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Medication Management

Psychotropic pharmacologic (medication) management is a covered benefit. When provided in conjunction with a psychotherapy visit, reimbursement for medication management is included in the allowable charge for psychotherapy.

Any provider practicing within the scope of a state license may prescribe psychotropic medications as part of an office visit. However, all patients receiving psychotropic medication must be under the care of a qualified mental health provider authorized by state licensure to prescribe drugs. 

Cost Information

Billing Guidelines and Approval Requirements

According to the American Psychological Association (APA) and the American Medical Association (AMA) CPT® manual, psychotropic pharmacologic (medication) management services can be billed one of three ways depending on the type of provider and the services being rendered.

1. Physicians or certified psychiatric nurse specialists providing psychotropic pharmacologic management WITHOUT psychotherapy services:

  • Use these CPT® codes: Evaluation and Management (E&M) services 99201–99255, 99281–99285, 99304–99337, or 99341–99350.
  • Authorization requirements: Prior authorization is not required (these services are not considered mental health care.) However, a referral is required for TRICARE Prime beneficiaries or point-of-service cost shares will apply. 
     

2. Physicians or certified psychiatric nurse specialists providing psychotropic pharmacologic management WITH psychotherapy services:

  • Use these CPT® codes: E&M services 99201–99255, 99281–99285, 99304–99337, or 99341–99350 plus the appropriate psychotherapy service add-on code 90833, 90836, or 90838.
  • Authorization requirements: Active duty service members (ADSMs) must have a referral from their primary care provider for all civilian mental health services prior to receiving services from a TRICARE-authorized provider. TRICARE Prime beneficiaries (excluding ADSMs) do not require an approval from Health Net Federal Services, LLC (HNFS) when seeing a network provider. TRICARE Select beneficiaries do not require an approval from HNFS.
     

3. Prescribing psychologists providing psychotropic pharmacologic management WITH psychotherapy services (based on state licensure currently only allowed in New Mexico and Louisiana)

  • Use these CPT® codes: The 90863 add-on code, in conjunction with the psychotherapy services codes 90832, 90834, or 90837.
  • Authorization requirements: ADSMs must have a referral from their primary care provider for all civilian mental health services prior to receiving services from a TRICARE-authorized provider. TRICARE Prime beneficiaries (excluding ADSMs) do not require an approval from HNFS when seeing a network provider. TRICARE Select beneficiaries do not require an approval from HNFS.

 

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