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2020 HCPCS Updates for Texas Medicaid SHARS Program – Counseling and Psychological Services

Last updated on 1/23/2020

Effective for dates of service on or after January 1, 2020, counseling and psychological services procedure codes 96152 and 96153 were discontinued by the 2020 annual Healthcare Common Procedure Coding System (HCPCS) updates. These procedure code changes will impact School Health and Related Services (SHARS) providers.

The following procedure code changes are effective for counseling and psychological services:

Service

Discontinued Procedure Code

Unit of Service for Discontinued Procedure Codes

Individual counseling services

96152 with modifier UB

15 minutes

Group counseling services

96153 with modifier UB

15 minutes

Individual psychological services

96152 with modifier AH

15 minutes

Group psychological services

96153 with modifier AH

15 minutes

Service

New Procedure Codes

Unit of Service for New Procedure Codes

Individual counseling services

96158 with modifier UB

30 minutes

Individual counseling services (add-on)

96159 with modifier UB

15 minutes

Group counseling services

96164 with modifier UB

30 minutes

Group counseling services (add-on)

96165 with modifier UB

15 minutes

Individual psychological services

96158 with modifier AH

30 minutes

Individual psychological services (add-on)

96159 with modifier AH

15 minutes

Group psychological services

96164 with modifier AH

30 minutes

Group psychological services (add-on)

96165 with modifier AH

15 minutes

Services are limited to a total of three units (one hour) per day, any provider, as follows:

  • The initial 30 minutes (procedure codes 96158 and 96164) is limited to one unit per day.
  • Each additional 15 minutes (procedure codes 96159 and 96165) is limited to two units per day.

Procedure codes 96159 and 96165 are add-on procedure codes and must be billed on the same date of service as the corresponding primary procedure code to be considered for reimbursement.

Refer to: The Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 3.3.2, “Counseling Services,” and subsection 3.3.3.2, “Psychological Services,” for additional information about counseling and psychological services.

For more information, call the TMHP Contact Center at 800-925-9126.