195
Total CPT Codes
171
Primary Codes
24
Add-on Codes
0
In Calculator
Category
Code Type
99234 primary
Low
Hospital IP/OBS same date - straightforward/low MDM (45 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per same date encounter - Hospital IP/OBS same date - straightforward/low MDM. Time: 45 minutes. Admission and discharge same date.
Evaluation & Management Primary code
Aetna: $140.30 Optum: $84.11
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:
Hospital IP/OBS same date - straightforward/low MDM. Time: 45 minutes. Admission and discharge same date.
99235 primary
Moderate
Hospital IP/OBS same date - moderate MDM (70 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per same date encounter - Hospital IP/OBS same date - moderate MDM. Time: 70 minutes. Same date admit/discharge moderate complexity.
Evaluation & Management Primary code
Aetna: $175.15 Optum: $135.67
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:
Hospital IP/OBS same date - moderate MDM. Time: 70 minutes. Same date admit/discharge moderate complexity.
99236 primary
High
Hospital IP/OBS same date - high MDM (85 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per same date encounter - Hospital IP/OBS same date - high MDM. Time: 85 minutes. Same date admit/discharge high complexity.
Evaluation & Management Primary code
Aetna: $226.22 Optum: $177.72
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:
Hospital IP/OBS same date - high MDM. Time: 85 minutes. Same date admit/discharge high complexity.
99238 primary
Moderate
Hospital discharge day management - 30 min or less
Individual psychotherapy, 60 minutes (53+ minutes).
Per discharge - Hospital discharge day management - 30 minutes or less. Final exam, discharge instructions.
Evaluation & Management Primary code
Aetna: $82.40 Optum: $68.84
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:
Hospital discharge day management - 30 minutes or less. Final exam, discharge instructions.
99239 primary
Moderate
Hospital discharge day management - more than 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per discharge - Hospital discharge day management - more than 30 minutes. Complex discharge coordination.
Evaluation & Management Primary code
Aetna: $110.59 Optum: $97.65
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:
Hospital discharge day management - more than 30 minutes. Complex discharge coordination.
99241 primary
Straightforward
Office/OP consultation - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $123.60 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
99241 primary
Straightforward
Office/OP consultation - straightforward MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $123.60 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
99242 primary
Straightforward
Office/OP consultation - straightforward MDM (20 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - straightforward MDM. Requested opinion from another provider.
Evaluation & Management Primary code
Aetna: $123.60 Optum: $64.81
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 consultation - straightforward MDM. Requested opinion from another provider.
99242 primary
Straightforward
Office/OP consultation (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - straightforward MDM. Requested opinion from another provider.
Evaluation & Management Primary code
Aetna: $123.60 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 consultation - straightforward MDM. Requested opinion from another provider.
99243 primary
Low
Office/OP consultation - low MDM (30 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - low MDM. Time: 30 minutes. Low complexity consultation.
Evaluation & Management Primary code
Aetna: $125.53 Optum: $97.07
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 consultation - low MDM. Time: 30 minutes. Low complexity consultation.
99243 primary
Low
Office/OP consultation - low MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - low MDM. Time: 30 minutes. Low complexity consultation.
Evaluation & Management Primary code
Aetna: $125.53 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 consultation - low MDM. Time: 30 minutes. Low complexity consultation.
99244 primary
Moderate
Office/OP consultation - moderate MDM (40 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - moderate MDM. Time: 40 minutes. Moderate complexity consultation.
Evaluation & Management Primary code
Aetna: $188.61 Optum: $138.84
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:
Office/OP consultation - moderate MDM. Time: 40 minutes. Moderate complexity consultation.
99244 primary
Moderate
Office/OP consultation - moderate MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - moderate MDM. Time: 40 minutes. Moderate complexity consultation.
Evaluation & Management Primary code
Aetna: $188.61 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 consultation - moderate MDM. Time: 40 minutes. Moderate complexity consultation.
99245 primary
High
Office/OP consultation - high MDM (55 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - high MDM. Time: 55 minutes. High complexity consultation.
Evaluation & Management Primary code
Aetna: $229.82 Optum: $180.60
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 consultation - high MDM. Time: 55 minutes. High complexity consultation.
99245 primary
High
Office/OP consultation - high MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
Per consultation - Office/OP consultation - high MDM. Time: 55 minutes. High complexity consultation.
Evaluation & Management Primary code
Aetna: $229.82 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
Frequency Note:
Office/OP consultation - high MDM. Time: 55 minutes. High complexity consultation.
99251 primary
Straightforward
Inpatient consultation - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $123.60 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
99252 primary
Straightforward
Inpatient consultation - straightforward MDM (35 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per inpatient consultation - Inpatient consultation - straightforward MDM. Time: 35 minutes. Straightforward complexity.
Evaluation & Management Primary code
Aetna: $123.60 Optum: $61.06
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:
Inpatient consultation - straightforward MDM. Time: 35 minutes. Straightforward complexity.
99253 primary
Low
Inpatient consultation - low MDM (45 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per inpatient consultation - Inpatient consultation - low MDM. Time: 45 minutes. Low complexity inpatient consult.
Evaluation & Management Primary code
Aetna: $123.60 Optum: $85.26
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:
Inpatient consultation - low MDM. Time: 45 minutes. Low complexity inpatient consult.
99254 primary
Moderate
Inpatient consultation - moderate MDM (60 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per inpatient consultation - Inpatient consultation - moderate MDM. Time: 60 minutes. Moderate complexity inpatient consult.
Evaluation & Management Primary code
Aetna: $174.41 Optum: $118.68
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:
Inpatient consultation - moderate MDM. Time: 60 minutes. Moderate complexity inpatient consult.
99255 primary
High
Inpatient consultation - high MDM (80 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per inpatient consultation - Inpatient consultation - high MDM. Time: 80 minutes. High complexity inpatient consult.
Evaluation & Management Primary code
Aetna: $209.74 Optum: $159.00
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:
Inpatient consultation - high MDM. Time: 80 minutes. High complexity inpatient consult.
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