New Psychiatric Services Procedure Codes for 2013 HCPCS Now Available

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New Psychiatric Services Procedure Codes for 2013 HCPCS Now Available Information posted December 21, 2012 The 2013 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions for psychiatric services will be effective for dates of service on or after January 1, 2013, and are now available. All new, revised, and discontinued 2013 HCPCS procedure codes will be effective for dates of service on or after January 1, 2013. The 2013 HCPCS discontinued procedure codes will no longer be reimbursed after December 31, 2012. Providers must contact the appropriate copyright holder to obtain procedure code descriptions. Important: Texas will follow the American Psychiatric Association coding crosswalk for 2012 Common Procedural Terminology (CPT) procedure codes to 2013 CPT procedure codes with a few exceptions as noted in the table below. Providers must use the comparable procedure codes that replace the discontinued codes that are currently used for rendered services. New and Deleted Procedure Codes The following psychiatric services procedure codes will be discontinued and replaced as indicated: Category 2012 Procdure Codes 2013 Procedure Codes Diagnostic 90801 90791, 90792 90802 90791, 90792 Psychotherapy 90804, 90816 90832 90806, 90818 90834 Psychotherapy (interactive) Psychotherapy with evaluation and management (E/M) 90808, 90821 90837 90810, 90823 90832 90812, 90826 90834 90814, 90828 90837 90805, 90807, 90809, 90817, 90819, 90822 E/M procedure code based on key components plus psychotherapy add-on code 90833, 90836, or 90838 (time-based) Psychotherapy with E/M (interactive) 90811, 90813, 90815, 90824, 90827, 90829 E/M procedure code plus psychotherapy add-on code 90833, 90836, or 90838

Category 2012 Procdure Codes 2013 Procedure Codes Crisis psychotherapy None 90839 and 90840 are noncovered procedure codes. This service is included in the appropriate therapy procedure code and is not reimbursed separately. Family psychotherapy 90846, 90847, 90849 No changes Group psychotherapy 90853 90853 Interactive group psychotherapy 90857 90853 Pharmacologic management 90862 E/M procedure code Interactive complexity add-on procedure code 90875 will be informational only and not reimbursed separately from the appropriate psychotherapy procedures code. Reminder: New patient visits are limited to one every three years, per client, per provider. A new patient is one who has not received within the past three years any professional services from the physician or from another physician of the same specialty who belongs to the same group practice. Texas Benefit Changes The following Texas benefit changes support the 2013 HCPCS and CPT updates and will be effective for dates of service on or after January 1, 2013. Inpatient Behavioral Health Added 90791 90792 90832 90833 90834 90836 90837 90838 Discontinued 90801 90802 90816 90817 90818 90819 90821 90822 90823 90824 90826 90827 90828 90829 90857 90862 Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook: for more information. The descriptions of the following procedure codes have been revised: Procedure Codes 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99241 99242 99243 99244 99245 99251 99252 99253 99254 99255 99281 99282 99283 99284 99285 99304 99305 99306 99307 99308 99309 99310 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342

Procedure Codes 99343 99344 99345 99347 99348 99349 99350 99360 99464 Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, for more information. Outpatient Behavioral Health Services Added 90791 90792 90832 90833 90834 90836 90837 90838 Discontinued 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90857 90862 Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information. The descriptions of the following procedure codes have been revised: Procedure Codes 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99224 99225 99226 99231 99232 99233 99234 99235 99236 99241 99242 99243 99244 99245 99251 99252 99253 99254 99255 99281 99282 99283 99284 99285 99304 99305 99306 99307 99308 99309 99310 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 99360 99464 Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information. Screening Brief Intervention and Referral to Treatment (SBIRT) Added 90791 90792 90832 90833 90834 90836 90837 90838 Discontinued 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90857 90862 Limitations for added procedure codes: Providers may refer to the current Texas Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook for more information.

CSHCN Services Program Benefit Changes The following Children with Special Health Care Needs (CSHCN) Services Program benefit changes have been made to support the 2013 HCPCS and CPT updates and will be effective for dates of service on or after January 1, 2013. Behavioral Health Services Added 90791 90792 90832 90833 90834 90836 90837 90838 Discontinued 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90816 90817 90818 90819 90821 90822 90823 90824 90826 90827 90828 90829 90857 90862 Limitations for added procedure codes: Providers may refer to the current CSHCN Services Program Provider Manual, for more information. Providers may refer to the current CSHCN Services Program Provider Manual, section 29.2.6, Procedure Codes Included in the 12-Hour System Limitation, for more information. Reimbursement Rates Effective for dates of service on or after January 1, 2013, Texas and the CSHCN Services Program will implement initial reimbursement rates for some psychiatric services HCPCS procedure codes. The table that begins on the following page shows the reimbursement rates will be effective for dates of service on or after January 1, 2013: For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP- CSHCN Services Program Contact Center at 1-800-568-2413.

Type of Service (TOS)* Procedure Code 1 90785 1 90791 HCPCS - PSYCHIATRIC SERVICES Provider Age Adjusted Type/Specialty Range RVU** Fee Fee RVU** Fee Fee 3, 10,16, 18, 19, 20, Informational Informational 21, 22, 31, 40/51, 97 0-999 Not a Benefit Not a Benefit Item Item 31, 97 0-20 Not a Benefit Not a Benefit $119.82 $119.82 31, 97 21-999 Not a Benefit Not a Benefit $113.91 $113.91 1 90791 1 90792 0-20 Not a Benefit Not a Benefit $119.82 $119.82 1 90792 21-999 Not a Benefit Not a Benefit $113.91 $113.91 1 90801 All Provider Types 0-20 4.26 $28.640 $122.01 $119.57 Not a Benefit Not a Benefit 1 90801 All Provider Types 21-999 4.26 $27.276 $116.20 $113.88 Not a Benefit Not a Benefit 1 90802 All Provider Types 0-20 4.58 $27.640 $131.17 $128.55 Not a Benefit Not a Benefit 1 90802 All Provider Types 21-999 4.58 $27.276 $124.92 $122.42 Not a Benefit Not a Benefit 1 90804 All Provider Types 0-20 1.77 $28.640 $50.69 $49.68 Not a Benefit Not a Benefit 1 90804 All Provider Types 0-20 1.77 $28.640 $35.48 $34.77 Not a Benefit Not a Benefit 1 90804 All Provider Types 21-999 1.77 $27.276 $48.28 $47.31 Not a Benefit Not a Benefit 1 90804 All Provider Types 21-999 1.77 $27.276 $33.80 $33.12 Not a Benefit Not a Benefit 1 90805 All Provider Types 0-20 1.99 $28.640 $56.99 $55.85 Not a Benefit Not a Benefit 1 90805 All Provider Types 21-999 1.99 $27.276 $54.28 $53.19 Not a Benefit Not a Benefit 1 90806 All Provider Types 0-20 2.44 $28.640 $69.88 $68.48 Not a Benefit Not a Benefit 1 90806 All Provider Types 0-20 2.44 $28.640 $48.92 $47.94 Not a Benefit Not a Benefit 1 90806 All Provider Types 21-999 2.44 $27.276 $66.55 $65.22 Not a Benefit Not a Benefit 1 90806 All Provider Types 21-999 2.44 $27.276 $46.59 $45.66 Not a Benefit Not a Benefit 1 90807 All Provider Types 0-20 2.80 $28.640 $80.19 $78.59 Not a Benefit Not a Benefit 1 90807 All Provider Types 21-999 2.80 $27.276 $76.37 $74.84 Not a Benefit Not a Benefit 1 90808 All Provider Types 0-20 3.59 $28.640 $102.82 $100.76 Not a Benefit Not a Benefit 1 90808 All Provider Types 0-20 3.59 $28.640 $71.97 $70.53 Not a Benefit Not a Benefit 1 90808 All Provider Types 21-999 3.59 $27.276 $97.92 $95.96 Not a Benefit Not a Benefit 1 90808 All Provider Types 21-999 3.59 $27.276 $68.54 $67.17 Not a Benefit Not a Benefit 1 90809 All Provider Types 0-20 3.95 $28.640 $113.13 $110.87 Not a Benefit Not a Benefit 1 90809 All Provider Types 21-999 3.95 $27.276 $107.74 $105.59 Not a Benefit Not a Benefit 1 90810 All Provider Types 0-20 1.87 $28.640 $53.56 $52.49 Not a Benefit Not a Benefit 1 90810 All Provider Types 21-999 1.87 $27.276 $51.01 $49.99 Not a Benefit Not a Benefit 1 90811 All Provider Types 0-20 2.22 $28.640 $63.58 $62.31 Not a Benefit Not a Benefit 1 90811 All Provider Types 21-999 2.22 $27.276 $60.55 $59.34 Not a Benefit Not a Benefit 1 90812 All Provider Types 0-20 2.66 $28.640 $76.18 $74.66 Not a Benefit Not a Benefit 1 90812 All Provider Types 21-999 2.66 $27.276 $72.55 $71.10 Not a Benefit Not a Benefit 1 90813 All Provider Types 0-20 3.02 $28.640 $86.49 $84.76 Not a Benefit Not a Benefit 1 90813 All Provider Types 21-999 3.02 $27.276 $82.37 $80.72 Not a Benefit Not a Benefit 1 90814 All Provider Types 0-20 3.87 $28.640 $110.84 $108.62 Not a Benefit Not a Benefit 1 90814 All Provider Types 21-999 3.87 $27.276 $105.56 $103.45 Not a Benefit Not a Benefit 1 90815 All Provider Types 0-20 4.18 $28.640 $119.72 $117.33 Not a Benefit Not a Benefit 1 90815 All Provider Types 21-999 4.18 $27.276 $114.01 $111.73 Not a Benefit Not a Benefit

Type of Service (TOS)* HCPCS - PSYCHIATRIC SERVICES RVU** Fee Fee RVU** Adjusted Fee Procedure Code Provider Type/Specialty Age Range Fee 1 90816 All Provider Types 0-20 1.61 $28.640 $46.11 $45.19 Not a Benefit Not a Benefit 1 90816 All Provider Types 21-999 1.61 $27.276 $43.91 $43.03 Not a Benefit Not a Benefit 1 90817 All Provider Types 0-20 1.84 $28.640 $52.70 $51.65 Not a Benefit Not a Benefit 1 90817 All Provider Types 21-999 1.84 $27.276 $50.19 $49.19 Not a Benefit Not a Benefit 1 90818 All Provider Types 0-20 2.40 $28.640 $68.74 $67.37 Not a Benefit Not a Benefit 1 90818 All Provider Types 21-999 2.40 $27.276 $65.46 $64.15 Not a Benefit Not a Benefit 1 90819 All Provider Types 0-20 2.63 $28.640 $75.32 $73.81 Not a Benefit Not a Benefit 1 90819 All Provider Types 21-999 2.63 $27.276 $71.74 $70.31 Not a Benefit Not a Benefit 1 90821 All Provider Types 0-20 3.55 $28.640 $101.67 $99.64 Not a Benefit Not a Benefit 1 90821 All Provider Types 21-999 3.55 $27.276 $96.83 $94.89 Not a Benefit Not a Benefit 1 90822 All Provider Types 0-20 3.79 $28.640 $108.55 $106.38 Not a Benefit Not a Benefit 1 90822 All Provider Types 21-999 3.79 $27.276 $103.38 $101.31 Not a Benefit Not a Benefit 1 90823 All Provider Types 0-20 1.74 $28.640 $49.83 $48.83 Not a Benefit Not a Benefit 1 90823 All Provider Types 21-999 1.74 $27.276 $47.46 $46.51 Not a Benefit Not a Benefit 1 90824 All Provider Types 0-20 1.97 $28.640 $56.42 $55.29 Not a Benefit Not a Benefit 1 90824 All Provider Types 21-999 1.97 $27.276 $53.73 $52.66 Not a Benefit Not a Benefit 1 90826 All Provider Types 0-20 2.54 $28.640 $72.75 $71.30 Not a Benefit Not a Benefit 1 90826 All Provider Types 21-999 2.54 $27.276 $69.28 $67.89 Not a Benefit Not a Benefit 1 90827 All Provider Types 0-20 2.76 $28.640 $79.05 $77.47 Not a Benefit Not a Benefit 1 90827 All Provider Types 21-999 2.76 $27.276 $75.28 $73.77 Not a Benefit Not a Benefit 1 90828 All Provider Types 0-20 3.68 $28.640 $105.40 $103.29 Not a Benefit Not a Benefit 1 90828 All Provider Types 21-999 3.68 $27.276 $100.38 $98.37 Not a Benefit Not a Benefit 1 90829 All Provider Types 0-20 3.92 $28.640 $112.27 $110.02 Not a Benefit Not a Benefit 1 90829 All Provider Types 21-999 3.92 $27.276 $106.92 $104.78 Not a Benefit Not a Benefit 1 90832 31, 97 0-20 Not a Benefit Not a Benefit $49.39 $49.39 1 90832 16, 18, 40/51 0-20 Not a Benefit Not a Benefit $34.57 $34.57 31, 97 21-999 Not a Benefit Not a Benefit $44.66 $44.66 1 90832 1 90832 16, 18, 40/51 21-999 Not a Benefit Not a Benefit $31.26 $31.26 1 90833 3, 10, 19, 20, 21, 22 0-20 Not a Benefit Not a Benefit $18.68 $18.68 1 90833 3, 10, 19, 20, 21, 22 21-999 Not a Benefit Not a Benefit $19.29 $19.29 1 90834 31, 97 0-20 Not a Benefit Not a Benefit $68.49 $68.49 1 90834 16, 18, 40/51 0-20 Not a Benefit Not a Benefit $47.94 $47.94 31, 97 21-999 Not a Benefit Not a Benefit $65.08 $65.08 1 90834 1 90834 16, 18, 40/51 21-999 Not a Benefit Not a Benefit $45.56 $45.56 1 90836 3, 10, 19, 20, 21, 22 0-20 Not a Benefit Not a Benefit $41.77 $41.77 1 90836 3, 10, 19, 20, 21, 22 21-999 Not a Benefit Not a Benefit $40.01 $40.01 1 90837 31, 97 0-20 Not a Benefit Not a Benefit $100.78 $100.78

Type of Service (TOS)* HCPCS - PSYCHIATRIC SERVICES Procedure Provider Age Adjusted Code Type/Specialty Range RVU** Fee Fee RVU** Fee Fee 1 90837 16, 18, 40/51 0-20 Not a Benefit Not a Benefit $70.55 $70.55 31, 97 21-999 Not a Benefit Not a Benefit $95.93 $95.93 1 90837 1 90837 16, 18, 40/51 21-999 Not a Benefit Not a Benefit $67.15 $67.15 1 90838 3, 10, 19, 20, 21, 22 0-20 Not a Benefit Not a Benefit $72.43 $72.43 1 90838 3, 10, 19, 20, 21, 22 21-999 Not a Benefit Not a Benefit $70.27 $70.27 1 90853 31, 97 0-20 0.88 $28.640 $25.20 $24.70 0.88 $28.0672 $24.70 $24.70 31, 97 21-999 0.88 $27.276 $24.00 $23.52 0.88 $26.7305 $23.52 $23.52 1 90853 1 90853 16, 18, 40/51 0-20 $17.64 $17.29 $17.29 $17.29 1 90853 16, 18, 40/51 21-999 $16.80 $16.46 $16.46 $16.46 1 90857 All Provider Types 0-20 0.98 $28.640 $28.07 $27.51 Not a Benefit Not a Benefit 1 90857 All Provider Types 21-999 0.98 $27.276 $26.73 $26.20 Not a Benefit Not a Benefit 1 90862 All Provider Types 0-20 1.56 $28.640 $44.68 $43.79 Not a Benefit Not a Benefit 1 90862 All Provider Types 21-999 1.56 $27.276 $42.55 $41.70 Not a Benefit Not a Benefit

Type of Service (TOS)* Procedure Code Provider Type/Specialty Age Range RVU** HCPCS - PSYCHIATRIC SERVICES Fee Fee RVU** Fee Adjusted Fee *Type of Service (TOS) 1 Medical Services **RVU Relative Value Unit Provider Type/Provider Specialty 3 County Indigent Health Care Program 10 Advanced Practice Nurse 16 18 19 20 21 22 31 40/51 97 All Provider Types Licensed Professional Counselor or Licensed Marriage and Family Therapist Comprehensive Care Program Social Worker Physician (D.O.) Physician (M.D.) Physician Group (D.O.) Physician Group (M.D.) Psychologist Licensed Clinical Social Worker (Licensed Master Social Worker) Psychology Group All payable provider types for these procedure codes will be discontinued

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