ABA group adaptive behavior treatment - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes group
- ABA group adaptive behavior treatment - per 15 minutes. Group format with 2+ patients.
ABA Services
Primary code
Aetna: $13.88
Optum: $9.26
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 group adaptive behavior treatment - per 15 minutes. Group format with 2+ patients.
ABA protocol modification by QHP - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes (QHP)
- ABA protocol modification by QHP - per 15 minutes. QHP reviews data and modifies treatment protocol.
ABA Services
Primary code
Aetna: $18.74
Optum: $16.42
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 protocol modification by QHP - per 15 minutes. QHP reviews data and modifies treatment protocol.
ABA family treatment guidance - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes
- ABA family treatment guidance - per 15 minutes. Face-to-face with caregivers, with or without patient.
ABA Services
Primary code
Aetna: $18.94
Optum: $14.88
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 family treatment guidance - per 15 minutes. Face-to-face with caregivers, with or without patient.
ABA multiple-family group guidance - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes group
- ABA multiple-family group guidance - per 15 minutes. Group format for multiple families without patients.
ABA Services
Primary code
Aetna: $18.87
Optum: $7.09
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 multiple-family group guidance - per 15 minutes. Group format for multiple families without patients.
ABA group treatment with protocol modification - per 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per 15 minutes group (QHP)
- ABA group treatment with protocol modification - per 15 minutes. QHP-led group with protocol modification.
ABA Services
Primary code
Aetna: $18.87
Optum: $9.84
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 group treatment with protocol modification - per 15 minutes. QHP-led group with protocol modification.
Office/OP services provided in response to medical emergency
Individual psychotherapy, 60 minutes (53+ minutes).
Per emergency service
- Office/OP services provided in response to medical emergency. Unscheduled emergency care in office setting.
Evaluation & Management
Primary code
Aetna: $167.89
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:
Office/OP services provided in response to medical emergency. Unscheduled emergency care in office setting.
Office/OP visit new patient - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management
Primary code
Aetna: $45.82
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
Office/OP visit new patient - straightforward MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management
Primary code
Aetna: $45.82
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
Office/OP visit new patient - straightforward MDM (15-29 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - straightforward MDM. Time: 15-29 minutes. Minimal complexity.
Evaluation & Management
Primary code
Aetna: $76.39
Optum: $61.93
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:
Office/OP visit new patient - straightforward MDM. Time: 15-29 minutes. Minimal complexity.
Office/OP visit new patient - straightforward MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - straightforward MDM. Time: 15-29 minutes. Minimal complexity.
Evaluation & Management
Primary code
Aetna: $76.39
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:
Office/OP visit new patient - straightforward MDM. Time: 15-29 minutes. Minimal complexity.
Office/OP visit new patient - low MDM (30-44 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - low MDM. Time: 30-44 minutes. 2+ stable chronic conditions.
Evaluation & Management
Primary code
Aetna: $111.10
Optum: $95.91
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:
Office/OP visit new patient - low MDM. Time: 30-44 minutes. 2+ stable chronic conditions.
Office/OP visit new patient - low MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - low MDM. Time: 30-44 minutes. 2+ stable chronic conditions.
Evaluation & Management
Primary code
Aetna: $111.10
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:
Office/OP visit new patient - low MDM. Time: 30-44 minutes. 2+ stable chronic conditions.
Office/OP visit new patient - moderate MDM (45-59 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - moderate MDM. Time: 45-59 minutes. Prescription management, data review.
Evaluation & Management
Primary code
Aetna: $171.00
Optum: $142.29
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:
Office/OP visit new patient - moderate MDM. Time: 45-59 minutes. Prescription management, data review.
Office/OP visit new patient - moderate MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - moderate MDM. Time: 45-59 minutes. Prescription management, data review.
Evaluation & Management
Primary code
Aetna: $171.00
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:
Office/OP visit new patient - moderate MDM. Time: 45-59 minutes. Prescription management, data review.
Office/OP visit new patient - high MDM (60-74 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - high MDM. Time: 60-74 minutes. Severe exacerbation, hospitalization risk.
Evaluation & Management
Primary code
Aetna: $213.03
Optum: $187.80
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:
Office/OP visit new patient - high MDM. Time: 60-74 minutes. Severe exacerbation, hospitalization risk.
Office/OP visit new patient - high MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per new patient episode
- Office/OP visit new patient - high MDM. Time: 60-74 minutes. Severe exacerbation, hospitalization risk.
Evaluation & Management
Primary code
Aetna: $213.03
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:
Office/OP visit new patient - high MDM. Time: 60-74 minutes. Severe exacerbation, hospitalization risk.
Office/OP visit established - minimal problem
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day
- Office/OP visit established - minimal problem. Usually by clinical staff. Minimal complexity.
Evaluation & Management
Primary code
Aetna: $22.72
Optum: $19.87
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:
Office/OP visit established - minimal problem. Usually by clinical staff. Minimal complexity.
Office/OP visit established - minimal problem (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day
- Office/OP visit established - minimal problem. Usually by clinical staff. Minimal complexity.
Evaluation & Management
Primary code
Aetna: $22.72
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:
Office/OP visit established - minimal problem. Usually by clinical staff. Minimal complexity.
Office/OP visit established - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day
- Office/OP visit established - straightforward MDM. Time: 10-19 minutes. 1 self-limited problem.
Evaluation & Management
Primary code
Aetna: $45.48
Optum: $48.39
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:
Office/OP visit established - straightforward MDM. Time: 10-19 minutes. 1 self-limited problem.
Office/OP visit established - straightforward MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day
- Office/OP visit established - straightforward MDM. Time: 10-19 minutes. 1 self-limited problem.
Evaluation & Management
Primary code
Aetna: $45.48
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:
Office/OP visit established - straightforward MDM. Time: 10-19 minutes. 1 self-limited problem.