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CPT® Code 90836 refers to a specific type of psychotherapy session that lasts for 45 minutes and is conducted with a patient. This service is performed in conjunction with an evaluation and management (E/M) service, which means that it is billed separately in addition to the primary procedure code for the E/M service. The psychotherapy provided under this code involves various therapeutic techniques aimed at helping the patient understand and modify their behavior. Techniques may include re-education, support, reassurance, and insight discussions. Occasionally, medication may also be utilized to assist in behavior modification. The goal of this psychotherapy is to enhance the patient's self-understanding and to evaluate and improve family relationship dynamics that may be impacting the patient's mental health condition. It is important to note that if psychotherapy is provided without the accompanying E/M service, different codes are used based on the duration of the session: CPT® Code 90832 for 30 minutes, CPT® Code 90834 for 45 minutes, and CPT® Code 90837 for 60 minutes. When psychotherapy is performed alongside E/M services, the appropriate codes to report are CPT® Code 90833 for 30 minutes, CPT® Code 90836 for 45 minutes, and CPT® Code 90838 for 60 minutes.
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The indications for using CPT® Code 90836 include various mental health conditions and situations where psychotherapy is deemed beneficial. This may encompass:
The procedure for CPT® Code 90836 involves several key steps that ensure the effective delivery of psychotherapy in conjunction with evaluation and management services. These steps include:
Post-procedure care following a session billed under CPT® Code 90836 typically involves ongoing monitoring of the patient's mental health status and the effectiveness of the psychotherapy. Patients may be advised to engage in self-care practices and to maintain open communication with their therapist regarding any changes in their condition. Additionally, the therapist may provide resources or referrals for further support if needed. Regular follow-up sessions are encouraged to ensure continuity of care and to adjust the treatment plan as necessary based on the patient's evolving needs.
| Short Descr | PSYTX W PT W E/M 45 MIN | Medium Descr | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN | Long Descr | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5B - Specialist - psychiatry | MUE | 2 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 99202 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99203 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99204 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99205 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99211 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | 99212 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | 99213 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99214 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99215 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99221 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99222 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. | 99223 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. | 99231 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | 99232 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99233 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. | 99234 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99235 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded. | 99236 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded. | 99238 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | 99239 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 99242 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99243 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99244 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99245 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. | 99252 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99253 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99254 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99255 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded. | 99304 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | 99305 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99306 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. | 99307 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | 99308 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99309 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99310 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99315 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Nursing facility discharge management; 30 minutes or less total time on the date of the encounter | 99316 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Nursing facility discharge management; more than 30 minutes total time on the date of the encounter | 99341 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99342 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99344 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99345 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. | 99347 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99348 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99349 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99350 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | G0463 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC J2 Hospital outpatient clinic visit for assessment and management of a patient | 0770T | Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure) | 90785 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Interactive complexity (List separately in addition to the code for primary procedure) |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GT | Via interactive audio and video telecommunication systems | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | FQ | The service was furnished using audio-only communication technology | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | SA | Nurse practitioner rendering service in collaboration with a physician | FR | The supervising practitioner was present through two-way, audio/video communication technology | V3 | Demonstration modifier 3 | AF | Specialty physician | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | U6 | Medicaid level of care 6, as defined by each state | GJ | "opt out" physician or practitioner emergency or urgent service | UB | Medicaid level of care 11, as defined by each state | CR | Catastrophe/disaster related | AM | Physician, team member service | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GQ | Via asynchronous telecommunications system | UA | Medicaid level of care 10, as defined by each state | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | HF | Substance abuse program | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 32 | Mandated services: services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure. | 56 | Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | AG | Primary physician | AH | Clinical psychologist | AJ | Clinical social worker | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AR | Physician provider services in a physician scarcity area | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | FS | Split (or shared) evaluation and management visit | G1 | Most recent urr reading of less than 60 | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | HB | Adult program, non geriatric | HE | Mental health program | HK | Specialized mental health programs for high-risk populations | HO | Masters degree level | HP | Doctoral level | KX | Requirements specified in the medical policy have been met | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | TD | Rn | U1 | Medicaid level of care 1, as defined by each state | U4 | Medicaid level of care 4, as defined by each state | UC | Medicaid level of care 12, as defined by each state | UD | Medicaid level of care 13, as defined by each state | UF | Services provided in the morning | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2021-01-01 | Note | Guidelines changed. |
| 2017-01-01 | Changed | Long, Medium and Short descriptions changed. |
| 2013-01-01 | Added | Added |
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