LCD Reference Article Billing and Coding Article

Billing and Coding: Outpatient Psychotherapy

A59723

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59723
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Outpatient Psychotherapy
Article Type
Billing and Coding
Original Effective Date
10/20/2024
Revision Effective Date
10/20/2024
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

42 CFR §410.73-§410.76 Coverage of services provided by social workers, physician assistants, nurse practitioners, or clinical nurse specialists

CMS Internet-Only Manual, Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, §160 Clinical Psychologist Services, §170 Clinical Social Worker (CSW) Services, §180 Nurse-Midwife (CNM) Services, §190 Physician Assistant (PA) Services, §200 Nurse Practitioner (NP) Services and §210 Clinical Nurse Specialist (CNS) Services

CMS Internet-Only Manual, Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, §110 Physician Assistant (PA) Services Payment Methodology, §120 Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) Services Payment Methodology, §120.1 Limitations for Assistant-at-Surgery Services Furnished by Nurse Practitioners and Clinical Nurse Specialists, §150 Clinical Social Worker (CSW) Services, §160 Independent Psychologist Services, §170 Clinical Psychologist Services, §170.1 Payment and §210 Outpatient Mental Health Treatment Limitation

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Outpatient Psychotherapy L39853.

General Coding

Psychiatry and psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases.

Providers referenced: physicians, nonphysicians (clinical psychologists, independent psychologists, NPs, PAs, CNMs, etc.), provide services within the scope of their state license and clinical practice/education.

Individual psychotherapy CPT® codes should only be used when focus of treatment is on individual psychotherapy.

Psychiatric service CPT® codes should not be used when other CPT® codes, such as an evaluation and management (E/M) service or pharmacologic code is more appropriate.

Interactive complexity (90785) is an add-on code specific for psychiatric services. It refers to communication difficulties during a psychiatric procedure. This code is to be reported in conjunction with other codes (90791-90792, 90832-90834, 90836-90838, 90853) and is excluded when coding for the following: 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T, 90839,90840, 96136-96139, 96146, 96130-96133.

Communication difficulties include:

  • Other individual responsible for the care of the patient, adults with guardians.
  • A request for another individual to be involved with care during a visit, such as family members, interpreter or translator.
  • Requiring the participation of a third party.

Interactive complexity may be reported with:

  • The need to manage maladaptive communication (related to anxiety, high reactivity, repeated questions, etc.) among participants, complicating delivery of care.
  • Caregiver emotion/behavior interfering with delivery of care.
  • Reporting to a third party, such as negligence or abuse, initial evidence/disclosure of a sentinel event with patient and visit participants.
  • Overcoming language barriers.

This code is not to be reported in conjunction with crisis codes 90839, 90840.

Psychotherapy codes 90832, 90834 and 90837 refer to psychotherapy without medical management.

90833, 90836, 90838 are for psychotherapy with medical E/M. These are add-on codes in addition to the appropriate E/M codes. E/M codes alone do not include psychotherapy services.

For psychotherapy sessions greater than 90 minutes, medical records must document face-to-face time spent with the patient and medical necessity to be reimbursed.

Psychotherapy codes 90846 and 90847 refer to family psychotherapy. These codes do not pertain to history taking or E/M counseling services. This does not include the supervision of therapy by professional caretaker or staff.

Psychotherapy code 90853 refers to group therapy. If medically necessary, code 90785, medical complexity, may be billed in conjunction with this code.

Psychotherapy crisis code is 90839, first 60 minutes. Code 90840 is for each additional 30 minutes. These are standalone codes, 90840 must be billed with 90839.

 

Billing Guidelines

If coding for both E/M services and psychotherapy services, the two services must be significant and separately identifiable.

For the same date of service, there is no requirement for a separate diagnosis.

Site of service is not always applicable to psychotherapy; psychotherapy codes are applicable in all settings.

 

Documentation Requirements

  • Time spent in the psychotherapy encounter as well as the therapeutic interventions (behavioral modification, supportive interaction, interpretive interactions) utilized to encourage therapeutic change.
  • Behavioral modification is not a separate service; it is an adjunct to psychotherapy.
  • Periodic summary of goals
  • Progress toward the goals set
  • Updated treatment plans, generally, every three months, should include estimated duration of treatment and treatment goals, the targeted symptoms should be outlined, and the treatment goals related to behavioral changes, though processes and /or medications detailed.
  • Presence of a psychiatric illness and/or a demonstration of emotional/behavioral symptoms sufficient to alter base-line functioning.
  • Detailed summary of the session including therapeutic intervention, degree of patient interaction and participation as well as documentation of the goal-oriented outcomes and any progression or lack thereof in the patient’s symptoms/ behavior.
  • In a family psychotherapy session without the patient present, there must be documentation of themes addressed in the session, descriptive documentation of the therapeutic interventions, the degree of patient participation and interaction with the family members, the reaction to the group, the group’s reaction to the patient and any changes/lack of changes in patient symptoms and/or behavior as a result of the therapy session.
  • Documentation is not to include privileged information.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(427 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
F01.A0 Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.A11 Vascular dementia, mild, with agitation
F01.A18 Vascular dementia, mild, with other behavioral disturbance
F01.A2 Vascular dementia, mild, with psychotic disturbance
F01.A3 Vascular dementia, mild, with mood disturbance
F01.A4 Vascular dementia, mild, with anxiety
F01.B0 Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.B11 Vascular dementia, moderate, with agitation
F01.B18 Vascular dementia, moderate, with other behavioral disturbance
F01.B2 Vascular dementia, moderate, with psychotic disturbance
F01.B3 Vascular dementia, moderate, with mood disturbance
F01.B4 Vascular dementia, moderate, with anxiety
F01.C0 Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.C11 Vascular dementia, severe, with agitation
F01.C18 Vascular dementia, severe, with other behavioral disturbance
F01.C2 Vascular dementia, severe, with psychotic disturbance
F01.C3 Vascular dementia, severe, with mood disturbance
F01.C4 Vascular dementia, severe, with anxiety
F04 Amnestic disorder due to known physiological condition
F05 Delirium due to known physiological condition
F06.0 Psychotic disorder with hallucinations due to known physiological condition
F06.1 Catatonic disorder due to known physiological condition
F06.2 Psychotic disorder with delusions due to known physiological condition
F06.31 Mood disorder due to known physiological condition with depressive features
F06.32 Mood disorder due to known physiological condition with major depressive-like episode
F06.33 Mood disorder due to known physiological condition with manic features
F06.34 Mood disorder due to known physiological condition with mixed features
F06.4 Anxiety disorder due to known physiological condition
F06.70 Mild neurocognitive disorder due to known physiological condition without behavioral disturbance
F06.71 Mild neurocognitive disorder due to known physiological condition with behavioral disturbance
F06.8 Other specified mental disorders due to known physiological condition
F07.0 Personality change due to known physiological condition
F07.81 Postconcussional syndrome
F10.10 Alcohol abuse, uncomplicated
F10.11 Alcohol abuse, in remission
F10.120 Alcohol abuse with intoxication, uncomplicated
F10.121 Alcohol abuse with intoxication delirium
F10.130 Alcohol abuse with withdrawal, uncomplicated
F10.131 Alcohol abuse with withdrawal delirium
F10.132 Alcohol abuse with withdrawal with perceptual disturbance
F10.14 Alcohol abuse with alcohol-induced mood disorder
F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified
F10.180 Alcohol abuse with alcohol-induced anxiety disorder
F10.181 Alcohol abuse with alcohol-induced sexual dysfunction
F10.182 Alcohol abuse with alcohol-induced sleep disorder
F10.188 Alcohol abuse with other alcohol-induced disorder
F10.20 Alcohol dependence, uncomplicated
F10.21 Alcohol dependence, in remission
F10.220 Alcohol dependence with intoxication, uncomplicated
F10.221 Alcohol dependence with intoxication delirium
F10.230 Alcohol dependence with withdrawal, uncomplicated
F10.231 Alcohol dependence with withdrawal delirium
F10.232 Alcohol dependence with withdrawal with perceptual disturbance
F10.24 Alcohol dependence with alcohol-induced mood disorder
F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions
F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations
F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder
F10.27 Alcohol dependence with alcohol-induced persisting dementia
F10.280 Alcohol dependence with alcohol-induced anxiety disorder
F10.281 Alcohol dependence with alcohol-induced sexual dysfunction
F10.282 Alcohol dependence with alcohol-induced sleep disorder
F10.288 Alcohol dependence with other alcohol-induced disorder
F11.10 Opioid abuse, uncomplicated
F11.11 Opioid abuse, in remission
F11.13 Opioid abuse with withdrawal
F11.20 Opioid dependence, uncomplicated
F11.21 Opioid dependence, in remission
F11.23 Opioid dependence with withdrawal
F11.24 Opioid dependence with opioid-induced mood disorder
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.281 Opioid dependence with opioid-induced sexual dysfunction
F11.282 Opioid dependence with opioid-induced sleep disorder
F11.288 Opioid dependence with other opioid-induced disorder
F12.10 Cannabis abuse, uncomplicated
F12.11 Cannabis abuse, in remission
F12.13 Cannabis abuse with withdrawal
F12.20 Cannabis dependence, uncomplicated
F12.21 Cannabis dependence, in remission
F12.23 Cannabis dependence with withdrawal
F12.250 Cannabis dependence with psychotic disorder with delusions
F12.251 Cannabis dependence with psychotic disorder with hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified
F12.280 Cannabis dependence with cannabis-induced anxiety disorder
F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated
F13.21 Sedative, hypnotic or anxiolytic dependence, in remission
F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated
F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium
F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder
F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder
F14.10 Cocaine abuse, uncomplicated
F14.11 Cocaine abuse, in remission
F14.20 Cocaine dependence, uncomplicated
F14.21 Cocaine dependence, in remission
F14.23 Cocaine dependence with withdrawal
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions
F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations
F14.280 Cocaine dependence with cocaine-induced anxiety disorder
F14.281 Cocaine dependence with cocaine-induced sexual dysfunction
F14.282 Cocaine dependence with cocaine-induced sleep disorder
F14.288 Cocaine dependence with other cocaine-induced disorder
F15.10 Other stimulant abuse, uncomplicated
F15.11 Other stimulant abuse, in remission
F15.13 Other stimulant abuse with withdrawal
F15.20 Other stimulant dependence, uncomplicated
F15.21 Other stimulant dependence, in remission
F15.23 Other stimulant dependence with withdrawal
F15.24 Other stimulant dependence with stimulant-induced mood disorder
F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions
F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations
F15.280 Other stimulant dependence with stimulant-induced anxiety disorder
F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction
F15.282 Other stimulant dependence with stimulant-induced sleep disorder
F15.288 Other stimulant dependence with other stimulant-induced disorder
F16.10 Hallucinogen abuse, uncomplicated
F16.11 Hallucinogen abuse, in remission
F16.20 Hallucinogen dependence, uncomplicated
F16.21 Hallucinogen dependence, in remission
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder
F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)
F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
F18.10 Inhalant abuse, uncomplicated
F18.11 Inhalant abuse, in remission
F18.20 Inhalant dependence, uncomplicated
F18.21 Inhalant dependence, in remission
F18.24 Inhalant dependence with inhalant-induced mood disorder
F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions
F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations
F18.27 Inhalant dependence with inhalant-induced dementia
F18.280 Inhalant dependence with inhalant-induced anxiety disorder
F18.288 Inhalant dependence with other inhalant-induced disorder
F19.10 Other psychoactive substance abuse, uncomplicated
F19.11 Other psychoactive substance abuse, in remission
F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
F19.131 Other psychoactive substance abuse with withdrawal delirium
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.20 Other psychoactive substance dependence, uncomplicated
F19.21 Other psychoactive substance dependence, in remission
F19.230 Other psychoactive substance dependence with withdrawal, uncomplicated
F19.231 Other psychoactive substance dependence with withdrawal delirium
F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance
F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder
F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions
F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations
F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia
F19.280 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder
F19.281 Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction
F19.282 Other psychoactive substance dependence with psychoactive substance-induced sleep disorder
F19.288 Other psychoactive substance dependence with other psychoactive substance-induced disorder
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.5 Residual schizophrenia
F20.81 Schizophreniform disorder
F20.89 Other schizophrenia
F21 Schizotypal disorder
F22 Delusional disorders
F23 Brief psychotic disorder
F24 Shared psychotic disorder
F25.0 Schizoaffective disorder, bipolar type
F25.1 Schizoaffective disorder, depressive type
F25.8 Other schizoaffective disorders
F30.11 Manic episode without psychotic symptoms, mild
F30.12 Manic episode without psychotic symptoms, moderate
F30.13 Manic episode, severe, without psychotic symptoms
F30.2 Manic episode, severe with psychotic symptoms
F30.3 Manic episode in partial remission
F30.4 Manic episode in full remission
F30.8 Other manic episodes
F31.0 Bipolar disorder, current episode hypomanic
F31.11 Bipolar disorder, current episode manic without psychotic features, mild
F31.12 Bipolar disorder, current episode manic without psychotic features, moderate
F31.13 Bipolar disorder, current episode manic without psychotic features, severe
F31.2 Bipolar disorder, current episode manic severe with psychotic features
F31.31 Bipolar disorder, current episode depressed, mild
F31.32 Bipolar disorder, current episode depressed, moderate
F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features
F31.61 Bipolar disorder, current episode mixed, mild
F31.62 Bipolar disorder, current episode mixed, moderate
F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features
F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features
F31.81 Bipolar II disorder
F31.89 Other bipolar disorder
F32.0 Major depressive disorder, single episode, mild
F32.1 Major depressive disorder, single episode, moderate
F32.2 Major depressive disorder, single episode, severe without psychotic features
F32.3 Major depressive disorder, single episode, severe with psychotic features
F32.4 Major depressive disorder, single episode, in partial remission
F32.5 Major depressive disorder, single episode, in full remission
F32.81 Premenstrual dysphoric disorder
F32.89 Other specified depressive episodes
F33.0 Major depressive disorder, recurrent, mild
F33.1 Major depressive disorder, recurrent, moderate
F33.2 Major depressive disorder, recurrent severe without psychotic features
F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
F33.41 Major depressive disorder, recurrent, in partial remission
F33.42 Major depressive disorder, recurrent, in full remission
F33.8 Other recurrent depressive disorders
F34.0 Cyclothymic disorder
F34.1 Dysthymic disorder
F34.81 Disruptive mood dysregulation disorder
F34.89 Other specified persistent mood disorders
F40.01 Agoraphobia with panic disorder
F40.02 Agoraphobia without panic disorder
F40.11 Social phobia, generalized
F40.210 Arachnophobia
F40.218 Other animal type phobia
F40.220 Fear of thunderstorms
F40.228 Other natural environment type phobia
F40.230 Fear of blood
F40.231 Fear of injections and transfusions
F40.232 Fear of other medical care
F40.233 Fear of injury
F40.240 Claustrophobia
F40.241 Acrophobia
F40.242 Fear of bridges
F40.243 Fear of flying
F40.248 Other situational type phobia
F40.290 Androphobia
F40.291 Gynephobia
F40.298 Other specified phobia
F40.8 Other phobic anxiety disorders
F41.0 Panic disorder [episodic paroxysmal anxiety]
F41.1 Generalized anxiety disorder
F41.3 Other mixed anxiety disorders
F41.8 Other specified anxiety disorders
F42.2 Mixed obsessional thoughts and acts
F42.3 Hoarding disorder
F42.4 Excoriation (skin-picking) disorder
F42.8 Other obsessive-compulsive disorder
F42.9 Obsessive-compulsive disorder, unspecified
F43.0 Acute stress reaction
F43.11 Post-traumatic stress disorder, acute
F43.12 Post-traumatic stress disorder, chronic
F43.21 Adjustment disorder with depressed mood
F43.22 Adjustment disorder with anxiety
F43.23 Adjustment disorder with mixed anxiety and depressed mood
F43.24 Adjustment disorder with disturbance of conduct
F43.25 Adjustment disorder with mixed disturbance of emotions and conduct
F43.29 Adjustment disorder with other symptoms
F43.89 Other reactions to severe stress
F44.0 Dissociative amnesia
F44.1 Dissociative fugue
F44.2 Dissociative stupor
F44.4 Conversion disorder with motor symptom or deficit
F44.5 Conversion disorder with seizures or convulsions
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
F44.81 Dissociative identity disorder
F44.89 Other dissociative and conversion disorders
F45.0 Somatization disorder
F45.1 Undifferentiated somatoform disorder
F45.20 Hypochondriacal disorder, unspecified
F45.21 Hypochondriasis
F45.22 Body dysmorphic disorder
F45.29 Other hypochondriacal disorders
F45.41 Pain disorder exclusively related to psychological factors
F45.42 Pain disorder with related psychological factors
F45.8 Other somatoform disorders
F48.1 Depersonalization-derealization syndrome
F48.2 Pseudobulbar affect
F48.8 Other specified nonpsychotic mental disorders
F50.010 Anorexia nervosa, restricting type, mild
F50.011 Anorexia nervosa, restricting type, moderate
F50.012 Anorexia nervosa, restricting type, severe
F50.013 Anorexia nervosa, restricting type, extreme
F50.014 Anorexia nervosa, restricting type, in remission
F50.020 Anorexia nervosa, binge eating/purging type, mild
F50.021 Anorexia nervosa, binge eating/purging type, moderate
F50.022 Anorexia nervosa, binge eating/purging type, severe
F50.023 Anorexia nervosa, binge eating/purging type, extreme
F50.024 Anorexia nervosa, binge eating/purging type, in remission
F50.21 Bulimia nervosa, mild
F50.22 Bulimia nervosa, moderate
F50.23 Bulimia nervosa, severe
F50.24 Bulimia nervosa, extreme
F50.25 Bulimia nervosa, in remission
F50.810 Binge eating disorder, mild
F50.811 Binge eating disorder, moderate
F50.812 Binge eating disorder, severe
F50.813 Binge eating disorder, extreme
F50.814 Binge eating disorder, in remission
F50.82 Avoidant/restrictive food intake disorder
F50.83 Pica in adults
F50.89 Other specified eating disorder
F51.01 Primary insomnia
F51.02 Adjustment insomnia
F51.03 Paradoxical insomnia
F51.04 Psychophysiologic insomnia
F51.05 Insomnia due to other mental disorder
F51.09 Other insomnia not due to a substance or known physiological condition
F51.11 Primary hypersomnia
F51.12 Insufficient sleep syndrome
F51.13 Hypersomnia due to other mental disorder
F51.19 Other hypersomnia not due to a substance or known physiological condition
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmare disorder
F51.8 Other sleep disorders not due to a substance or known physiological condition
F52.0 Hypoactive sexual desire disorder
F52.1 Sexual aversion disorder
F52.21 Male erectile disorder
F52.22 Female sexual arousal disorder
F52.31 Female orgasmic disorder
F52.32 Male orgasmic disorder
F52.4 Premature ejaculation
F52.5 Vaginismus not due to a substance or known physiological condition
F52.6 Dyspareunia not due to a substance or known physiological condition
F52.8 Other sexual dysfunction not due to a substance or known physiological condition
F53.0 Postpartum depression
F53.1 Puerperal psychosis
F54 Psychological and behavioral factors associated with disorders or diseases classified elsewhere
F55.0 Abuse of antacids
F55.1 Abuse of herbal or folk remedies
F55.2 Abuse of laxatives
F55.3 Abuse of steroids or hormones
F55.4 Abuse of vitamins
F55.8 Abuse of other non-psychoactive substances
F60.0 Paranoid personality disorder
F60.1 Schizoid personality disorder
F60.2 Antisocial personality disorder
F60.3 Borderline personality disorder
F60.4 Histrionic personality disorder
F60.5 Obsessive-compulsive personality disorder
F60.6 Avoidant personality disorder
F60.7 Dependent personality disorder
F60.81 Narcissistic personality disorder
F60.89 Other specific personality disorders
F63.0 Pathological gambling
F63.1 Pyromania
F63.2 Kleptomania
F63.3 Trichotillomania
F63.81 Intermittent explosive disorder
F63.89 Other impulse disorders
F64.0 Transsexualism
F64.1 Dual role transvestism
F64.2 Gender identity disorder of childhood
F64.8 Other gender identity disorders
F65.0 Fetishism
F65.1 Transvestic fetishism
F65.2 Exhibitionism
F65.3 Voyeurism
F65.4 Pedophilia
F65.51 Sexual masochism
F65.52 Sexual sadism
F65.81 Frotteurism
F65.89 Other paraphilias
F66 Other sexual disorders
F68.11 Factitious disorder imposed on self, with predominantly psychological signs and symptoms
F68.12 Factitious disorder imposed on self, with predominantly physical signs and symptoms
F68.13 Factitious disorder imposed on self, with combined psychological and physical signs and symptoms
F68.A Factitious disorder imposed on another
F68.8 Other specified disorders of adult personality and behavior
F70 Mild intellectual disabilities
F71 Moderate intellectual disabilities
F80.0 Phonological disorder
F80.1 Expressive language disorder
F80.2 Mixed receptive-expressive language disorder
F80.4 Speech and language development delay due to hearing loss
F80.81 Childhood onset fluency disorder
F80.82 Social pragmatic communication disorder
F80.89 Other developmental disorders of speech and language
F81.0 Specific reading disorder
F81.2 Mathematics disorder
F81.81 Disorder of written expression
F81.89 Other developmental disorders of scholastic skills
F82 Specific developmental disorder of motor function
F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type
F90.2 Attention-deficit hyperactivity disorder, combined type
F90.8 Attention-deficit hyperactivity disorder, other type
F91.0 Conduct disorder confined to family context
F91.1 Conduct disorder, childhood-onset type
F91.2 Conduct disorder, adolescent-onset type
F91.3 Oppositional defiant disorder
F91.8 Other conduct disorders
F93.0 Separation anxiety disorder of childhood
F93.8 Other childhood emotional disorders
F94.0 Selective mutism
F94.1 Reactive attachment disorder of childhood
F94.2 Disinhibited attachment disorder of childhood
F94.8 Other childhood disorders of social functioning
F95.0 Transient tic disorder
F95.1 Chronic motor or vocal tic disorder
F95.2 Tourette's disorder
F95.8 Other tic disorders
F95.9 Tic disorder, unspecified
F98.0 Enuresis not due to a substance or known physiological condition
F98.1 Encopresis not due to a substance or known physiological condition
F98.21 Rumination disorder of infancy and childhood
F98.29 Other feeding disorders of infancy and early childhood
F98.3 Pica of infancy and childhood
F98.4 Stereotyped movement disorders
F98.5 Adult onset fluency disorder
F98.8 Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
G30.0 Alzheimer's disease with early onset
G30.1 Alzheimer's disease with late onset
G30.8 Other Alzheimer's disease
Z01.818 Encounter for other preprocedural examination
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

ICD-10 codes must be coded to the highest level of specificity.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

(22 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
GZ2ZZZZ Crisis Intervention
GZ50ZZZ Individual Psychotherapy, Interactive
GZ51ZZZ Individual Psychotherapy, Behavioral
GZ52ZZZ Individual Psychotherapy, Cognitive
GZ53ZZZ Individual Psychotherapy, Interpersonal
GZ54ZZZ Individual Psychotherapy, Psychoanalysis
GZ55ZZZ Individual Psychotherapy, Psychodynamic
GZ56ZZZ Individual Psychotherapy, Supportive
GZ58ZZZ Individual Psychotherapy, Cognitive-Behavioral
GZ59ZZZ Individual Psychotherapy, Psychophysiological
GZ72ZZZ Family Psychotherapy
GZHZZZZ Group Psychotherapy
HZ50ZZZ Individual Psychotherapy for Substance Abuse Treatment, Cognitive
HZ51ZZZ Individual Psychotherapy for Substance Abuse Treatment, Behavioral
HZ52ZZZ Individual Psychotherapy for Substance Abuse Treatment, Cognitive-Behavioral
HZ54ZZZ Individual Psychotherapy for Substance Abuse Treatment, Interpersonal
HZ55ZZZ Individual Psychotherapy for Substance Abuse Treatment, Interactive
HZ56ZZZ Individual Psychotherapy for Substance Abuse Treatment, Psychoeducation
HZ57ZZZ Individual Psychotherapy for Substance Abuse Treatment, Motivational Enhancement
HZ58ZZZ Individual Psychotherapy for Substance Abuse Treatment, Confrontational
HZ59ZZZ Individual Psychotherapy for Substance Abuse Treatment, Supportive
HZ5BZZZ Individual Psychotherapy for Substance Abuse Treatment, Psychoanalysis
N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/20/2024 R2

Under Article Text the following verbiage has been removed: “Biofeedback is not a service covered by Medicare for psychosomatic disorders.” Formatting, punctuation, and typographical errors were corrected throughout the article. Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added F07.0, F07.81, F11.10, F11.11, F11.13, F11.20, F11.21, F11.23, F11.24, F11.250, F11.251, F11.281, F11.282, F11.288, F12.10, F12.11, F12.13, F12.20, F12.21, F12.23, F12.250, F12.251, F12.259, F12.280, F13.10, F13.11, F13.130, F13.131, F13.132, F13.20, F13.21, F13.230, F13.231, F13.232, F13.24, F13.250, F13.251, F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F14.10, F14.11, F14.20, F14.21, F14.23, F14.24, F14.250, F14.251, F14.280, F14.281, F14.282, F14.288, F15.10, F15.11, F15.13, F15.20, F15.21, F15.23, F15.24, F15.250, F15.251, F15.280, F15.281, F15.282, F15.288, F16.10, F16.11, F16.20, F16.21, F16.24, F16.250, F16.251, F16.280, F16.283, F16.288, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, F18.10, F18.11, F18.20, F18.21, F18.24, F18.250, F18.251, F18.27, F18.280, F18.288, F19.10, F19.11, F19.130, F19.131, F19.132, F19.20, F19.21, F19.230, F19.231, F19.232, F19.24, F19.250, F19.251, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F21, F22, F23, F24, F25.0, F25.1, F25.8, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F31.0, F31.11, F31.12, F31.13, F31.2, F31.31, F31.32, F31.4, F31.5, F31.61, F31.62, F31.63, F31.64, F31.81, F31.89, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F33.0, F33.1, F33.2, F33.3, F33.41, F33.42, F33.8, F40.01, F40.02, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F41.0, F41.1, F41.3, F41.8, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.11, F43.12, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.89, F44.0, F44.1, F44.2, F44.4, F44.5, F44.6, F44.7, F44.81, F44.89, F45.0, F45.1, F45.20, F45.21, F45.22, F45.29, F45.41, F45.42, F45.8, F50.010, F50.011, F50.012, F50.013, F50.014, F50.020, F50.021, F50.022, F50.023, F50.024, F50.21, F50.22, F50.23, F50.24, F50.25, F50.810, F50.811, F50.812, F50.813, F50.814, F50.82, F50.83, F50.89, F51.01, F51.02, F51.03, F51.04, F51.05, F51.09, F51.11, F51.12, F51.13, F51.19, F51.3, F51.4, F51.5, F51.8, F52.0, F52.1, F52.21, F52.22, F52.31, F52.32, F52.4, F52.5, F52.6, F52.8, F53.0, F53.1, F54, F55.0, F55.1, F55.2, F55.3, F55.4, F55.8, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F64.0, F64.1, F64.2, F64.8, F65.0, F65.1, F65.2, F65.3, F65.4, F65.51, F65.52, F65.81, F65.89, F66, F68.11, F68.12, F68.13, F68.A, F68.8, F70, F71, F80.0, F80.1, F80.2, F80.4, F80.81, F80.82, F80.89, F81.0, F81.2, F81.81, F81.89, F82, F90.0, F90.1, F90.2, F90.8, F91.0, F91.1, F91.2, F91.3, F91.8, F93.0, F93.8, F94.0, F94.1, F94.2, F94.8, F95.0, F95.1, F95.2, F95.8, F95.9, F98.0, F98.1, F98.21, F98.29, F98.3, F98.4, F98.5, F98.8, G30.0, G30.1, G30.8 and Z01.818. This revision is retroactive effective for dates of service on or after 10/20/24.

10/20/2024 R1

Under CPT/HCPCS Codes Group 1: Paragraph removed verbiage “Codes 0821T and 0822T, code first 0820T”. Under CPT/HCPCS Codes Group 1: Codes deleted 90875, 90876, and 90880.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L39853 - Outpatient Psychotherapy
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
11/01/2024 10/20/2024 - N/A Currently in Effect You are here
10/14/2024 10/20/2024 - N/A Superseded View
08/29/2024 10/20/2024 - N/A Superseded View

Keywords

  • Outpatient psychotherapy