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Elizabeth M. Whitehorn, Director

Provider Notice Issued 02/03/2023

Date:   February 3, 2023

To:  All Medical Assistance Program Providers

Re:   Coverage of Interprofessional Consultation Procedure Codes for Psychiatric Services Effective February 1, 2023

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This notice introduces coverage of Interprofessional Consultation procedure codes for psychiatric services. These additional procedure codes will be covered under both Medicaid fee-for-service (FFS) and Medicaid managed care organizations (MCOs) effective for dates of service on or after February 1, 2023.

The Department of Healthcare and Family Services (HFS) is allowing the following  Interprofessional Consultation CPT codes to be billable for psychiatric services effective with dates of service beginning February 1, 2023:

CPT

Description

 Rate

99446

Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

$11.09

99447

11-20 minutes of medical consultative discussion and review

$21.74

99448

21-30 minutes of medical consultative discussion and review

$32.53

99449

31 minutes or more or medical consultative discussion and review

$43.51

99451

Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional; 5 minutes or more of medical consultative discussion and review

$21.44

 

Interprofessional Consultation services are reimbursable to licensed physicians and advanced practice nurses who meet all the following: 1) have a Child/Adolescent Psychiatric (CAP) residency or General Psychiatric Residency (GAP) specialty on their HFS provider file; and 2) are enrolled in IMPACT with a psychiatric specialty. Providers should confirm their CAP or GAP specialty using their Provider Information Sheet.

The above codes are not to be billed in conjunction with the Collaborative Care Model codes identified in the June 21, 2022, provider notice. As defined in the CPT codebook, the consultant practitioner should not have seen the patient in a face-to-face encounter within a 14-day period before or after the consult.

Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services for FFS claims at 877-782-5565 or the applicable MCO.

 

Kelly Cunningham, Administrator

Division of Medical Programs