Psychiatric Consultations to Primary Care Providers

Revised: 03-23-2016

· Eligible Providers

· Eligible Recipients

· Covered Services

· Billing

· Legal References

Eligible Providers

The following providers can provide psychiatric consultation to primary care providers:

· Psychiatrist

· Licensed Psychologist (LP) (working within the scope of practice)

· Licensed Independent Clinical Social Worker (LICSW) (working within the scope of practice)

· Licensed Marriage and Family Therapist (LMFT) (working within the scope of practice)

· Psychiatric Nurse Practitioner (NP)

· Clinical Nurse Specialist (CNS)

The following Primary Care providers are eligible to request a psychiatric consultation:

· Certified nurse midwives

· Clinical nurse specialists

· Nurse practitioners

· Physician’s assistants

· Registered nurse in a physician-directed clinic as defined in the Physician Extender section of the Physician and Professional Services chapter

· Pediatricians

· Family practice physicians

· Psychiatrist

· Any other prescriber

Services may be provided on the basis of a verbal agreement. The consulting professional and primary care provider must maintain documentation of the consultation in the patient record.

Both providers are responsible for the following:

· Applying HIPAA-compliant privacy and security protections for the recipient

· Obtaining and maintaining HIPAA-compliant technology

· Ensuring procedures are in place to prevent a breach of privacy or exposure of recipient mental health records to unauthorized people

· Recording the psychiatric consultation in the recipient’s medical record

Eligible Recipients

All MHCP recipients are eligible recipients.

Covered Services

Consultation includes communication between a consulting professional and a primary care provider for the purpose of medical management, behavioral health care and treatment of a recipient. A psychologist, independent clinical social worker and marriage and family therapists may provide consultation about alternatives to medication, medication combined with psychosocial treatments and potential results of medication usage. The provider may conduct the consultation without the recipient present.

Billing

· The primary care provider and consulting professional may bill separately for this service.

· Primary care providers are allowed to bill an office visit and a consultation if appropriate.

· Primary care providers and consulting professionals may bill services provided on the same day using the appropriate modifier.

Use the following CPT codes to bill the appropriate level of service:

Psychiatric Consultation to Primary Care Providers
CPT Code	Modifier	Provider	Brief Description	Unit	Service Limitations
99499	HE AG	Primary Care Providers	Communication between a consulting professional and a primary care provider, for consultation or medical management; or behavioral health care and treatment of a recipient.	1 Session	Add the U4 modifier if not face-to-face Add the U7 modifier if provided by a Physician Extender
99499	HE AM	Consulting Professionals	Communication between a consulting professional and a primary care provider, for consultation or medical management; or behavioral health care and treatment of a recipient.	1 Session	Add the U4 modifier if not face-to-face

Legal References

Minnesota Statute 256B.0625 subd., 48