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