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TRICARE Policy Manual 6010.60-M, April 1, 2015
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 DATES
3.1  January 1, 2013.
3.2  Removal of quantitative limits on mental health care, October 3, 2016.
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