195
Total CPT Codes
171
Primary Codes
24
Add-on Codes
0
In Calculator
Category
Code Type
99334 primary
Straightforward
Home visit established - straightforward MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $62.72 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
99335 primary
Low
Home visit established - low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $98.11 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
99336 primary
Moderate
Home visit established - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $138.26 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
99337 primary
High
Home visit established - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $199.70 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
99341 primary
Straightforward
Home visit new patient - straightforward MDM (15 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit new patient - straightforward MDM. Time: 15 minutes.
Evaluation & Management Primary code
Aetna: $57.25 Optum: $41.48
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:
Home visit new patient - straightforward MDM. Time: 15 minutes.
99342 primary
Low
Home visit new patient - low MDM (30 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit new patient - low MDM. Time: 30 minutes.
Evaluation & Management Primary code
Aetna: $82.83 Optum: $66.25
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:
Home visit new patient - low MDM. Time: 30 minutes.
99343 primary
Moderate
Home visit new patient - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $135.31 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
99344 primary
High
Home visit new patient - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $188.63 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
99345 primary
High
Home visit new patient - high MDM comprehensive
Individual psychotherapy, 60 minutes (53+ minutes).
Evaluation & Management Primary code
Aetna: $227.38 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
99347 primary
Straightforward
Home visit established - straightforward MDM (20 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit established - straightforward MDM. Time: 20 minutes.
Evaluation & Management Primary code
Aetna: $57.60 Optum: $38.02
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:
Home visit established - straightforward MDM. Time: 20 minutes.
99348 primary
Low
Home visit established - low MDM (30 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit established - low MDM. Time: 30 minutes.
Evaluation & Management Primary code
Aetna: $87.14 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:
Home visit established - low MDM. Time: 30 minutes.
99349 primary
Moderate
Home visit established - moderate MDM (40 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit established - moderate MDM. Time: 40 minutes.
Evaluation & Management Primary code
Aetna: $131.65 Optum: $108.59
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:
Home visit established - moderate MDM. Time: 40 minutes.
99350 primary
High
Home visit established - high MDM (60 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per home visit episode - Home visit established - high MDM. Time: 60 minutes. Comprehensive home assessment.
Evaluation & Management Primary code
Aetna: $183.86 Optum: $158.42
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:
Home visit established - high MDM. Time: 60 minutes. Comprehensive home assessment.
99408 primary
Low
Alcohol/SA screening & brief intervention 15-30 min
Individual psychotherapy, 60 minutes (53+ minutes).
1 per screening episode - Alcohol/SA screening & brief intervention 15-30 minutes. Structured screening tool required.
Care Management Primary code
Aetna: $36.92 Optum: $29.67
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:
Alcohol/SA screening & brief intervention 15-30 minutes. Structured screening tool required.
99408 primary
Low
Alcohol/SA screening & brief intervention (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per screening episode - Alcohol/SA screening & brief intervention 15-30 minutes. Structured screening tool required.
Care Management Primary code
Aetna: $36.92 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:
Alcohol/SA screening & brief intervention 15-30 minutes. Structured screening tool required.
99409 primary
Moderate
Alcohol/SA screening & brief intervention >30 min
Individual psychotherapy, 60 minutes (53+ minutes).
1 per intervention episode - Alcohol/SA screening & brief intervention >30 minutes. Extended intervention with motivational interviewing.
Care Management Primary code
Aetna: $71.96 Optum: $56.75
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:
Alcohol/SA screening & brief intervention >30 minutes. Extended intervention with motivational interviewing.
99409 primary
Moderate
Alcohol/SA screening & brief intervention >30 min (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per intervention episode - Alcohol/SA screening & brief intervention >30 minutes. Extended intervention with motivational interviewing.
Care Management Primary code
Aetna: $71.96 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:
Alcohol/SA screening & brief intervention >30 minutes. Extended intervention with motivational interviewing.
99415 primary
N/A
Prolonged clinical staff service first hour
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per hour - Prolonged clinical staff service first hour. Direct patient contact with physician supervision.
Prolonged Services Primary code
Aetna: $0.00 Optum: $16.13
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:
Prolonged clinical staff service first hour. Direct patient contact with physician supervision.
99416 add‑on
N/A
Prolonged clinical staff service each additional 30 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per 30 minutes - Prolonged clinical staff service each additional 30 minutes. Add-on to 99415.
Prolonged Services Add-on code
Aetna: $0.00 Optum: $7.49
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:
Prolonged clinical staff service each additional 30 minutes. Add-on to 99415.
99417 primary
N/A
Prolonged outpatient E/M service each 15 min
Individual psychotherapy, 60 minutes (53+ minutes).
Add-on per 15 minutes - Prolonged outpatient E/M service each 15 minutes. Beyond primary service time.
Prolonged Services Primary code
Aetna: $0.00 Optum: $26.50
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:
Prolonged outpatient E/M service each 15 minutes. Beyond primary service time.
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