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Claims Processing Issue and Billing Reminder for MFT and LCSW Providers

March 17, 2016

Effective January 1, 2014, Marriage and Family Therapists (MFT) and Licensed Clinical Social Workers (LCSW) may submit Medi-Cal claims for psychotherapy services. A claims processing issue has caused some claims for MFTs and LCSWs to process incorrectly. The Department of Health Care Services will reach out to affected providers regarding payment of denied claims.

To ensure that claims are reimbursed correctly, providers must bill with the correct procedure code, billed amount and place of service. At this time, it is recommended that providers do not submit claims for more than the maximum allowance listed in the Psychological Services: Billing Codes and Reimbursement Rates section of the Medi-Cal provider manual.

MFTs and LCSWs may bill using the following CPT-4 codes:

CPT-4 Code Description
90832 Psychotherapy, 30 minutes with patient and/or family member
90837 Psychotherapy, 60 minutes with patient and/or family member
90839 Psychotherapy for crisis; first 60 minutes
90840 each additional 30 minutes
90853 Group psychotherapy
99366 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional
99368 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional

MFTs and LCSWs may also use the following Place of Service codes:

CMS-1500
Place of Service Code
Description
11 Office
12 Home
22 On Campus Outpatient Hospital
53 Community Mental Health Center
62 Comprehensive Outpatient Rehabilitation Clinic
71 Public Health Clinic
72 Rural Health Clinic
99 Other Place of Service

Providers are encouraged to refer back to the Medi-Cal website regularly for further updates.