Outpatient mental health treatment

For Medicaid Members: Please reference Medicaid behavioral health services for information regarding outpatient mental health benefit.

Prior Authorization isn't required for outpatient mental health therapy with a participating provider.

If you're a non-participating provider requesting an exception to provide outpatient mental health services to a Priority Health member, please fill out the Behavioral Health authorization form and fax it to 616.975.0249.

These are the contracted billable codes for outpatient mental health providers. 

+ = Services must be billed under participating Master's-level clinician

Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
Evaluation and Management (E&M) codes X
90785 Psychotherapy, complex interactive X X X
90791 Psychiatric diagnostic evaluation X X X
90792 Psychiatric diagnostic evaluation w/medical services X
90832 Psychotherapy, patient and/or family, 30 min. X X X
90833 Psychotherapy, patient and/or family w/E&M, 30 min. X
90834 Psychotherapy, patient and/or family, 45 min. X X X
90836 Psychotherapy, patient and/or family w/ E&M, 45 min. X
90837 Psychotherapy, patient and/or family, 60 min. X X X
90838 Psychotherapy, patient and/or family w/E&M, 60 min. X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
90839 Psychotherapy for crisis; first 60 min. X X X
90840 Psychotherapy for crisis; each additional 30 min. (list separately in addition to code for primary service) X X X
90845 Psychoanalysis X
90846 Family psychotherapy w/o patient X X X
90847 Family psychotherapy w/patient X X X
90849 Multiple family group psychotherapy X X X
90853 Group psychotherapy X X X
90863 Pharmacologic management w/psychotherapy X
90867 Transcranial magnetic stimulation, initial -TMS X
90868 Transcranial magnetic stimulation, subsequent treatment, delivery & management X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
90869 Transcranial magnetic stimulation, redetemination motor threshold, delivery & management X
90870 Electroconvulsive therapy X
96102 Psychological testing, technician X
96103 Psychological testing, computer X
96116 Neurobehavioral status exam, first hour   X  
96119 Neuropsychological testing, technician
   X  
96120 Neuropsycholgical testing, computer X
96121 Neurobehavioral status exam, additional hour X
96130 Psychological testing, first hour X
96131 Psychological testing, additional hours X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
96132 Neuropsychological testing, first hour   X  
96133 Neuropsychological testing, additional hours   X  
96136 Psychological testing or neuropsychological testing administered and scored by physician, first 30 minutes   X  
96137 Psychological testing or neuropsychological testing administered and scored by physician, additional 30 minutes   X  
96138 Psychological testing or neuropsychological testing administered and scored by a technician, first 30 minutes   X  
96139 Psychological testing or neuropsychological testing administered and scored by a technician, additional 30 minutes   X  
96146 Psychological or neuropsychological test administered with single automated standardized instrument via electronic platform, automated results only   X  
96150 Health & behavioral initial evaluation X X
96151 Health & behavioral re-assessment X X
96152 Health & behavioral intervention, individual X X
Code Description Physician Fully licensed psychologist LMSW, MA LLP, LPC
96153 Health & behavioral intervention, group X X
96154 Health & behavioral intervention, family and patient X X
96155 Health & behavioral intervention, family X X

Special credentialing is required to provide the services below

CPT Code
Effective Jan. 1, 2020		 Description Physician Fully licensed psychologist LMSW, MA
LLP, LPC
97151 Mental health assessment, non-physician, autism X X
97151 Mental health service plan, non-physician, autism X X
97153 Skills training, 15 min., for autism   X  X 
97154 Therapy, behavioral health services, 15 min., for autism X X
97155 Supervision, 15 min., for autism   X X 
97156 Parent training, 15 min., for autism   X 

X

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