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Official Description

Mental health service plan development by non-physician
Short Descr Mh svc plan dev by non-md
Coverage Not payable by Medicare
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS Z2 – Undefined codes
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2003
Status Code Not Valid for Medicare Purposes
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 218 - Psychological and psychiatric evaluation and therapy
U3 Medicaid level of care 3, as defined by each state
U6 Medicaid level of care 6, as defined by each state
TS Follow-up service
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
AJ Clinical social worker
FQ The service was furnished using audio-only communication technology
GT Via interactive audio and video telecommunication systems
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
HO Masters degree level
Q2 Demonstration procedure/service
SA Nurse practitioner rendering service in collaboration with a physician
U4 Medicaid level of care 4, as defined by each state
UA Medicaid level of care 10, as defined by each state
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
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