CPT Code Description
90801 Interview evaluation
90804 Individual therapy 20 – 30 min
90806 Psychotherapy
90807 Psychotherapy with medical evaluation and management
90862 Pharmacologic management
New and Deleted Procedure Codes
The following psychiatric services procedure codes will be discontinued and replaced as indicated:
Category 2012 Procdure Codes 2013 Procedure Codes
90801 90791, 90792
90802 90791, 90792
90804, 90816 90832
90806, 90818 90834
90808, 90821 90837
Psychiatric Diagnostic Interview Examination (CPT code 90801):
An E/M service may be substituted for the initial interview procedure, including consultation CPT codes, (CPT codes 99241-99263), provided required elements of the E/M service billed are fulfilled. Consultation services require, in addition to the interview and examination, the provision of a written opinion and/or advice. E/M CPT codes do not include a psychotherapy service.
B. Interactive Psychiatric Diagnostic Interview Examination (CPT code 90802):
CPT codes 90802, 90810-90815, 90823-90829 and 90857 may also be covered for any psychiatric disorder as specified in the “ICD-9-CM codes that Support Medical Necessity”
section for adults who also have one of the conditions as specified in the Local Coverage Determination. Both the primary psychiatric diagnosis and secondary communication disorder must be submitted on the claim.
Understanding the Diagnosis and Treatment of Depression
In an effort to identify ways that we may help to improve Member anti-depression medication compliance, a research study was designed and conducted by TideWatch Partners, LLC to examine the diagnosis and treatment of depression. The study gathered insights from providers, primary care physicians (PCP) and behavioral health specialists, specifically psychiatrists, about
their experience treating patients who have been diagnosed with depression.
The objectives of this study were to:
• Gain an understanding of the depression diagnosing process, including diagnostic tools and methods, and treatment plan development
• Identify barriers to Member compliance with anti-depression medications
• Assess ways that Oxford might help Members overcome these barriers Analysis of the survey showed that, among other issues, clarifying and educating providers about referrals specific to depression might help eliminate some of the perceived barriers. The following list is a summary of information that will assist you when referring Oxford Members for behavioral healthcare.
• All inpatient behavioral health services require precertification
• Outpatient behavioral health services require precertification or a PCP referral when provided to all Members, excluding Members of New Jersey small group and Individual plans
• Services provided to Members of New Jersey small group gated plans and New Jersey Individual gated plans require a referral only
• Services provided to Members of New Jersey small group non-gated plans and New Jersey Individual non-gated plans do not require a referral or precertification
• Members may obtain referrals for outpatient behavioral health services through their PCP or by calling Provider Services at 800-666-1353
Please note: Members who obtain a referral from the Behavioral Health Department do not need to go to their PCP.
• Medication management may be authorized once a month or 12 times in one year for Members who are stabilized on medication; however, if more sessions are required to stabilize a patient, providers may request additional sessions by calling the Behavioral Health Department at 800- 201-6991
• A list of participating specialists (including psychiatrists, social workers and nurse practitioners) is available through the Doctor Search tool on www.oxfordhealth.com or by calling Provider Services at 800-666-1353
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