90880
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
2.19
Facility
$79.49
Non-Facility
$103.88
Documentation Required
- Medical record must document that the billing provider personally evaluated the patient and initiated the course of treatment prior to incident-to psychological services being provided.
- Maintain documentation of practitioner credentials, state licensure or authorization, and evidence that the practitioner is acting within the state-authorized scope of practice.
- Document the supervisory arrangement showing general physician supervision (physician's overall direction/control) and the physician's responsibility for training and maintenance of equipment/supplies.
- If the physician's office is located in an institution, document that auxiliary personnel are members of the physician's office staff and that supplies are expenses of the physician's office.
Key Coverage Criteria
- Psychological services may be furnished 'incident to' a physician's professional services only after the billing provider personally evaluates the patient and initiates the course of treatment; trained therapists may then provide services under the billing provider's general supervision.
- Psychological services incident to are covered when performed by one of the listed practitioner types—Doctorate or Masters Clinical Psychologist, Clinical Social Worker, Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Marriage and Family Therapist (MFT), or Mental Health Counselor (MHC)—each acting within their state-authorized scope of clinical practice and providing services represented by the specified CPT/HCPCS codes.
- General physician supervision is required for incident-to psychological services (physician need not be present but retains overall direction/control and responsibility for training and equipment/supplies).
- When a physician's office is located within an institution, incident-to coverage applies only if the auxiliary personnel are members of the physician's office staff, the cost of supplies is an expense to the physician's office, and services are generally supervised by the physician.
- Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
- CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
16 Active Policies
A57480 — Billing and Coding: Psychiatry and Psychology Services
J05
L34616 — Psychiatry and Psychology Services
J05
L33632 — Psychiatry and Psychology Services
J06
A56937 — Billing and Coding: Psychiatry and Psychology Services
J06
A52825 — Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians Medical Policy Article
Related Codes
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