Military Health System

4.1.1  Inpatient or outpatient individual psychotherapy (Current Procedural Terminology (CPT) procedure codes 90806, 90807, 90818, 90819) approximately 45 to 50 minutes; or (CPT procedure codes 90804, 90805, 90816, 90817) approximately 20 to 30 minutes.

4.1.2  Inpatient or outpatient group, conjoint or family psychotherapy: 90 minutes (CPT procedure codes):

4.1.3  Crisis intervention (CPT procedure codes):

4.2.1  Inpatient or outpatient individual psychotherapy: 30 minutes (CPT procedure codes 90832 and 90833); 45 minutes (CPT procedure codes 90834 and 90836); or 60 minutes (CPT procedure codes 90837 and 90838).

4.2.2  Inpatient or outpatient group, conjoint or family psychotherapy (CPT procedure codes):

4.2.3  Crisis intervention (CPT procedure codes):

4.3.1  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.

4.3.2  Collateral visits (CPT procedure 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.

4.3.3  Psychoanalysis (CPT procedure 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.

4.3.4  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.

4.3.5  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.

4.3.6  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/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.

4.3.7  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.