GAGA IndividualAndFamilyTherapy


1 Individual and amily p sychotherapy f Background : This update provides an overview of the billing and coding guidelines for i ndividual and family psychotherapy services. What this mean  s supports the practice to you Amerigroup : Community Care of rendering individual and family therapy sessions on the same date of service. This provider update provides an overview for the billing and coding guidelines of these services. do I need to know? What Effective January 1, 2013, there were significant changes to the Current Procedural Terminology 90838 - (CPT) codes for psychiatry and psychotherapy services. Psychotherapy CPT codes 90832 ation (AMA) as are defined by the American Medical Associ services psychotherapy face - to - face with the patient and/or family members . These service codes include ongoing assessment and adjustment of psychotherapeutic interventions and may include involvement of family members or others in the treatment process. Family therapy CPT c odes 90846 and 90847 did not change with the 2013 AMA changes. CPT code 90846 is defined as family psychotherapy without the patient present . CPT 90847 is code he patient present family psychotherapy with t defined as . When to use psychotherapy v ersus family therapy CPT codes ’ Family psychotherapy is covered w hen there is a need to observe the patient s interaction with st the family family members and/or where there is a need to assess the capabilities of and assi members in aiding in the management of the patient. Family psychotherapy is only acceptable when the primary purpose of counseling is the  treatment of the patient ’ s condition. Individual and family therapy codes can be billed on the same  date of service if there are two separate counseling sessions – one with the patient and one with the family member and patient present. Providers should not bill an individual therapy code with the family therapy code if only one  ndered. session of therapy is re s Family therapy codes should not be billed when the therapist request a brief update on the  member ’ s behaviors prior to or after the individual session takes place. T provides a summary of the acceptable practices for billing he table on the next page individual and family psychotherapy services .

2 Summary of the acceptabl 90838, 90846, 90847, or 90832 - 90838 e practices for billing 90832 - 90847/90846 and Clinical f ocus of s Who is present Appropriate CPT ession c ode o nly Patient 90832 - 90838 Patient Patient and f amily member(s) Patient 90832 - 90838 Patient and f Family member(s) 90847 amily member(s) Family member(s) 90846 Family member(s) p atient o nly 90832 90838 and Session 1: p atient - Session 1: patient and f amily Session 2: f amily 90847 Session 2: member(s) member(s) o Session 1: p atient nly and 90838 - 90832 Session 1: p atient Session 2: f amily amily member(s) f Session 2: 90846 member(s) Please note that Amerigroup has the following claim edits in place:  If there are multiple family members in the family therapy session who are enrolled with Amerigroup, providers will receive reimbursement for the therapy session for only one of the - enrolled patients. Providers should not b ill a therapy session for each family Amerigroup member enrolled with Amerigroup . codes 90846 and 90847 on the same date of  Providers will not be reimbursed for billing CPT service, regardless if they are for two separate sessions. Amerigroup will only reimburse for one of the family therapy codes per day. What if I need assistance? the quality health care you provide to our members and we are committed to We appreciate keeping you updated about issues and developments affecting your practice. If you have please contact your local Provider Relations representative or call Provider Services at questions, - 800 - 454 - 3730. 1 GAPEC - 0745 - 14 Issued Decem ber 2014 by Amerigroup Community Care

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