Provider Notice Issued 01/07/2019

Date:    January 7, 2020
 
To:       Enrolled Physicians
 
Re:      Psychiatric Add-on Payments Retroactive to Dates of Service Beginning July 1, 2019
 
 
This notice informs physicians of add-on payments prompted by Public Act 101-0010 for specific psychiatric services. These add-on payments apply to claims for participants covered under both traditional fee-for-service and managed care plans. 
 
Effective with dates of service beginning July 1, 2019, the psychiatric services add-on payments are authorized to participating physicians board-certified in psychiatry.
 
The following procedure codes will receive the add-on for dates of service beginning July 1, 2019:
 
Add-Ons
Proc Code
Description
Unit
price
Max Qty
State
Max
Child
Adult
Psych Add-On Child or Adult
90791  
Psychiatric diagnostic evaluation                          
 
1
122.11
 
 
23.57
90792  
Psychiatric diagnostic evaluation w/ medical services    
 
1
124.44
 
 
40.50
90832  
Psychotherapy, 30 minutes w/ patient and/or family members
 
1
29.48
 
 
41.52
90833  
Psychotherapy, 30 min w/ patient &/or family w/ E/M service
 
1
24.62
 
 
49.63
90834  
Psychotherapy, 45 min w/ patient and/or family members
44.20
2
88.40
 
 
50.45
90836  
Psychotherapy, 45 min w/ patient &/or family w/ E/M service
 
1
40.24
 
 
53.34
90837  
Psychotherapy, 60 min w/ patient and/or family members
66.71
2
133.42
 
 
75.62
99213  
Office/other outpatient visit, established patient, expanded focus     
 
1
28.35
18.21
18.21
50.87
99214  
Office/other outpatient visit, established patient, detailed/moderate complexity
 
1
42.50
30.47
30.47
73.33
99215  
Office/other outpatient visit, established patient, comprehensive/complexity
 
1
48.00
1.95
1.95
107.62

As there was a delay until mid-October in finalizing the psychiatric add-on payments, claims submitted prior to that would not have received the add-on. Providers may submit replacement claims to receive the correct reimbursement. The Department will accept electronic transactions submitted through MEDI or via 837P files to replace a paid claim, if submitted within 12 months from the original paid voucher date. Instructions for replacement claim submittal may be found in the Chapter 300 Companion Guide.
 
The Practitioner Fee Schedule has been updated with a specific sheet that identifies the procedure codes and psychiatric add-on payments.
 
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service claims, or to the applicable managed care plan.
 
 
Doug Elwell
Medicaid Director
 

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