Medicine
Chapter 7
Section 3.12
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:
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 DATES
3.1 January 1, 2013.
3.2 Removal of quantitative limits
on mental health care, October 3, 2016.
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