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.
- END -