195
Total CPT Codes
171
Primary Codes
24
Add-on Codes
0
In Calculator
Category
Code Type
99281 primary
Straightforward
Emergency department visit - minimal problem
Individual psychotherapy, 60 minutes (53+ minutes).
Per ED visit - Emergency department visit - minimal problem. No physician/QHP may be required.
Evaluation & Management Primary code
Aetna: $51.50 Optum: $10.08
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:
Emergency department visit - minimal problem. No physician/QHP may be required.
99282 primary
Straightforward
Emergency department visit - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per ED visit - Emergency department visit - straightforward MDM. Minimal complexity ED visit.
Evaluation & Management Primary code
Aetna: $51.50 Optum: $35.72
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:
Emergency department visit - straightforward MDM. Minimal complexity ED visit.
99283 primary
Low
Emergency department visit - low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per ED visit - Emergency department visit - low MDM. Low complexity ED evaluation.
Evaluation & Management Primary code
Aetna: $67.73 Optum: $61.35
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:
Emergency department visit - low MDM. Low complexity ED evaluation.
99284 primary
Moderate
Emergency department visit - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per ED visit - Emergency department visit - moderate MDM. Moderate complexity ED evaluation.
Evaluation & Management Primary code
Aetna: $124.91 Optum: $103.12
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:
Emergency department visit - moderate MDM. Moderate complexity ED evaluation.
99285 primary
High
Emergency department visit - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per ED visit - Emergency department visit - high MDM. High complexity ED evaluation.
Evaluation & Management Primary code
Aetna: $181.62 Optum: $150.07
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:
Emergency department visit - high MDM. High complexity ED evaluation.
99304 primary
Low
Initial nursing facility care - straightforward/low MDM (25 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial nursing facility care - straightforward/low MDM. Time: 25 minutes.
Evaluation & Management Primary code
Aetna: $96.43 Optum: $68.55
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:
Initial nursing facility care - straightforward/low MDM. Time: 25 minutes.
99305 primary
Moderate
Initial nursing facility care - moderate MDM (35 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial nursing facility care - moderate MDM. Time: 35 minutes.
Evaluation & Management Primary code
Aetna: $137.48 Optum: $113.49
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:
Initial nursing facility care - moderate MDM. Time: 35 minutes.
99306 primary
High
Initial nursing facility care - high MDM (45 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial nursing facility care - high MDM. Time: 45 minutes.
Evaluation & Management Primary code
Aetna: $174.00 Optum: $154.96
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:
Initial nursing facility care - high MDM. Time: 45 minutes.
99307 primary
Straightforward
Subsequent nursing facility care - straightforward MDM (10 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent nursing facility care - straightforward MDM. Time: 10 minutes.
Evaluation & Management Primary code
Aetna: $46.02 Optum: $33.70
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:
Subsequent nursing facility care - straightforward MDM. Time: 10 minutes.
99308 primary
Low
Subsequent nursing facility care - low MDM (15 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent nursing facility care - low MDM. Time: 15 minutes.
Evaluation & Management Primary code
Aetna: $71.10 Optum: $63.37
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:
Subsequent nursing facility care - low MDM. Time: 15 minutes.
99309 primary
Moderate
Subsequent nursing facility care - moderate MDM (30 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent nursing facility care - moderate MDM. Time: 30 minutes.
Evaluation & Management Primary code
Aetna: $93.51 Optum: $90.73
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:
Subsequent nursing facility care - moderate MDM. Time: 30 minutes.
99310 primary
High
Subsequent nursing facility care - high MDM (45 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent nursing facility care - high MDM. Time: 45 minutes.
Evaluation & Management Primary code
Aetna: $139.27 Optum: $130.48
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:
Subsequent nursing facility care - high MDM. Time: 45 minutes.
99315 primary
Moderate
Nursing facility discharge management - 30 min or less
Individual psychotherapy, 60 minutes (53+ minutes).
Per discharge - Nursing facility discharge management - 30 minutes or less.
Evaluation & Management Primary code
Aetna: $75.59 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:
Nursing facility discharge management - 30 minutes or less.
99316 primary
Moderate
Nursing facility discharge management - more than 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Per discharge - Nursing facility discharge management - more than 30 minutes.
Evaluation & Management Primary code
Aetna: $108.36 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:
Nursing facility discharge management - more than 30 minutes.
99318 primary
Moderate
Annual nursing facility assessment
Individual psychotherapy, 60 minutes (53+ minutes).
Annually - Annual nursing facility assessment. Comprehensive annual evaluation.
Evaluation & Management Primary code
Aetna: $99.18 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:
Annual nursing facility assessment. Comprehensive annual evaluation.
99324 primary
Straightforward
Home visit new patient - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $57.61 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
99325 primary
Low
Home visit new patient - low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $83.85 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
99326 primary
Moderate
Home visit new patient - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $144.30 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
99327 primary
High
Home visit new patient - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $192.67 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
99328 primary
High
Home visit new patient - high MDM comprehensive
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $223.81 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
Encounter Calculator
Aetna
Optum

No codes added yet

AI Assistant Gemini
Hello! Ask me about CPT codes, billing rules, or MDM levels for PMHNP in Louisiana.