Effective April 20, 2020, NC Medicaid in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policy 8C: Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.
These temporary changes are retroactive to March 10, 2020 and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. When the temporary modifications end, all prior service requirements will resume.
During the North Carolina declared state of emergency, services must continue to be provided at an intensity and quality that meet the needs of the individual, consistent with the individual’s goals and the intended outcomes of the service. In addition, the service must be provided by a licensed professional or licensed professional associate with the expertise and scope necessary to meet the needs of each individual.
In addition to previous flexibilities published in COVID-19 Special Medicaid Bulletins #9, #19, and #46, the Department is issuing guidance on allowing telephonic outpatient psychotherapy, in addition to the telehealth flexibilities previously added. As clinically appropriate, services may still be offered via HIPAA-compliant, real-time, two-way interactive audio and video telehealth appointment to proceed with the behavioral health intervention(s).
Note: Please see OCR guidance relaxing technology requirements. If that option is not available, services may be offered via non-HIPAA compliant audio and video telehealth appointment with documented beneficiary or legal guardian consent. If two-way audio-visual options are not accessible to the beneficiary, the following services may be offered via telephonic modality.
The following table outlines the outpatient psychotherapy codes allowed to be used telephonically during the declared state of emergency. For full details see the CPT 2020 Professional Edition Manual.
Table 1: Outpatient Psychotherapy CPT Codes
CPT Code | CPT Code Description |
|---|---|
90846 | Family Psychotherapy without Patient present |
90847 | Family Psychotherapy with Patient present |
90849 | Multiple-Family Group Psychotherapy |
90853 | Group Psychotherapy |
90785 | Psychotherapy Complex Interactive Note: The use of this code telephonically is targeted to use of an interpreter, and not interactive play therapy. |
90791 | Psychotherapy Diagnostic Evaluation |
90832 | Psychotherapy with Patient 30 minutes |
90833 | Add on code for Individual Psychotherapy with Patient and/or Family member when performed with an approved E&M code - 30 minutes Note: This code can be used temporarily as an add-on to the time-based telephonic E&M codes: 99441, 99442, or 99443. The time spent on E&M elements should only count toward the E&M billing, and the time spent on psychotherapy should only count toward the add-on billing. |
90834 | Psychotherapy with Patient 45 minutes |
90836 | Add on code for Individual Psychotherapy with Patient and/or Family member when performed with an approved E&M code - 45 minutes. Note: This code can be used temporarily as an add-on to the time-based telephonic E&M codes: 99441, 99442, or 99443. The time spent on E&M elements should only count toward the E&M billing, and the time spent on psychotherapy should only count toward the add-on billing. |
90837 | Psychotherapy with Patient 60 minutes |
90838 | Add on code for Individual Psychotherapy with Patient and/or Family member when performed with an approved E&M code - 60 minutes. Note: This code can be used temporarily as an add-on to the time-based telephonic E&M codes: 99441, 99442, or 99443. The time spent on E&M elements should only count toward the E&M billing, and the time spent on psychotherapy should only count toward the add-on billing. |
90839 | Psychotherapy Crisis Initial 60 minutes |
90840 | Psychotherapy Crisis Each Additional 30 minutes |
97156 | Family Adaptive Behavior Treatment Guidance |
97157 | Multiple Family Group Adaptive Behavior Treatment Guidance |
Modifiers
Provider(s) shall follow applicable modifier guidelines.
- Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive two-way real-time audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
- Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions.
Billing Unit
- Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).
- The use of Telephonic intervention reimburses at a rate of 80 percent in fee for service as long as standard of care is met. LME-MCOs maintain rate setting authority. Providers operating within an LME-MCO structure, consult your LME-MCO regarding rates.
Place of Service
Telemedicine and telepsychiatry claims related to COVID-19 shall be filed with the provider’s usual place of service for fee-for-service claims submitted to NCTracks. Claims submissions to LME-MCOs will follow the guidance of the LME-MCO.
Additional Resources
- NC Medicaid Telehealth Billing Code Summary Chart
- NC Medicaid Telehealth Resources website
- NC Medicaid COVID-19 Resources website
Contact
Medicaid Contact Center: 888-245-0179