Read CPTtable.PDF text version

Table 1: Potential CPT Codes to Use for Reimbursement of Healthy Steps Services

CPT Code

90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90846 90847 90849 90853 90857 96100 96110 Testing

TITLE (paraphrased)

20-30 minutes, face-to-face with the patient. Individual psychotherapy, insight oriented, behavior modifying and/or supportive in an office or OUTPATIENT 45-50 minutes, face-to-face with the patient. facility. 75-80 minutes, face-to-face with the patient. Individual psychotherapy, INTERACTIVE, using play equipment, physical devices, language interpreter or other mechanisms of nonverbal communication in an office or OUTPATIENT facility. Typically furnished to children. Family psychotherapy Group psychotherapy 20-30 minutes, face-to-face with the patient. 45-50 minutes, face-to-face with the patient. 75-80 minutes, face-to-face with the patient.

CPT Code

With medical evaluation and management services. With medical evaluation and management services. With medical evaluation and management services. With medical evaluation and management services. With medical evaluation and management services. 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90846 90847 90849 90853 90857 96100 96110

HEALTHY STEPS COMPONENTS

Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Child dvlpmt tel. info. line Extended well-child office visit Parent groups Parent groups (?) Parent groups Extended well-child office visit Extended well-child office visit Parent groups Home visit Parent groups

Reimbursement Likelihood*

With medical evaluation and management services. Without patient present. With patient present. Multiple family. Group other than a multiple family group. Interactive. Psychological, including interpretation and report, per hour. Developmental, limited, including interpretation and report. (E.g., Developmental Screening Test II, Early Language Milestone Screen.) Developmental, extended, including interpretation and report, per hour. (Includes assessment of motor language, social, adaptive and/or cognitive functioning by standardized developmental instruments, e.g., Bayley Scales of Infant Development.) Neurobehavioral status exam, with interpretation and report, per hour. (Clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, memory, visual spatial abilities, language functions, planning.)

Home visit Home visit

Child devlpmt assessments Child dvlpmt assessments

96111

96111 Extended well-child office visit 96115 97770 99071 99078 99082 Extended well-child office visit Extended well-child office visit Written materials Parent groups Extended well-child office visit

Home visit

Child dvlpmt assessments

96115 97770 99071 99078 99082

Home visit Home visit Community links

Child devlpmt assessments

Development of cognitive skills to improve attention, memory, problem solving, includes compensatory training and/or sensory integrative activities, direct (one on one) patient contact by the provider per 15 minutes. Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patient's education at a cost to the physician. Physician educational services rendered to patients in a group setting (e.g., prenatal, obesity, or diabetic instructions). Unusual travel (e.g., transportation and escort of patient).

3 3

Parent groups

3

*Reimbursement Likelihood: 1= Highly Likely; 2=Potentially Feasible; 3= Unlikely Page 1 6/1/99

Table 1: Potential CPT Codes to Use for Reimbursement of Healthy Steps Services

CPT Code

99341

TITLE (paraphrased)

Components: problem focused history; problem focused examination; and straightforward medical decision making. Presenting problems of low severity. Physician typically spends 20 minutes face-to-face with the patient and/or family. Components: expanded problem focused history; expanded problem focused examination; and medical decision making of low complexity. Presenting problems of moderate severity. Physician typically spends 30 minutes face-to-face with the patient and/or family. Home Visit for the evaluation and management of a NEW patient. Components: detailed history; detailed examination; and medical decision making of moderate complexity. Presenting problems of moderate to high severity. Physician typically spends 45 minutes face-to-face with the patient and/or family. Components: comprehensive history; comprehensive examination; and medical decision making of moderate complexity. Presenting problems of high severity. Physician typically spends 60 minutes face-to-face with the patient and/or family. Components: comprehensive history; comprehensive examination; and medical decision making of high complexity. Patient is usually unstable or has developed a significant new problem requiring immediate physician attention. Physician typically spends 75 minutes face-to-face with the patient and/or family. 2 of these 3 components: a problem focused interval history; a problem focused examination; and straightforward decision making. Typically, problems are self-limited or minor; physicians spend 15 minutes face-to-face with patient and/or family. 2 of these 3 components: an expanded problem focused interval history; an expanded problem focused examination; and medical decision making of low complexity. Typically, problems are of low to moderate severity and physicians spend 25 minutes face-to-face with patient and/or family. 2 of these 3 components: a detailed interval history; a detailed examination; and medical decision making of moderate complexity. Typically, problems are of moderate to high severity and physicians spend 40 minutes face-to-face with patient and/or family. 2 of these 3 components: a comprehensive interval history; a comprehensive examination; and medical decision making of moderate to high complexity. Typically, problems are of moderate to high severity; the patient may be unstable or may have developed a new problem requiring immediate physician attention. Physicians spend 60 minutes face-to-face with patient and/or family. First hour. Each additional 30 minutes. First hour. Each additional 30 minutes. Medical conference by a physician with an interdisciplinary team of health professionals or community agencies representatives to coordinate activities of patient care (patient not present). Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals. 30 minutes. 60 minutes. Simple or brief. Intermediate. Complex or lengthy.

CPT Code

99341 Home visit

HEALTHY STEPS COMPONENTS

Reimbursement Likelihood*

99342

99342

Home visit

99343

99343

Home visit

99344

99344

Home visit

99345

99345

Home visit

99347

99347

Home visit

99348 Home visit for the evaluation and management of an ESTABLISHED patient.

99348

Home visit

99349

99349

Home visit

99350

99350

Home visit

99354 99355 99358 99359 99361 99362 99371 99372 99373

Prolonged physician service with direct (face-to-face) In the office or other OUTPATIENT setting; use in patient contact requiring direct contact beyond the usual conjunction with other specified codes (99201-215; service. 99241-245; 99301-350). Prolonged evaluation and management service before and/or after direct patient care.

99354 99355 99358 99359 99361 99362 99371 99372 99373

Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit HS team meetings HS team meetings Child dvlpmt tel. info. line Child dvlpmt tel. info. line Child dvlpmt tel. info. line Home visit Home visit Community links Community links Community links Community links Community links Parent groups Parent groups

3 3 3

*Reimbursement Likelihood: 1= Highly Likely; 2=Potentially Feasible; 3= Unlikely Page 2 6/1/99

Table 1: Potential CPT Codes to Use for Reimbursement of Healthy Steps Services

CPT Code

99381 99382 99391 99392 99401 99402 Preventive medicine counseling. 99403 99404 99411 99412 99420 99429 99432 Individual.

TITLE (paraphrased)

Preventive medicine evaluation and management of an Initial evaluation; NEW patient. individual. Includes a comprehensive history, a comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions and the Periodic reevaluation; ESTABLISHED patient. ordering of appropriate laboratory/diagnostic procedures. Infant, age under 1 year Early childhood, age 1 through 4 years Infant, age under 1 year Early childhood, age 1 through 4 years 15 minutes 30 minutes 45 minutes 60 minutes 30 minutes 60 minutes

CPT Code

99381 99382 99391 99392 99401 99402 99403 99404 99411 99412 99420 99429 99432

HEALTHY STEPS COMPONENTS

Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Extended well-child office visit Parent group Parent group Child devlpmt assessments All Extended well-child office visit Home visit Home visit Home visit Home visit Home visit Home visit Home visit Home visit Child dvlpmt assessments Child dvlpmt assessments Child dvlpmt assessments Child dvlpmt assessments Child dvlpmt tel. info. line Child dvlpmt tel. info. line Child dvlpmt tel. info. line Child dvlpmt tel. info. line

Reimbursement Likelihood* 1 1 1 1

Group.

Administration and interpretation of health risk assessment instrument. Unlisted preventive medicine service. Normal newborn care in other than hospital/birthing room setting, including physical examination of baby and conferences with parent(s).

3 Home visit

*Reimbursement Likelihood: 1= Highly Likely; 2=Potentially Feasible; 3= Unlikely Page 3 6/1/99

Table 1: Potential CPT Codes to Use for Reimbursement of Healthy Steps Services

CPT Code

TITLE (paraphrased)

CPT Code

HEALTHY STEPS COMPONENTS

Reimbursement Likelihood*

The AAP Coding for Pediatrics book recommends that the following codes only be used to bill sick-visits.

99201 99202 99203 99204 99205 99211 3 components: a problem focused history; a problem focused examination; and straightforward medical decision making. Typically, physicians spend 10 minutes face-to-face with patient and/or family. 3 components: an expanded problem focused history; an expanded problem focused examination; and a straightforward medical decision making. Typically, physicians spend 20 minutes face-to-face with patient and/or family. Office or other OUTPATIENT visit for the evaluation and 3 key components: a detailed history; a detailed examination; and medical decision making of low complexity. Typically, physicians spend 30 minutes face-to-face with patient and/or family. management of a NEW patient. 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Typically, physicians spend 45 minutes face-to-face with patient and/or family. 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Typically, physicians spend 60 minutes face-to-face with patient and/or family. May not require the presence of a physician; usually minimal presenting problems; 5 minutes typically spent performing or supervising these services. 2 of these 3 components: a problem focused history; a problem focused examination; and straightforward decision making. Typically, problems are self-limited or minor; physicians spend 10 minutes face-to-face with patient and/or family. 2 of these 3 components: an expanded problem focused history; an expanded problem focused examination; and medical Office or other OUTPATIENT visit for the evaluation and decision making of low complexity. Typically, problems are of low to moderate severity and physicians spend 15 minutes management of an ESTABLISHED patient. face-to-face with patient and/or family. 2 of these 3 components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Typically, problems are of moderate to high severity and physicians spend 25 minutes face-to-face with patient and/or family. 2 of these 3 components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Typically, problems are of moderate to high severity and physicians spend 40 minutes face-to-face with patient and/or family. 99201 99202 99203 99204 99205 99211 If HSS participates in sick-visit If HSS participates in sick-visit If HSS participates in sick-visit If HSS participates in sick-visit If HSS participates in sick-visit If HSS participates in sick-visit

99212

99212

If HSS participates in sick-visit

99213

99213

If HSS participates in sick-visit

99214

99214

HSS participates in sick-visit

99215

99215

If HSS participates in sick-visit

The following codes require psychiatric services and may only be reimbursable if provided by a psychiatrist.

90801 Psychiatric Diagnosis. 90802 90885 90887 90889 Interview examination Interactive interview examination using play equipment, physical devices, language interpreter, or other forms of communication. Typically furnished to children. 90801 90802 90885 90887 90889 Extended well-child office visit Extended well-child office visit Child devlpmt assessments Child dvlpmt tel. info. line Extended well-child office visit Child devlpmt assessments Home visit Child devlpmt assessments Home visit Home visit

Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes. Interpretation or explanation of results of psychiatric, other medical examinations/procedures or other accumulated data to family or other responsible persons, or advising them how to assist patient. Preparation of report of patient's psychiatric status, history, treatment or progress for other physicians, agencies, or insurance carriers.

*Reimbursement Likelihood: 1= Highly Likely; 2=Potentially Feasible; 3= Unlikely Page 4 6/1/99

Information

CPTtable.PDF

4 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

140650


You might also be interested in

BETA
Advancements in Standards of Care for Early, Periodic Screening, Diagnosis and Testing (EPSDT)
CPTtable.PDF
255172-United Health Care