Psychotherapy for Crisis

Date: 04-01-2014

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Authorization

· Billing

· Legal References

Overview

Psychotherapy for crisis services help to reduce a recipient’s mental health crisis through immediate assessment and psychotherapeutic interventions. An intervention of psychotherapy for crisis will diminish the suffering of the recipient in crisis and help restore life functioning.

Eligible Providers

The following providers may provide psychotherapy for crisis:

· 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 Members

Eligible recipients of psychotherapy for crisis must:

· Have a diagnosis of mental illness as determined by an emergency assessment

· Be in need of immediate response, due to an increase of mental illness symptoms that put the recipient at risk of one of the following:

· Experiencing a life threatening mental health crisis

· Needing a higher level of care

· Worsening of symptoms without mental health intervention

· Harm to self, others, or property damage

· Significant disruption of normal functioning in at least one life area, such as self-care or housing

A recipient may receive one session of psychotherapy (including psychotherapy for crisis) prior to receiving a diagnostic assessment.

Covered Services

Psychotherapy for crisis services must include:

· Emergency assessment of the crisis situation (does not take the place of a diagnostic assessment)

· Mental status exam

· Psychotherapeutic interventions to reduce the crisis

· Development of a post-crisis plan that addresses the recipient’s coping skills and community resources

Documentation of Covered Services

The mental health professional or clinical trainee must clearly document:

· Factors that make the mental health crisis life threatening or complex

· History of the crisis

· Results of the mental status exam

· Recipient’s coping skills used to reduce the crisis

· Community resources used

· Psychotherapy techniques and interventions used and the recipient’s response

· Protective and risk factors that influenced the outcome of the intervention

· Reason for the particular services chosen

· Steps taken to assure the recipient’s safety after the intervention

Authorization Requirements

Refer to Authorization for general authorization policy and procedures. Authorization is required to exceed:

· 3 occurrences per calendar month

· 10 occurrences per calendar year

Total time billed for psychotherapy for crisis is also included in the:

· 26 hour per year psychotherapy (with patient and/or family member) benefit limit

· 200 hour CTSS benefit limit, when provided as a CTSS service

Billing

· Bill the appropriate psychotherapy for crisis CPT code(s)

· Use modifier UA when provided as a CTSS service

· Enter the rendering provider NPI on each service line

· Use HN modifier for services performed by a clinical trainee

Psychotherapy for Crisis Billing
Proc. Code	Brief Description	Unit (*Per CPT Time Rule)	Service Limitation
90839	Psychotherapy for Crisis	60 (30-74*) min	Bill only once per day. The following benefit limits apply, see Authorization: · 3 occurrences per calendar month · 10 occurrences per calendar year · 26 hour per year psychotherapy (with patient and/or family member) benefit limit · 200 hour CTSS benefit limit, when provided as a CTSS service
90840	Psychotherapy for Crisis (Each additional 30 minutes)	30 min	Maximum of 2 units (additional 60 min) per day. Additional time is included in the hourly limits, above.

Legal References

MS 245.461 to 245.468 Minnesota Comprehensive Adult Mental Health Act
MS 245.462 Definitions
MS 256B.0625, subd. 20 Mental Health Case Management