billed on a day that psychotherapy was
not rendered. If the provider who is primarily responsible for treatment
of the mental disorder is not a physician, charges for medical management
services by a physician are coverable, but only if the physician
is rendering services that the non-physician provider is prohibited
from providing. Concurrent inpatient care by providers of the same
or different disciplines is covered only if second or third level
review determines that the patient’s condition requires the skills
of multiple providers.
4.2.7 Physical examination. A physical
examination is an essential component of the work up of the psychiatric
patient, and for all admissions should be performed either by the
attending psychiatrist or by another physician. The examination
may lead to confirmation of a known psychiatric diagnosis or consideration
of other unsuspected psychiatric or medical illness. When not performed
by the attending psychiatrist, payment may be made to another physician
for performance of the initial physical examination. Any additional
concurrent care provided by a physician other than the attending
psychiatrist may be covered only if it meets the criteria under inpatient
concurrent care.