Find in Table of Contents:

Psychotherapy

Revised: 07-22-2011

· Overview

· Eligible Providers

· Eligible Recipients

· Covered Psychotherapy Services

· Documentation

· Authorization

· Billing

· Legal References

Overview

Psychotherapy is a planned and structured face-to-face treatment of a recipient’s mental illness through the psychological, psychiatric, or interpersonal method most appropriate to the needs of the recipient according to current community standards of mental health practice; and is directed to accomplish measurable goals and objectives specified in the recipient’s 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.

Exception: A new recipient may receive either one session of individual, or group or family psychotherapy, prior to completing the diagnostic assessment.

Covered Psychotherapy Services

Individual Psychotherapy (including interactive individual psychotherapy)

· is designed for one individual

· may include hypnotherapy (conducted by a mental health professional or clinical trainee trained in hypnotherapy). Hypnotherapy is not separately billed.

· May include individual psychophysiological therapy incorporating biofeedback, with psychotherapy

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 (including interactive 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 ever exceed 12 recipients. Group size applies regardless of the number of MHCP recipients in the group.

Interactive Psychotherapy

Interactive psychotherapy is typically provided to children, and procedures are distinct diagnostic and medical psychotherapeutic procedures using physical aids and nonverbal communication to overcome barriers to therapeutic interaction between the physician and recipient who:

· Has lost or has not yet developed either the expressive language communication skills to explain his/her symptoms and response to treatment; or

· Does not possess the receptive communication skills to understand the mental health professional if he/she were to use ordinary adult language for communication.

Interactive psychotherapy services count toward the same coverage and authorization limits as individual and group psychotherapy sessions.

Do not provide individual or group psychotherapy concurrently with interactive individual or interactive group psychotherapy.

Documentation

Progress Notes

A progress note must be legible and is the documentation of treatment information which can be kept to a minimum.

Progress notes 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 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.

Authorization

· Authorization is required when threshold limits are exceeded: see the billing charts below for threshold limits for each type of psychotherapy

· Review the Authorization section of this manual

· Copies of the diagnostic assessment or clinical summary, individual treatment plan, and progress notes are requested as part of the authorization process for continuation of services.

Billing

Submit claims only for the recipient who is the primary subject of the psychotherapy sessions, regardless of the number of other family/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

· Use the individual treating provider NPI number

· 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

Mental Health Psychotherapy Benefits for Children under age 21 and Adults
Proc Code	Brief Description	Unit	Service Limitations
90804	Individual Psychotherapy	20-30 min	· Authorization is required in order to exceed 26 hours individual psychotherapy per calendar year, cumulative. · Do not provide individual psychotherapy concurrently with interactive individual psychotherapy.
90805	Individual Psychotherapy with Medical E/M, psychiatrist, NP, CNS-MH	20-30 min
90806	Individual Psychotherapy	45-50 min
90807	Individual Psychotherapy with Medical E/M, psychiatrist , NP, CNS-MH	45-50 min
90808	Individual Psychotherapy	75-80 min
90809	Individual Psychotherapy with Medical E/M, psychiatrist , NP, CNS-MH	75-80 min
90810	Interactive Individual Psychotherapy	20-30 min
90811	Interactive Individual Psychotherapy with Medical E/M, psychiatrist , NP, CNS-MH	20-30 min
90812	Interactive Individual Psychotherapy	45-50 min
90813	Interactive Individual Psychotherapy with Medical E/M, psychiatrist , NP, CNS-MH	45-50 min
90814	Interactive Individual Psychotherapy	75-80 min
90815	Interactive Individual Psychotherapy with Medical E/M, psychiatrist , NP, CNS-MH	75-80 min
90816	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting	20-30 min
90817	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting, with evaluation & management	20-30 min
90818	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting	45-50 min
90819	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting, with evaluation & management	45-50 min
90821	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting	75-80 min
90822	Individual psychotherapy, inpatient hospital, partial hospital or residential care setting, with evaluation & management	75-80 min
90823	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting	20-30 min
90824	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting, with evaluation & management	20-30 min
90826	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting	45-50 min
90827	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting, with evaluation & management	45-50 min
90828	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting	75-80 min
90829	Individual psychotherapy, interactive; inpatient hospital, partial hospital or residential care setting, with evaluation & management	75-80 min
90875	Individual psychophysiological therapy incorporating biofeedback, with psychotherapy	20-30 min
90876	Individual psychophysiological therapy incorporating biofeedback, with psychotherapy	45-50 min
90846	Family Psychotherapy without patient present psychiatrist, NP, CNS-MH, LICSW, LLP, LMFT, LP, LPCC	1 session	Authorization is required in order to exceed 26 sessions per calendar year, cumulative.
90847	Family Psychotherapy with patient present psychiatrist, NP, CNS-MH, LICSW, LLP, LMFT, LP, LPCC	1 session
90853	Group Psychotherapy	1 session	· Authorization is required to exceed 52 sessions per calendar year, cumulative. · The provider cannot bill both 90853 and 90857 for the same recipient. Choose one or the other.
90857	Interactive Group Psychotherapy	1 session
90849	Multiple Family Group Psychotherapy	1 session	· 10 sessions per calendar year.

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