TMPPM 2010 > Behavioral Health, Rehabilitation, and Case Management Services Handbook > Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers > Psychotherapy/Counseling > Insight Oriented Behavior Modifying and/or Supportive Outpatient Psychotherapy/Counseling

7.12.5 Insight Oriented Behavior Modifying and/or Supportive Outpatient Psychotherapy/Counseling

Psychiatric diagnostic interviews, pharmacological regimen oversight, and pharmacological management will be denied as part of the following outpatient psychotherapy/counseling services when billed on the same date of service by the same provider in addition to the limitations detailed below by procedure code:

•Insight oriented outpatient psychotherapy/counseling without medical E/M services (procedure code 90804, 90806, or 90808):

•Procedure codes 36640, 90801, 90802, 90862, and M0064 will be denied as part of procedure code 90804 (20-30 minutes)

•Procedure codes 36640, 90801, 90802, 90804, 90805, 90862, and M0064 will be denied as part of procedure code 90806 (45-50 minutes)

•Procedure codes 36640, 90801, 90802, 90804, 90805, 90806, 90807, 90862, and M0064 will be denied as part of procedure code 90808 (75-80 minutes)

•Insight oriented outpatient psychotherapy/counseling with medical E/M services (procedure code 90805, 90807, or 90809):

•Procedure codes 36640, 90801, 90802, 90804, 90862, M0064, and any E/M service will be denied as part of procedure code 90805 (20-30 minutes)

•Procedure codes 36640, 90801, 90802, 90804, 90805, 90806, 90862, M0064, and any E/M service will be denied as part of procedure code 90807 (45-50 minutes)

•Procedure codes 36640, 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90862, M0064, and any E/M service will be denied as part of procedure code 90809 (75-80 minutes)

•Interactive outpatient psychotherapy/counseling without medical E/M services (procedure code 90810, 90812, or 90814):

•Procedure codes 36640, 90801, 90802, 90862, and M0064 will be denied as part of procedure code 90810 (20-30 minutes)

•Procedure codes 36640, 90801, 90802, 90804, 90805, 90862, and M0064 will be denied as part of procedure code 90812 (45-50 minutes)

•Procedure codes 36640, 90801, 90802, 90812, 90862, and M0064 will be denied as part of procedure code 90814 (75-80 minutes)

•Interactive outpatient psychotherapy/counseling with medical E/M services (procedure code 90811, 90813, or 90815):

•Procedure codes 36640, 90801, 90802, 90810, 90862, M0064, and any E/M service will be denied as part of procedure code 90811 (20-30 minutes)

•Procedure codes 36640, 90801, 90802, 90811, 90812, 90862, M0064, and any E/M service will be denied as part of procedure code 90813 (45-50 minutes)

•Procedure codes 36640, 90801, 90802, 90812, 90813, 1-90814, 90862, M0064, and any E/M service will be denied as part of procedure code 90815 (75-80 minutes)