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28.2.6 Procedure Codes Included in the 12-Hour System Limitation
The following table lists the outpatient behavioral health procedure codes included in the system limitation. The table also includes the time increments that the system applies based on the billed procedure code. The system uses the "time applied" time increments to determine whether the 12-hour-per-day system limitation has been exceeded.
Procedure code 90853 is not included in the 12-hour system limitation, so it is not shown in the table.
LCSWs or LPCs may use only the following procedure codes when filing claims: 90804, 90806, 90808, 90847, and 90853.
LMFTs may use only the following procedure codes and modifier U8 when filing claims: 90804, 90806, 90808, 90847, and 90853.
Psychiatrists only may use the following procedure codes when filing claims:
Psychiatrists and psychologists may use the following procedure codes when filing claims:
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