I-SMART - Substance Abuse Tx Service Desciptions and CPT Codes

January 2013

The below table below shows the changes in the Substance Abuse Treatment Domain for Services related to the CPT Codes changes that go into effect Nationally on 1/1/13. Those Highlighted in light red are Services that have CPT Codes that are expiring 1/1/13. To allow programs to enter the correct Services for Encounters that occur on/before 12/31/12, these Services will be available in the Encounter Service dropdown through 1/13/13. Those Services highlighted in Yellow are new Services with the related new CPT Codes that go into effect on 1/1/13. Those Services not highlighted are not affected by the CPT code changes.

Service Description EOP Group W3500-No Show, No Call; Medicaid 90801 - Psychiatric diagnostic interview examination 90802 - Interactive psychiatric diagnostic interview examination 90804 - Individual Psychotherapy - Insight Oriented

Measure Unit Duration Duration Duration Duration

Effective Expiration 1/1/2006 12/31/2012 8/14/2006 12/31/2012 1/1/2005 1/13/2013 1/1/2006 1/13/2013 1/1/2005 1/13/2013 1/1/2006 1/13/2013

CPT Code 90806 W3500 90801 90802 90804 90806

90806 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, Duration in an office or outpatient facility, approx. 45 to 50 min. face-to- face with the patient 90808 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, Duration in an office or outpatient facility, approx. 75 to 80 min. face-to-face with the patient 90810 - Individual Psychotherapy - Interactive 90812 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approx. 45 to 50 min. face-to-face 90814 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approx. 75 to 80 min. face-to-face Duration Duration

1/1/2006 1/1/2006 1/1/2006

1/13/2013 1/13/2013 1/13/2013

90808 90810 90812

Duration

1/1/2006

1/13/2013

90814

90816 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, Duration in an inpatient hospital, partial hospital or residential care setting, approx. 20 to 30 min. face-to-face with the patient 90818 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, Duration in an inpatient hospital, partial hospital or residential care setting, approx. 45 to 50 min. face-to-face with the patient 90821 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, Duration in an inpatient hospital, partial hospital or residential care setting, approx. 75 to 80 min. face-to-face with the patient 90823 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, 90826 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, 90828 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, Duration

1/1/2006

1/13/2013

90816

1/1/2006

1/13/2013

90818

1/1/2006

1/13/2013

90821

1/1/2006

1/13/2013

90823

Duration

1/1/2006

1/13/2013

90826

Duration

1/1/2006

1/13/2013

90828

Page 1

updated January 11, 2013

I-SMART - Substance Abuse Tx Service Desciptions and CPT Codes

Service Description 90857 - Interactive group psychotherapy 99058 - Office Emergency Services 81000 - Urinalysis, Nonauto w/Scope 90791 - Assessment Interview (no medical services) 90792 - Assessment Interview (with medical services) 90832 - Psychotherapy (30 min) 90834 - Psychotherapy (45 min) 90837 - Psychotherapy (60 min) 90839 - Psychotherapy for Crisis (first 60 min) 90840 - Crisis Code add-on (each additional 30 min) 90846 - Family psychotherapy (without the patient present) 90847 - Family psychotherapy (conjoint psychotherapy) with patient present 90849 - Multiple-Family group psychotherapy 90853-Group psychotherapy (other than multi-family group) 90863 - Pharmacologic Management w/Psychotherapy 90880 - Hypnotherapy 90899 - Unlisted psychiatric service or procedure 99202 - E/M New Out Patient Visit (20 min) 99203 - E/M New Out Patient Visit (30 min) 99204 - E/M New Out Patient Visit (45 min) 99205 - E/M New Out Patient Visit (60 min) 99211 - E/M Established Out Patient Visit (5 min) 99213 - E/M Established Out Patient Visit (15 min) G0177 - Education Session G0410 - Group Psychotherapy (Hospital Based) H0015 - Intensive Outpatient tx (at least 3 hrs/day, 3 days/wk) II.1 H0018 - Primary Residential Treatment (III.3/5, per diem) H0018 - Medically Monitored Detoxification Services (III.7D, per diem) H0035 - Substance Abuse Partial Hospitalization (II.5) H2034 - Halfway house services (III.1, per diem) NBL - Non billable Expiring Service Description (1/13/13) New Service Description (1/1/13) Measure Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Duration Unit Unit Unit Unit Unit Unit Duration Effective 1/1/2006 1/1/2006 1/27/2010 1/1/2013 1/1/2013 1/1/2013 1/1/2013 1/1/2013 1/1/2013 1/1/2013 1/1/2006 1/1/2006 1/1/2006 1/1/2006 1/1/2013 1/1/2006 1/1/2006 8/1/2011 1/1/2013 1/1/2013 1/1/2013 8/1/2011 8/1/2011 1/1/2006 2/1/2012 1/1/2006 8/14/2006 8/14/2006 1/7/2005 1/1/2006 1/1/2006 Expiration 1/13/2013 1/13/2013

January 2013

CPT Code 90857 99058 81000 90791 90792 90832 90834 90837 90839 90840 90846 90847 90849 90853 90863 90880 90899 99202 99203 99204 99205 99211 99213 G0177 G0410 H0015 H0018-TF H0018-TG H0035 H2034 NBL

Page 2

updated January 11, 2013