Medicaid Releases Psychiatric Rate Add-ons

Jan. 13, 2020

MEMORANDUM

On January 7, the Illinois Department of Healthcare and Family Services (HFS) issued a Provider Notice that informs physicians of psychiatric service add-on payments effective with dates of service beginning July 1, 2019, authorized to participating board-certified psychiatrists billing the procedure codes listed in the table below.

Due to a delay until mid-October in finalizing the psychiatric add-on payments, claims submitted prior to that would not have received the add-on. Providers may submit replacement claims to receive the correct reimbursement. HFS will accept electronic transactions submitted through the Medical Electronic Data Interchange (MEDI) System or via 837P files to replace a paid claim, if submitted within 12 months from the original paid voucher date.  Instructions for replacement claim submittal may be found in the Chapter 300 Companion Guide.

The Practitioner Fee Schedule has been updated with a specific sheet that identifies the procedure codes and psychiatric add-on payments.  Prompted by Public Act 101-0010, the following procedure codes are eligible to receive the add-on payments:

					Add-On Payments
Proc. Code	Description	Unit Price	Max Qty.	State Max	Child	Adult	Psychiatric Add-On Child or Adult
90791	Psychiatric diagnostic evaluation		1	122.11			23.57
90792	Psychiatric diagnostic evaluation w/ medical services		1	124.44			40.50
90832	Psychotherapy, 30 minutes w/ patient and/or family members		1	29.48			41.52
90833	Psychotherapy, 30 min w/ patient &/or family w/ E/M service		1	24.62			49.63
90834	Psychotherapy, 45 min w/ patient and/or family members	44.20	2	88.40			50.45
90836	Psychotherapy, 45 min w/ patient &/or family w/ E/M service		1	40.24			53.34
90837	Psychotherapy, 60 min w/ patient and/or family members	66.71	2	133.42			75.62
99213	Office/other outpatient visit, established patient, expanded focus		1	28.35	18.21	18.21	50.87
99214	Office/other outpatient visit, established patient, detailed/moderate complexity		1	42.50	30.47	30.47	73.33
99215	Office/other outpatient visit, established patient, comprehensive/complexity		1	48.00	1.95	1.95	107.62

 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service claims, or to the applicable managed care plan. Questions or comments for IHA can be submitted here.