Mental Health Regulatory Information

When does the DSM V become mandated?

The DSM V was released in May of 2013, insurance companies have to have the DSM V and the ICD 10 codes incorporated January 1 2014, mental health and medical professionals will have to adopt the DSM V codes by October 1 2014.

With all of the recent health care changes, what will the effects be on mental health?

The first is the Mental Health Parity Act, this legislates that mental health be treat like any other illness, with no limits on visits or coverage.

The Affordable Health Care Act, which takes effect January 1st 2014 includes the Mental Health Parity Act, it also makes Depression Screening and outcome tracking a mandatory component of wellness. This must be offered with no co-pay or deductible.


Medicaid Billing National Reimbursement Rates – 2013 *

  • Psychiatric Evaluation by Physician - $210 (H2000)
  • Psychiatric Evaluation by Non-Physician - $150 (H2000
  • Psychiatric diagnostic evaluation – between $111 and $151 (90791)
  • Psychological testing, computer – between $51 and $70 (96103)
  • Psychiatric diagnostic evaluation (90791)
  • FL - $160.31
  • NY - $168.55
  • PA - $157.44
*Rates will vary by state and county. These we confirmed for 2013.

Private Insurance Codes – 2013

You can look up the cost of a particular CPT code in your city or state on the AMA website.

Code Description
90801 Psychological Diagnostic Interview Examination (Includes report prep time 90885)
90802 Interactive Diagnostic Interview (with language interpreter or other mechanisms
90816 Individual medical psychotherapy, 20 – 30 minutes for Inpatient (Outpatient = 90804)
90818 Individual medical psychotherapy, 45 – 50 minutes for Inpatient (Outpatient = 90806)
90821 Individual medical psychotherapy, 75 – 80 minutes for Inpatient (Outpatient = 90808)
90847 Family Psychotherapy with patient Present (90846 without patient present; 90849 Multiple-family group psychotherapy)
90853 Group psychotherapy
96101 Psychological testing, interpretation and reporting per hour by a psychologist (Per Hour)
96102 Psychological testing per hour by a technician (Per Hour)
96103 Psychological testing by a computer, including time for the psychologist’s interpretation and reporting (Per Hour)
96105 Assessment of Aphasia
96111 Developmental Testing, Extended
96115 Neurobehavioral Status Exam (Per Hour)
96116 Chart Review, Scoring and Interpretation of Instruments, Note-Writing
96118 Neuropsychological testing, interpretation and reporting per hour by a psychologist
96119 Neuropsychological testing per hour by a technician
96120 Neuropsychological testing by a computer, including time for the psychologist’s interpretation and reporting
96150 Health & Behavioral Assessment – Initial
96151 Reassessment
96152 Health & Behavior Intervention – Individual
96153 Health & Behavior Intervention – Group
96154 Health & Behavior Intervention – Family with Patient
96155 Health & Behavior Intervention – Family without Patient
97770 Cognitive Rehabilitation

Mental Health Facts

  • 26% of Americans walk around with a diagnosable mental illness, 37% of CMS.
  • NIH says U.S. spent 5605 Billion on mental health in 2012. That will raise to 2.6 Trillion by 2014.
  • It takes between 3-8 years to get a correct diagnosis.
  • 50% of Americans will have a mental illness in their lifetime.
  • Time magazine says that 50% of the homeless have a mental illness, & over 30% of the prison population.
  • Patient to practitioner ratio of 10,000:1.
  • People with mental Illness are 250% more likely to be hospitalized.
  • Most missed diagnoses come from hidden comorbid conditions.
  • Longitudinal studies suggest that roughly a third of all depressions have a bipolar course.
  • Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population.
  • Bipolar disorder results in 9.2 years reduction in expected life span.

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