Initial Units Authorized - Mental Health As of 6/1/16 AMERIGROUP Fax 1-800-505-1193 CENPATICO Phone 1-800-454-3730 UNITED SERVICE TYPE CPT CODE/UNIT Fax 1-866-694-3649 ANNUAL LIMITS. RESET Fax 1-855-268-9392 INFORMATION Phone 1-866-896-7293 EACH CALENDAR YEAR. Phone 1-855-802-7095 NEED OTR IF EXCEED UNITS LISTED. Psychiatric Diagnostic Interview – CPT Code – 90791 1 session within 6 rolling 5 sessions 5 sessions No Medical Services Unit = Visit months Maximum 1 unit per day Psychiatric Diagnostic Interview – With CPT Code – 90792 1 session within 6 rolling Included in Psychiatric 5 sessions Medical Services Unit = Visit months Diagnostic Interview – No Maximum 1 unit per day Medical Services Admission Evaluation Not applicable Refer to Psychiatric Diagnostic Refer to Psychiatric Diagnostic Refer to Psychiatric Diagnostic Interview Interview Interview Outpatient Individual Psychotherapy CPT Codes – 90832, 90834, Unlimited benefit Unlimited benefit Unlimited benefit & 90837 Unit = Visit Maximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per day Outpatient Individual Psychotherapy with CPT Codes – 90833, 90836, Unlimited benefit Unlimited benefit Unlimited benefit Medical Management & 90838 (Add on Services) Unit = Visit Maximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per day Family Psychotherapy CPT Code – 90847 Unlimited benefit Unlimited benefit Unlimited benefit Unit = Visit Maximum 1 unit per day Family Psychotherapy in the Home CPT Code – 90847 HK Unlimited benefit Unlimited benefit Unlimited benefit Unit = equal to or less than 90 minutes Maximum 1 unit per day Group Psychotherapy CPT Code – 90853 Unlimited benefit Unlimited benefit Unlimited benefit Unit = Visit Maximum 1 unit per day
Initial Units Authorized - Mental Health As of 6/1/16 SERVICE TYPE CPT CODE/UNIT INFORMATION CENPATICO Fax 1-866-694-3649 Phone 1-866-896-7293 AMERIGROUP Fax 1-800-505-1193 Phone 1-800-454-3730 ANNUAL LIMITS. RESET EACH CALENDAR YEAR. NEED OTR IF EXCEED UNITS LISTED. UNITED Fax 1-855-268-9392 Phone 1-855-802-7095 Psychiatric Diagnostic Interview – No Medical Services CPT Code – 90791 Unit = Visit Maximum 1 unit per day 1 session within 6 rolling months 5 sessions 5 sessions Psychiatric Diagnostic Interview – With Medical Services CPT Code – 90792 Unit = Visit Maximum 1 unit per day 1 session within 6 rolling months Included in Psychiatric Diagnostic Interview – No Medical Services 5 sessions Admission Evaluation Not applicable Refer to Psychiatric Diagnostic Interview Refer to Psychiatric Diagnostic Interview Refer to Psychiatric Diagnostic Interview Outpatient Individual Psychotherapy CPT Codes – 90832, 90834, & 90837 Unit = Visit Maximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per day Unlimited benefit Unlimited benefit Unlimited benefit Outpatient Individual Psychotherapy with Medical Management (Add on Services) CPT Codes – 90833, 90836, & 90838 Unit = Visit Maximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per day Unlimited benefit Unlimited benefit Unlimited benefit Family Psychotherapy CPT Code – 90847 Unit = Visit Maximum 1 unit per day Unlimited benefit Unlimited benefit Unlimited benefit Family Psychotherapy in the Home CPT Code – 90847 HK Unit = equal to or less than 90 minutes Maximum 1 unit per day Unlimited benefit Unlimited benefit Unlimited benefit Group Psychotherapy CPT Code – 90853 Unit = Visit Maximum 1 unit per day Unlimited benefit Unlimited benefit Unlimited benefit
Summary-of-Initial-Units-Authorized-060116.ACMHC_.rev-051716.docx