Psychological test admin & scoring by professional; first 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
First 30 minutes
- Psychological/Neuropsychological test administration and scoring by professional; first 30 minutes.
Psychological Testing
Primary code
Aetna: $53.11
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological/Neuropsychological test administration and scoring by professional; first 30 minutes.
Psychological test admin & scoring by professional; first 30 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
First 30 minutes
- Psychological/Neuropsychological test administration and scoring by professional; first 30 minutes.
Psychological Testing
Primary code
Aetna: $53.11
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological/Neuropsychological test administration and scoring by professional; first 30 minutes.
Psychological test admin & scoring; each additional 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Each additional 30 minutes
- Psychological test administration and scoring; each additional 30 minutes. Add-on to 96136.
Psychological Testing
Add-on code
Aetna: $48.48
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological test administration and scoring; each additional 30 minutes. Add-on to 96136.
Psychological test admin & scoring; each additional 30 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Each additional 30 minutes
- Psychological test administration and scoring; each additional 30 minutes. Add-on to 96136.
Psychological Testing
Add-on code
Aetna: $48.48
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological test administration and scoring; each additional 30 minutes. Add-on to 96136.
Psychological test admin & scoring by technician; first 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
First 30 minutes (tech)
- Psychological test administration and scoring by technician; first 30 minutes. Requires QHP supervision.
Psychological Testing
Primary code
Aetna: $41.51
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological test administration and scoring by technician; first 30 minutes. Requires QHP supervision.
Psychological test admin & scoring by technician; each additional 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Each additional 30 minutes (tech)
- Psychological test administration and scoring by technician; each additional 30 minutes. Add-on to 96138.
Psychological Testing
Add-on code
Aetna: $41.51
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological test administration and scoring by technician; each additional 30 minutes. Add-on to 96138.
Psychological test admin with single instrument, automated
Individual psychotherapy, 60 minutes (53+ minutes).
Per instrument
- Psychological test administration with single instrument, automated platform. Electronic administration with automated results.
Psychological Testing
Primary code
Aetna: $2.50
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Psychological test administration with single instrument, automated platform. Electronic administration with automated results.
Health & Behavior Assessment or reassessment, untimed
Individual psychotherapy, 60 minutes (53+ minutes).
Per assessment episode
- Health & Behavior Assessment or reassessment, untimed. Comprehensive biopsychosocial assessment.
Health & Behavior
Primary code
Aetna: $0.00
Optum: $80.94
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Assessment or reassessment, untimed. Comprehensive biopsychosocial assessment.
Health & Behavior Intervention individual, 30 minutes
Individual psychotherapy, 60 minutes (53+ minutes).
Per 30 minutes
- Health & Behavior Intervention individual, 30 minutes. For health-related behavior change.
Health & Behavior
Primary code
Aetna: $0.00
Optum: $55.30
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention individual, 30 minutes. For health-related behavior change.
Health & Behavior Intervention individual, add-on 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per additional 15 minutes
- Health & Behavior Intervention individual, add-on 15 minutes. Add-on to 96158.
Health & Behavior
Add-on code
Aetna: $0.00
Optum: $19.01
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention individual, add-on 15 minutes. Add-on to 96158.
Health & Behavior Intervention group, 15 minutes
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes group
- Health & Behavior Intervention group, 15 minutes. Group format intervention.
Health & Behavior
Primary code
Aetna: $0.00
Optum: $8.36
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention group, 15 minutes. Group format intervention.
Health & Behavior Intervention group, add-on 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per additional 15 minutes group
- Health & Behavior Intervention group, add-on 15 minutes. Add-on to 96164.
Health & Behavior
Add-on code
Aetna: $0.00
Optum: $3.75
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention group, add-on 15 minutes. Add-on to 96164.
Health & Behavior Intervention family with patient, 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 30 minutes family
- Health & Behavior Intervention family with patient, 30 minutes. Family-based intervention.
Health & Behavior
Primary code
Aetna: $0.00
Optum: $58.76
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention family with patient, 30 minutes. Family-based intervention.
Health & Behavior Intervention family with patient, add-on 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on 15 minutes family
- Health & Behavior Intervention family with patient, add-on 15 minutes. Add-on to 96167.
Health & Behavior
Add-on code
Aetna: $0.00
Optum: $20.74
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior Intervention family with patient, add-on 15 minutes. Add-on to 96167.
Health & Behavior intervention family without patient, 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 30 minutes family without patient
- Health & Behavior intervention family without patient, 30 minutes. Family/caregiver intervention only.
Health & Behavior
Primary code
Aetna: $0.00
Optum: $66.83
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior intervention family without patient, 30 minutes. Family/caregiver intervention only.
Health & Behavior intervention family without patient, add-on 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on 15 minutes family without patient
- Health & Behavior intervention family without patient, add-on 15 minutes. Add-on to 96170.
Health & Behavior
Add-on code
Aetna: $0.00
Optum: $24.20
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Health & Behavior intervention family without patient, add-on 15 minutes. Add-on to 96170.
Therapeutic injection subcutaneous or intramuscular
Individual psychotherapy, 60 minutes (53+ minutes).
Per injection
- Therapeutic injection subcutaneous or intramuscular. For medication administration.
Medical Procedures
Primary code
Aetna: $0.00
Optum: $12.10
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Therapeutic injection subcutaneous or intramuscular. For medication administration.
ABA behavior identification assessment - per 15 min (QHP)
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes (QHP)
- ABA behavior identification assessment - per 15 minutes. Performed by QHP, includes assessment and treatment planning.
ABA Services
Primary code
Aetna: $19.70
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
ABA behavior identification assessment - per 15 minutes. Performed by QHP, includes assessment and treatment planning.
ABA behavior identification supporting assessment - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes (tech)
- ABA behavior identification supporting assessment - per 15 minutes. Performed by technician under QHP supervision.
ABA Services
Primary code
Aetna: $13.83
Optum: $0.00
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
ABA behavior identification supporting assessment - per 15 minutes. Performed by technician under QHP supervision.
ABA adaptive behavior treatment by protocol - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes (tech)
- ABA adaptive behavior treatment by protocol - per 15 minutes. Protocol-driven treatment by technician.
ABA Services
Primary code
Aetna: $13.88
Optum: $12.51
Documentation & MDM Details
- Therapy duration: 53+ minutes documented
- Moderate to high complexity: crisis intervention, trauma processing
- Significant therapeutic content documented
- Patient in acute distress or working through complex trauma
- Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
ABA adaptive behavior treatment by protocol - per 15 minutes. Protocol-driven treatment by technician.