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Minnesota Department of Human Services Provider Manual
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Psychotherapy

Revised: 01-20-2017

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Psychotherapy Services
  • Documentation
  • Clinical Supervision
  • Noncovered Services
  • Authorization
  • Billing
  • Legal References
  • Overview

    Psychotherapy is:

  • • A planned and structured, face-to-face treatment of a recipient’s mental illness
  • • Provided using the psychological, psychiatric or interpersonal method most appropriate to the needs of the recipient according to current community standards of mental health practice
  • • Directed to accomplish measurable goals and objectives specified in the recipient’s individual treatment plan (ITP)
  • Eligible Providers

    Psychotherapy may be provided by:

  • Clinical nurse specialist in mental health (CNS)
  • Licensed independent clinical social worker (LICSW)
  • Licensed marriage and family therapist (LMFT)
  • Licensed professional clinical counselor (LPCC)
  • Licensed psychologist (LP)
  • Psychiatric nurse practitioner (NP)
  • Psychiatrist
  • • Tribal mental health professional
  • • Mental health practitioners working as clinical trainees
  • Eligible Recipients

    Eligible recipients of psychotherapy must have a diagnosis of mental illness as determined by a diagnostic assessment. The diagnosis must be included in the diagnostic code list published by the commissioner to establish recipient eligibility.

    Exception: A new recipient may receive one session of psychotherapy prior to completing the diagnostic assessment.

    Covered Psychotherapy Services

    Psychotherapy (with patient or family member or both)

  • • Used for services with the patient or family member (or both) present
  • • Include some time without the patient, however the patient must be present for a significant amount of the psychotherapy time
  • • Used for both outpatient and inpatient settings
  • • May include hypnotherapy (conducted by a mental health professional or clinical trainee trained in hypnotherapy). Do not bill hypnotherapy separately
  • • May include individual psychophysiological therapy incorporating biofeedback, with psychotherapy
  • • May be used with interactive complexity add-on
  • Evaluation and management (E/M) with psychotherapy (patient or family or both)

  • • Used when psychotherapy is performed in addition to E/M services
  • • If providing both services, they must be separate and distinguishable
  • • Time spent on E/M activities may not be counted towards the psychotherapy time
  • • May be used with interactive complexity add-on
  • Family psychotherapy

  • • For the recipient and one or more family members or caregivers whose participation is necessary to accomplish the recipient’s treatment goals. Family means a person who is identified by the recipient (or recipient’s parent or guardian) as being important to the recipient’s mental health and may include (but not limited to) parents, children, spouse, committed partners, former spouses, person related by blood or adoption, or persons who are presently residing together as a family unit. Do not consider shift staff or other facility staff members at the recipient’s residence as family
  • • Family members or primary caregivers do not need to be eligible for MHCP
  • • If you believe the recipient’s absence from the family psychotherapy session is necessary to carry out the recipient’s treatment plan, document the length of time and reason for the recipient’s absence; also document reason(s) for a family member’s exclusion from family psychotherapy
  • Multiple family group psychotherapy

  • • Multiple family group psychotherapy is designed for at least two, but no more than five families, regardless of family members’ MHCP eligibility status or the number of family members who participate in the family psychotherapy session
  • • Directed toward meeting the identified treatment needs of each recipient as indicated in the recipient’s treatment plan
  • • If a recipient is excluded from a session, document the reason for and length of time of the exclusion
  • • Document reasons why a family member is excluded
  • Group psychotherapy

  • • Appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive benefit from treatment in a group setting
  • • Provided by one mental health professional for 3-8 recipients
  • • Provided by two mental health professionals for 9-12 recipients
  • • Group size cannot exceed 12 recipients
  • • Group size applies regardless of the number of MHCP recipients in the group
  • • May be used with interactive complexity add-on
  • Interactive Complexity

    Use the Interactive Complexity add-on code (90785) to designate a service with interactive complexity. Report interactive complexity for services when any of the following exist during the visit:

  • • Communication difficulties among participants that complicate care delivery, related to issues such as:
  • • High anxiety
  • • High reactivity
  • • Repeated questions
  • • Disagreement
  • • Caregiver emotions or behaviors that interfere with implementing the treatment plan
  • • Discovery or discussion of evidence relating to an event that must be reported to a third party. This may include events such as abuse or neglect that require a mandatory report to the state agency
  • • The mental health provider overcomes communication barriers:
  • • By using any of the following methods:
  • • Play equipment
  • • Physical devices
  • • An interpreter
  • • A translator
  • • For recipients who:
  • • Are not fluent in the same language as the mental health provider
  • • Have not developed or have lost the skills needed to use or understand typical language
  • Documentation of Covered Services

    Medical necessity

    Document the medical necessity for psychotherapy in the diagnostic assessment.

    Individualized treatment plan

    Document in the individualized treatment plan (ITP) the specific interventions with measurable goals and objective (including start and stop time) describing how the mental health professional will use psychotherapy to treat the recipient’s mental illness.

    Progress notes

    Document all psychotherapy rendered in a progress note for each episode of care on each date of service. A progress note must be legible. Documentation of treatment information can be kept to a minimum. Each progress note must include:

  • • Type of service
  • • Date of service
  • • Session start and stop times
  • • Scope of service (nature of interventions or contacts including treatment modalities, phone contacts, etc.)
  • • Recipient’s progress (or lack of) to overall treatment plan goals and objectives
  • • Recipient’s response or reaction to treatment intervention(s)
  • • Formal or informal assessment of the recipient’s mental health status
  • • Name and title of person who gave the service
  • • Date documentation was made in the client record
  • Other elements that may be included:

  • • Current risk factors the recipient may be experiencing
  • • Emergency interventions
  • • Consultations with or referrals to other professionals
  • • Summary of effectiveness of treatment, prognosis, discharge planning, etc.
  • • Test results and medications
  • • Symptoms
  • For clinical trainees conducting psychotherapy, the clinical supervisor must review and approve the recipient’s progress notes in accordance with the clinical trainee’s supervision plan.

    While providers need to keep progress notes in order to document treatment, it is at the discretion of the provider whether to keep additional psychotherapy notes. A psychotherapy note is the documentation or analysis of the contents of conversation during an individual, group or family psychotherapy session. Psychotherapy notes are kept separate from the rest of the individual’s medical record and are protected from normal record release under HIPAA even when requesting an authorization or continued services.

    Clinical Supervision

    Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.

    Noncovered Services

    Authorization

    Refer to Authorization for general authorization policy and procedures. For psychotherapy services, authorization is required to exceed:

  • • 26 hours psychotherapy (with patient or family member or both) (including biofeedback) per calendar year, cumulative
  • • 26 sessions of family psychotherapy per calendar year, cumulative
  • • 10 sessions of multiple family group psychotherapy per calendar year
  • • 52 sessions of group psychotherapy per calendar year, cumulative
  • Submit the following as part of the authorization process for continuation of services:

  • • Copy of the most current diagnostic assessment
  • • Clinical summary (including justification for each diagnosis)
  • • Individual treatment plan that includes same items as under documentation of covered service
  • • Progress notes that include same items as under documentation of covered service
  • • Other elements that may apply, including:
  • • Current risk factors the recipient may be experiencing
  • • Emergency interventions
  • • Consultations with or referrals to other professionals
  • • Summary of effectiveness of treatment, prognosis, discharge planning, etc.
  • • Test results and medications
  • • Symptoms
  • When requesting authorization for services that are to be performed with interactive complexity, include the Interactive Complexity add-on code on the authorization request.

    Billing

    Submit claims only for the primary recipient who is the subject of the psychotherapy sessions, regardless of the number of other family or group members in the session.

    When more than one family member is a recipient (such as two or three siblings, each receiving treatment within a specific timeframe), bill only for the time spent conducting psychotherapy for each recipient.

    When group psychotherapy is rendered by two professionals, only one claim may be submitted for each recipient. Professionals must determine which recipient each will bill for or one professional may claim for all recipients and reimburse the other professional.

    When billing:

  • • Bill psychotherapy services online using MN–ITS 837P
  • • Enter the treating provider NPI number on each claim line
  • • Hypnotherapy is part of psychotherapy, do not separately bill
  • • Teaching hospitals may enter the GC modifier for services performed under the direction of a supervising physician
  • Use the following table for billing services:

    Mental Health Psychotherapy Benefits for Children under 21 years old and Adults

    Proc Code

    Brief Description

    Unit
    (
    *Per CPT Time Rule)

    Service Limitation

    90832

    Psychotherapy (with patient or family member or both)

    30 (16-37*) min

    Use the appropriate prolonged services code (99354) with 90837 to report Psychotherapy, face-to-face with the recipient, of 90 minutes or longer.

    Interactive complexity add-on code (90785) may be used with:

  • • Psychotherapy (90832, 90834 or 90837)
  • • E/M with psychotherapy add-on codes (90833, 90836, 90838)
  • E/M with psychotherapy add-on limited to:

  • • Clinical nurse specialist-mental health (CNS-MH)
  • • Psychiatric nurse practitioner (NP)
  • • Psychiatrist
  • Calendar year threshold, see Authorization- 26 hours of psychotherapy (with patient or family member or both), cumulative (including biofeedback and E/M with psychotherapy add-on).

    90834

    Psychotherapy (with patient or family member or both)

    45 (38-52*) min

    90837

    Psychotherapy (with patient or family member or both)

    60 (53+*) min

    Appropriate E/M and 90833

    E/M and psychotherapy (with patient or family member or both)

    30 (16-37*) min

    Appropriate E/M and 90836

    E/M and psychotherapy (with patient or family member or both)

    45 (38-52*) min

    Appropriate E/M and 90838

    E/M and psychotherapy (with patient or family member or both)

    60 (53+*) min

    90875

    Individual psychophysiological therapy incorporating biofeedback, with psychotherapy

    30 (16-37*) min

    90876

    Individual psychophysiological therapy incorporating biofeedback, with psychotherapy

    45(38-52*) min

    90846

    Family psychotherapy without patient present

    50 (26+) min

    Calendar year thresholds, see Authorization:

  • • 26 sessions of family psychotherapy
  • • 10 sessions of multiple family group psychotherapy
  • *Codes 90846-90849 are used to report family psychotherapy. Billing for family psychotherapy may be separately reported for each patient in the family group, however, it should not be reported for each family member.
  • 90847

    Family psychotherapy with patient present

    50 (26+) min

    90849

    Multiple family group psychotherapy

    1 Session

    90853

    Group psychotherapy

    1 Session

    Interactive complexity add-on code (90785) may be used with 90853.

    Calendar year threshold, see Authorization- 52 sessions of group psychotherapy.


    Refer to the CTSS Billing table for additional information about CTSS services.

    For mental health services provided by:

    Payment rate is up to:

  • • Community mental health center
  • • 100% of MHCP allowed rate
  • • Doctoral-prepared mental health professional
  • • 100% of MHCP allowed rate
  • • Master’s prepared mental health professional
  • • 80% of MHCP allowed rate
  • Legal References

    MN Rules 9505.0372 (psychotherapy services)
    Code of Federal Regulations, title 45, section 164, parts 501 (45 CFR 164.501) (psychotherapy notes)

    Code of Federal Regulations title 45, section 160, parts 203 (45 C.F.R. 160.203 (b) ) (Release of Privacy)

    MN Statutes 144.292, subd. 2 and 7 (Minnesota Health Records Act – patient access and exception)

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