The following code changes for behavioral health are effective January 1, 2013.
Crosswalk of 2012 CPT‐4 codes to 2013 CPT‐4 codes
2012 Code (Deleted as of
January 1, 2013)
2013 New Replacement Code
90801 ‐ Psychiatric diagnostic interview evaluation Replaced with 90791 ‐ Psychiatric diagnostic evaluation Replaced with 90792 ‐ Psychiatric diagnostic evaluation with medical services Evaluation and Management new patient codes may be used in lieu of 90792. (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) 90802 ‐ Interactive Psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter or other mechanisms of communication Replaced with 90791 ‐ Psychiatric diagnostic evaluation Replaced with 90792 ‐ Psychiatric diagnostic evaluation with medical services Evaluation and Management new patient codes may be used in lieu of 90792. (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90791/90792 when appropriate 90804 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face to face with the patient 90832 ‐ Psychotherapy, 30 minutes with patient and/or family member 90805 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face to face with the patient ‐ with medical evaluation and management services 90833 ‐ Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) 90806 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face to face with the patient 90834 ‐ Psychotherapy, 45 minutes with patient and/or family member 90807 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face to face with the patient ‐ with medical evaluation and management services 90836 ‐ Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services)2012 Code (Deleted as of
January 1, 2013)
2013 New Replacement Code
90808 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face to face with the patient 90837 ‐ Psychotherapy, 60 minutes with patient and/or family member 90809 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face to face with the patient ‐ with medical evaluation and management services 90838 ‐ Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) 90810 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 20 to 30 minutes face to face with the patient 90832 ‐ Psychotherapy, 30 minutes with patient and/or family member Code 90785 may be billed in addition to 90832 when appropriate 90811 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 20 to 30 minutes face to face with the patient; with medical evaluation and management services 90833 ‐ Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90833 when appropriate 90812 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 45 to 50 minutes face to face with the patient 90834 ‐ Psychotherapy, 45 minutes with patient and/or family member Code 90785 may be billed in addition to 90834 when appropriate 90813 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 45 to 50 minutes face to face with the patient; with medical evaluation and management services 90836 ‐ Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90836 when appropriate 90814 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 75 to 80 minutes face to face with the patient 90837 ‐ Psychotherapy, 60 minutes with patient and/or family member Code 90785 may be billed in addition to 90837 when appropriate90815 ‐ Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter or other mechanisms of non‐verbal communication in an office or outpatient facility, approximately 75 to 80 minutes face to face with the patient; with medical evaluation and management services 90838 ‐ Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90838 when appropriate 90816 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face to face with the patient 90832 ‐ Psychotherapy, 30 minutes with patient and/or family member 90817 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face to face with the patient; with medical examination and management services 90833 ‐ Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) 90818 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face to face with the patient 90834 ‐ Psychotherapy, 45 minutes with patient and/or family member 90819 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face to face with the patient; with medical examination and management services 90836 ‐ Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) 90821 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face to face with the patient 90837 ‐ Psychotherapy, 60 minutes with patient and/or family member 90822 ‐ Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face to face with the patient; with medical examination and management services 90838 ‐ Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services)
2012 Code (Deleted as of
January 1, 2013)
2013 New Replacement Code
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, approximately 20 to 30 minutes face to face with the patient 90832 ‐ Psychotherapy, 30 minutes with patient and/or family member Code 90785 may be billed in addition to 90832 when appropriate 90824 ‐ 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, approximately 20 to 30 minutes face to face with the patient; with medical examination and management services 90833 ‐ Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90833 when appropriate 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, approximately 45 to 60 minutes face to face with the patient 90834 ‐ Psychotherapy, 45 minutes with patient and/or family member Code 90785 may be billed in addition to 90834 when appropriate 90827 ‐ 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, approximately 45 to 50 minutes face to face with the patient; with medical examination and management services 90836 ‐ Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90836 when appropriate 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, approximately 75 to 80 minutes face to face with the patient 90837 ‐ Psychotherapy, 60 minutes with patient and/or family member Code 90785 may be billed in addition to 90837 when appropriate 90829 ‐ 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, approximately 75 to 80 minutes face to face with the patient; with medical examination and management services 90838 ‐ Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) (Evaluation and Management codes are limited to those providers eligible to provide evaluation and management services) Code 90785 may be billed in addition to 90838 when appropriate 90862 ‐ Pharmacologic management, including prescription, use and review of medication with no more than minimal medical psychotherapy The appropriate evaluation and management code should be used in replacement of 90862 90863 ‐ Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (list separately in addition to the code for primary procedure). This service is limited to2012 Code (Deleted as of
January 1, 2013)
2013 Existing Replacement Code
90857 ‐ Interactive group psychotherapy 90853 ‐ Group medical psychotherapyNew Codes for 2013
90785 ‐ Interactive complexity (list separately in addition to the code for primary procedure) 90839 ‐ Psychotherapy for crisis; first 60 minutes 90840 ‐ Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service)Additional Evaluation and Management * codes added to providers on a Behavioral Health
Fee Schedule effective January 1st, 2013
(codes listed are in addition to the current evaluation and management codes currently
included on the Behavioral Health Fee Schedule)
*
Please note that Evaluation and Management codes are limited to those providers eligible to use evaluation and management codes. 99201 ‐ Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 10 minutes are spent face to face with the patient and/or family 99202 ‐ Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 20 minutes are spent face to face with the patient and/or family 99203 ‐ Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 30 minutes are spent face to face with the patient and/or family99204 ‐ Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 45 minutes are spent face to face with the patient and/or family 99205 ‐ Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 60 minutes are spent face to face with the patient and/or family 99211 ‐ Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified healthcare professional. Usually the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 99212 ‐ Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are self limited or minor, typically 10 minutes are spent face to face with the patient and/or family 99213 ‐ Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are of low to moderate severity, typically 15 minutes are spent face to face with the patient and/or family 99214 ‐ Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are of moderate to high severity, typically 25 minutes are spent face to face with the patient and/or family 99215 ‐ Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs, usually the presenting problem(s) are of moderate to high severity, typically 40 minutes are spent face to face with the patient and/or family. 99217 ‐ Observation care discharge day management (this code is to be utilized to report all services provided to a patient on discharge from "Observation status" if the discharge is on other then the initial date of "Observation status". To report services to a patient designated as "Observation status" or "Inpatient status" and discharged on the same date, use the codes for observation or inpatient care services (including admission and discharge services 99234‐99236 as appropriate). 99218 ‐ Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and medical decision making that is straight forward or of low complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission to "Observation status" are of low severity. Typically 30 minutes are spent face to face at the bedside and on the patient’s hospital floor or unit.
the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission to "Observation status" are of moderate severity. Typically 50 minutes are spent face to face at the bedside and on the patient’s hospital floor or unit. 99220 ‐ Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission to "Observation status" are of high severity. Typically 70 minutes are spent face to face at the bedside and on the patient’s hospital floor or unit. 99224 ‐ Subsequent observation care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused interval examination; Medical decision making that is straight forward or of low complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is stable, recovering or improving, typically 15 minutes are spent at the bedside and on the patient’s hospital floor or unit. 99225 ‐ Subsequent observation care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused interval examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically 25 minutes are spent at the bedside and on the patient’s hospital floor or unit. 99226 ‐ Subsequent observation care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is unstable or has developed a significant complication or significant new problem. Typically 35 minutes are spent at the bedside and on the patient’s hospital floor or unit. 99304 ‐ Initial nursing facility care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and medical decision making that is straight forward or of low complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission are of low severity. Typically 25 minutes are spent face to face at the bedside and on the patient’s facility floor or unit. 99305 ‐ Initial nursing facility care, per day, for the evaluation and management of a patient which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission are of moderate severity. Typically 35 minutes are spent face to face at the bedside and on the patient’s facility floor or unit. 99306 ‐ Initial nursing facility care, per day, for the evaluation and management of a patient which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the problem(s) requiring admission are of high severity. Typically 45 minutes are spent face to face at the bedside and on the patient’s facility floor or unit. 99307 ‐ Subsequent nursing facility care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is stable, recovering or improving. Typically, 10 minutes are spent at the bedside and on the patient’s facility floor or unit.
99308 ‐ Subsequent nursing facility care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically 15 minutes are spent at the bedside and on the patient’s facility floor or unit. 99309 ‐ Subsequent nursing facility care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed interval examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient has developed a significant complication or a significant new problem. Typically 25 minutes are spent at the bedside and on the patient’s facility floor or unit. 99310 ‐ Subsequent nursing facility care, per day, for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other healthcare professionals or agencies are provided consistent with the nature of the problem(s) and the patients and/or family needs. The patient may be unstable or may have developed a significant new problem requiring immediate Physician attention. Typically 35 minutes are spent at the bedside and on the patient’s facility floor or unit. 99315 ‐ Nursing facility discharge day management; 30 minutes or less 99365 ‐ Nursing facility discharge day management; more than 30 minutes 99318 ‐ Evaluation and Management of a patient involving an annual nursing facility assessment, which requires these 3 key components: A detailed interval history; A comprehensive examination; and medical decision making of low to moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is stable, recovering or improving. Typically, 30 minutes are spent at the bedside on the patient’s facility floor or unit. 99324 ‐ Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and straight forward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. 99325 ‐ Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. 99326 ‐ Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. 99327 ‐ Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider
the nature of the problem(s) and the patients and/or family needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate Physician attention.. Typically, 75 minutes are spent with the patient and/or family or caregiver. 99334 ‐ Domiciliary or rest home visit for the evaluation and management of a new patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straight forward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are self‐ limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. 99335 ‐ Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of low to moderate complexity. Typically, 25 minutes are spent with the patient and/or family or caregiver. 99336 ‐ Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. 99337 ‐ Domiciliary or rest home visit for the evaluation and management of an established patient, which requires 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; and medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate Physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. 99341 ‐ Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and straight forward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face to face with the patient and/or family 99342 ‐ Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face to face with the patient and/or family. 99343 ‐ Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face to face with the patient and/or family. 99344 ‐ Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face to face with the patient and/or family.
99345 ‐ Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate Physician attention. Typically, 75 minutes are spent face to face with the patient and/or family. 99347 ‐ Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; and straight forward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face to face with the patient and/or family 99348 ‐ Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of low to moderate complexity. Typically, 25 minutes are spent face to face with the patient and/or family. 99349 ‐ Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high complexity. Typically, 40 minutes are spent face to face with the patient and/or family. 99350 ‐ Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals or agencies are provider consistent with the nature of the problem(s) and the patients and/or family needs. Usually, the presenting problem(s) are of moderate to high complexity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face to face with the patient and/or family. 99408 ‐ Alcohol and/or Substance (other than tobacco) abuse structured screening (e.g., AUDIR, DAST), and brief intervention (SBI services); 15 to 30 minutes 99409 ‐ Alcohol and/or Substance (other than tobacco) abuse structured screening (e.g., AUDIR, DAST), and brief intervention (SBI services); greater than 30 minutes Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include Aetna Health Inc., Aetna Health of California Inc., Aetna Life Insurance Company, Aetna Health Insurance Company of New York, Aetna Health Insurance Company, Aetna Health Administrators, LLC, and Strategic Resource Company. The EAP is administered by Aetna Behavioral Health, LLC, Horizon Behavioral
