Code Description Rate Rate SNF or NF

Psychiatric Diagnostic Procedures Facility Non-Fac. Bill at DO NOT USE

90791 Psychiatric Diagnostic Eval $ 127.33 $ 138.95 $ 191.00 99212-99215
90792 Psych Dx Eval with Medical Services $ 144.23 $ 156.18 $ 216.35 99221-99233
99241-99252
Psychotherapy 99251-99255
90832 Psychotherapy 30 min. w/patient $ 63.98 $ 67.92 $ 95.97 Any POS 99281-99291

Psycotherapy, 30 min when performed 99291,

with an eval andmanagement service (list 99354-99360,
separately along with primary procedure - 99375,
90833 use with 99304-99337 et al, see CPT book)) $ 66.17 $ 70.48 $ 99.26 Any POS 99415, 99477

90823-33 must be between 16 - 37

minutes, do not report if less than 16 min,
90834 Psychotherapy 45 min w/patient $ 84.52 $ 90.49 $ 126.78 Any POS

Psychotherapy 45 min w/patient when

performed with an eval and mgmt service -
see nots on 90833; use with99307-99337
90836 et al. $ 83.69 $ 89.00 $ 125.54 Any POS
90834-36 time 38 - 52 minutes
90837 Psychotherapy 60 min w/patient $ 127.00 $ 135.96 $ 190.50 Any POS
90838 See 90833 and 90836; consult CPT book $ 110.64 $ 117.61 $ 165.96 Any POS
90837-38 time 53 minutes or more $ -
Psychotherapy for Crisis $ -
90839 Psychotherapy for crisis, first 60 min $ 132.68 $ 141.64 $ 199.02 Any POS

each additional 30 minutes, list separately

from primary procedure code; use with
90840 90839, see CPT Book $ 63.28 $ 67.92 $ 94.92 Any POS

Other Psycotherapy
90845 Psychoanalysis $ 90.56 $ 96.54 $ 135.84 Any POS
Family Psychotherapy w/o patioent
90846 present; 50 minutes $ 102.49 $ 109.46 $ 153.74 Any POS
Family psychotherapy w/patient present;
90847 50 minutes $ 103.42 $ 113.73 $ 155.13 Any POS
90849 Multiple family group therapy $ 30.79 $ 40.75 $ 46.19 Any POS
Group psychotherapy (other than multiple
90853 family) $ 25.15 $ 27.14 $ 37.73 Any POS

SNF/NF Medical Evaluation and Management (E/M)

Codes for Nursing Home
Initial
 Initial Nursing Facility Care, Eval and Mgmt;
99304 25 min. $ 90.39 $ 90.39 $ 135.59 SNF or NF
99305 See 99304; 35 min. $ 130.39 $ 130.39 $ 195.59 SNF or NF
99306 See 99304; 45 min. $ 166.95 $ 166.95 $ 250.43 SNF or NF
Subsequent $ -

Subsequent Nursing facility care, per day

for eval and mgmt of patient; 10 min. Use
99307 instead of 99212 $ 43.91 $ 43.91 $ 65.87 SNF or NF
99308 See 99307; 15 min. $ 68.64 $ 68.64 $ 102.96 SNF or NF
99309 See 99307; 25 min. $ 91.34 $ 91.34 $ 137.01 SNF or NF
99310 See 99307; 35 min. $ 135.36 $ 135.36 $ 203.04 SNF or NF
Discharge $ -
Nursing facility discharge day mgmt; 30 min
99315 or less $ 73.41 $ 73.41 $ 110.12 SNF or NF
99316 See 99315; more than 30 min. $ 105.85 $ 105.85 $ 158.78 SNF or NF
Eval & mgmt of patient involving an annual
99318 assessment $ 95.78 $ 95.78 $ 143.67 SNF or NF
Domiciliary, Rest Home, Boarding, Custodial Care $ -
New Patient $ -
99324 Visit for eval and mgmt; 20 min $ 55.48 $ 55.48 $ 83.22 A/L only
99325 See 99324; 30 min $ 80.52 $ 80.52 $ 120.78 A/L only
99326 See 99324; 45 min $ 139.60 $ 139.60 $ 209.40 A/L only
99327 See 99324; 60 min $ 187.14 $ 187.14 $ 280.71 A/L only
99328 see 99324; 75 min $ 220.28 $ 220.28 $ 330.42 A/L only
Established Patient $ -
99334 Visit and Eval, 15 min $ 60.30 $ 60.30 $ 90.45 A/L only
99335 Visit and Eval; 25 min $ 95.14 $ 95.14 $ 142.71 A/L only
99336 Visit and Eval; 40 min $ 135.79 $ 135.79 $ 203.69 A/L only
99337 Visit and eval; 60 min $ 194.57 $ 194.57 $ 291.86 A/L only
Domiciliary, Rest Home, Assisted Living, Custodial Care $ -

Individual physician supervision of a patient

(patient not present) requiring complex
and mulitdisciplinary care modalities;
review and revision of care plans, patient
status, lab and other studies, etc (see CPT
99339 Book); 15-29 min. no price shown A/L only
99340 See 99339; 30 minutes or more no price shown A/L only
Prolonged Services $ -

Prolonged eval amd mgmt or

psychotherapy services (beyond the typical
service time; use with 90837 et al; see CPT
99354 Book) $ 122.64 $ 130.33 $ 183.96
99355 each additional 30 min $ 92.75 $ 99.39 $ 139.13
 Prolonged servied in the inpatient
observation seeitng requiring unit/floor
time beyond the usual service (use with
99356 90837 et al, see CPT Book) $ 92.46 $ 92.46 $ 138.69 SNF or NF
99357 each additional 30 min $ 92.79 $ 92.79 $ 139.19 SNF or NF
Prolonged Service without Direct Patient Contact $ -

Prolonged evaluation and mgmt before

99358 and/or after direct patient care, first hour $ 112.30 $ 112.30 $ 168.45

each additional 30 min (list speparately in

99359 addition to primary code; use with 99358) $ 54.12 $ 54.12 $ 81.18
$ -
$ -
31 Place of Service Code - SNF; Med A
32 Place of Service Code - NF; Med B
13 Place of Service Code - Ass't Living
These are office visits only
These are hospital inpatient
These are outpatient visits
These are hospital inpatient
These are Emergency Room

These are other inpatient/outpatient

Code Description Rate Rate Bill at Humana Medicare UHC
Psychiatric Diagnostic Procedures Facility Non-Fac. Bill at
90791 Psychiatric Diagnostic Eval $ 127.33 $ 138.95 $ 191.00 no auth req
90792 Psych Dx Eval with Medical Services $ 144.23 $ 156.18 $ 216.35

Psychotherapy
90832 Psychotherapy 30 min. w/patient $ 63.98 $ 67.92 $ 95.97 57.17 $ 53.01

Psycotherapy, 30 min when performed

with an eval andmanagement service
(list separately along with primary
procedure - use with 99304-99337 et al,
90833 see CPT book)) $ 66.17 $ 70.48 $ 99.26

90823-33 must be between 16 - 37

minutes, do not report if less than 16
min,
90834 Psychotherapy 45 min w/patient $ 84.52 $ 90.49 $ 126.78 no auth req

Psychotherapy 45 min w/patient when

performed with an eval and mgmt
service - see nots on 90833; use
90836 with99307-99337 et al. $ 83.69 $ 89.00 $ 125.54
90834-36 time 38 - 52 minutes
90837 Psychotherapy 60 min w/patient $ 127.00 $ 135.96 $ 190.50 $ 90.61

90838 See 90833 and 90836; consult CPT book $ 110.64 $ 117.61 $ 165.96
90837-38 time 53 minutes or more $ -
Psychotherapy for Crisis $ -
90839 Psychotherapy for crisis, first 60 min $ 132.68 $ 141.64 $ 199.02

each additional 30 minutes, list

separately from primary procedure
90840 code; use with 90839, see CPT Book $ 63.28 $ 67.92 $ 94.92

Other Psycotherapy
 90845 Psychoanalysis $ 90.56 $ 96.54 $ 135.84
Family Psychotherapy w/o patioent
90846 present; 50 minutes $ 102.49 $ 109.46 $ 153.74 no auth req
Family psychotherapy w/patient
90847 present; 50 minutes $ 103.42 $ 113.73 $ 155.13 no auth req
90849 Multiple family group therapy $ 30.79 $ 40.75 $ 46.19 no auth req
Group psychotherapy (other than
90853 multiple family) $ 25.15 $ 27.14 $ 37.73 no auth req

SNF/NF Medical Evaluation and Management

Codes (E/M) for Nursing Home
Initial
Initial Nursing Facility Care, Eval and
99304 Mgmt; 25 min. $ 90.39 $ 90.39 $ 135.59
99305 See 99304; 35 min. $ 130.39 $ 130.39 $ 195.59
99306 See 99304; 45 min. $ 166.95 $ 166.95 $ 250.43
Subsequent $ -

Subsequent Nursing facility care, per

day for eval and mgmt of patient; 10
99307 min. Use instead of 99212 $ 43.91 $ 43.91 $ 65.87
99308 See 99307; 15 min. $ 68.64 $ 68.64 $ 102.96 $ 57.15 $ 45.74
99309 See 99307; 25 min. $ 91.34 $ 91.34 $ 137.01
99310 See 99307; 35 min. $ 135.36 $ 135.36 $ 203.04
Discharge $ -
Nursing facility discharge day mgmt; 30
99315 min or less $ 73.41 $ 73.41 $ 110.12
99316 See 99315; more than 30 min. $ 105.85 $ 105.85 $ 158.78
Eval & mgmt of patient involving an
99318 annual assessment $ 95.78 $ 95.78 $ 143.67
Domiciliary, Rest Home, Boarding, Custodial Care $ -
New Patient $ -
 99324 Visit for eval and mgmt; 20 min $ 55.48 $ 55.48 $ 83.22
99325 See 99324; 30 min $ 80.52 $ 80.52 $ 120.78
99326 See 99324; 45 min $ 139.60 $ 139.60 $ 209.40
99327 See 99324; 60 min $ 187.14 $ 187.14 $ 280.71
99328 see 99324; 75 min $ 220.28 $ 220.28 $ 330.42
Established Patient $ -
99334 Visit and Eval, 15 min $ 60.30 $ 60.30 $ 90.45
99335 Visit and Eval; 25 min $ 95.14 $ 95.14 $ 142.71
99336 Visit and Eval; 40 min $ 135.79 $ 135.79 $ 203.69
99337 Visit and eval; 60 min $ 194.57 $ 194.57 $ 291.86
Domiciliary, Rest Home, Assisted Living, Custodial Care $ -

Individual physician supervision of a

patient (patient not present) requiring
complex and mulitdisciplinary care
modalities; review and revision of care
plans, patient status, lab and other
99339 studies, etc (see CPT Book); 15-29 min. no price shown
99340 See 99339; 30 minutes or more no price shown
Prolonged Services $ -

Prolonged eval amd mgmt or

psychotherapy services (beyond the
typical service time; use with 90837 et
99354 al; see CPT Book) $ 122.64 $ 130.33 $ 183.96
99355 each additional 30 min $ 92.75 $ 99.39 $ 139.13

Prolonged servied in the inpatient

observation seeitng requiring unit/floor
time beyond the usual service (use with
99356 90837 et al, see CPT Book) $ 92.46 $ 92.46 $ 138.69
99357 each additional 30 min $ 92.79 $ 92.79 $ 139.19
Prolonged Service without Direct Patient Contact $ -
 Prolonged evaluation and mgmt before
and/or after direct patient care, first
99358 hour $ 112.30 $ 112.30 $ 168.45

each additional 30 min (list speparately

in addition to primary code; use with
99359 99358) $ 54.12 $ 54.12 $ 81.18
SNF/NF Medical Evaluation and Management
Codes (E/M) for Nursing Home
Initial
Initial Nursing Facility Care, Eval and
99304 Mgmt; 25 min. $ 90.39 $ 90.39 $ 135.59
99305 See 99304; 35 min. $ 130.39 $ 130.39 $ 195.59
99306 See 99304; 45 min. $ 166.95 $ 166.95 $ 250.43
Subsequent $ -

Subsequent Nursing facility care, per

day for eval and mgmt of patient; 10
99307 min. Use instead of 99212 $ 43.91 $ 43.91 $ 65.87
99308 See 99307; 15 min. $ 68.64 $ 68.64 $ 102.96 $ 58.34 $ 45.74
99309 See 99307; 25 min. $ 91.34 $ 91.34 $ 137.01
99310 See 99307; 35 min. $ 135.36 $ 135.36 $ 203.04
Discharge $ -
Nursing facility discharge day mgmt;
99315 30 min or less $ 73.41 $ 73.41 $ 110.12
99316 See 99315; more than 30 min. $ 105.85 $ 105.85 $ 158.78
Eval & mgmt of patient involving an
99318 annual assessment $ 95.78 $ 95.78 $ 143.67

Domiciliary, Rest Home, Assisted Living, Custodial Care $ -

Individual physician supervision of a

patient (patient not present)
requiring complex and
mulitdisciplinary care modalities;
review and revision of care plans,
patient status, lab and other studies,
99339 etc (see CPT Book); 15-29 min. no price shown A/L only
99340 See 99339; 30 minutes or more no price shown A/L only
Prolonged Services $ -

Prolonged eval amd mgmt or

psychotherapy services (beyond the
typical service time; use with 90837
99354 et al; see CPT Book) $ 122.64 $ 130.33 $ 183.96
99355 each additional 30 min $ 92.75 $ 99.39 $ 139.13

Prolonged servied in the inpatient

observation seeitng requiring
unit/floor time beyond the usual
service (use with 90837 et al, see CPT
99356 Book) $ 92.46 $ 92.46 $ 138.69 SNF or NF
 99357 each additional 30 min $ 92.79 $ 92.79 $ 139.19 SNF or NF

Prolonged Service without Direct Patient Contact $ -

Prolonged evaluation and mgmt

before and/or after direct patient
99358 care, first hour $ 112.30 $ 112.30 $ 168.45

each additional 30 min (list

speparately in addition to primary
99359 code; use with 99358) $ 54.12 $ 54.12 $ 81.18