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    Health Service Code 08.19M

    Second physician involved in the issuance, development and documentation of a CTO, per full 15 minutes

    NOTE:
    1. May not be claimed for travel time.
    2. The total time spent developing the CTO may be calculated on a cumulative basis over the course of several hours or several days; however, the time spent developing the CTO must be recorded on a session by session basis in the patient's record. The claim for this HSC must be made when the CTO is complete and ready for implementation.
    3. May only be claimed once per patient per year.
    4. If a CTO has been cancelled and reissued within the year, supporting text is required for payment.
    Category:V Visit
    Base rate:$46.99

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    SKLLGNMHReplace Base$46.99
    SKLLGPReplace Base$47.54
    SKLLPSYCReplace Base$61.52
    SESUSESU1 - 32For Each Call Pay Base At100%
    CALLM151 - 12For Each Call Pay Base At100%

    Governing Rules:

    • 2.3.1

      Unless otherwise specified, services that may be claimed once per year may be claimed 365 days after the previous service date or 366 days in a leap year.

    • 2.3.2

      Cumulative time is calculated by adding the total time spent delivering patient care as identified in the description of the HSC, over the course of the day (GR 1.19) and dividing the total time by the time units specified in the HSC to determine the appropriate number of calls. When the remainder of the time calculation equals less than half of one call, an additional call may not be claimed. Separate encounters may only be claimed when a special call for attendance has been made on the patient's behalf.

    • 2.3.3

      Where time is described as a full amount of minutes e.g. a full 5 minutes, the physician must spend the full amount of time stated in the HSC in order to submit a claim for the service.

    • 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.