Fee Navigator®

    Health Service Code 08.19GB

    Direct contact with a complex patient for psychiatric treatment (including medical psychotherapy and medication prescription), psychiatric reassessment, patient education and/or psychiatric counseling, per 15 minutes or major portion thereof

    1. May only be claimed by a psychiatrist or a generalist in mental health.
    2. May only be claimed when the patient meets the criteria outlined in note 3 and the score is identified in the patient's chart at least once every six months.
    3. Complex patient is defined as: a. An adult with a Global Assessment of Function (GAF) score of 40 or less. b. A child with a Children's Global Assessment of Function (CGAS) score of 41 or less.
    4. May not be claimed at the same encounter as HSCs 08.11A, 08.11C, 08.19A, 08.19AA, 08.19AZ, 08.19B, 08.19BB, 08.19C or 08.19CC.
    Category:V Visit
    Base rate:$47.90

    AMA billing tips:

    • The time claimed for 08.19GA/08.19GB is ONLY the face-to-face time with the patient. Time spent on charting or other patient management services MAY NOT be claimed in the total time for the 08.19GA/08.19GB.

      When claiming for one call of psychotherapy a minimum of 8 minutes MUST be spent. If more than one call is submitted, each unit must represent 15 minutes with the balance of the minutes being 8 or more in order to submit a claim for an additional call

      When claiming for time based codes and modifiers, be sure that the total time claimed for the day doesn't' exceed the actual time spent. For example, you spent a total of 6 hours of face to face time for 08.19GA/GB, you may only submit claims for 6 hours worth of time.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLGNMHReplace Base$47.90
    SKLLPSYCReplace Base$66.62
    SESUSESU1 - 32For Each Call Pay Base At100%
    CALLM151 - 12For Each Call Pay Base At100%
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 4.11.1

      A physician may submit claims for group psychotherapy, psychiatric management and/or indirect services for the same patient on the same day.

    • 4.11.2

      Psychotherapy or psychiatric management claims for time units may be submitted for separate encounters for the same patient on the same day.