Medication management uses E/M codes 99213-99215, not therapy codes. E/M level depends on complexity and medical decision-making, not session length. Time spent on medication discussion counts toward E/M level determination. When therapy and medication management occur on the same visit, use modifier 25 on the E/M to indicate a distinct service separate from therapy code. E/M codes bill at higher rates than therapy codes in most practices.
Never bill medication management as therapy code (90834, 90837). Always use E/M codes 99213-99215. Select E/M level based on complexity: 99213 for straightforward medication checks, 99214 for moderate complexity with dosage adjustments, 99215 for high complexity with multiple medications or significant clinical changes. Document medications reviewed, changes made, side effects assessed, and clinical rationale. If therapy and medication management both occur same visit, bill both codes with modifier 25 on the E/M.
Most payers do not require prior authorization for E/M-based medication management. Frequency limits vary; some payers allow monthly medication checks without restriction. Controlled substance prescribing (stimulants, benzodiazepines) requires parity with non-psychiatric practices. Some state Medicaid programs restrict frequency of psychiatric medication management visits. Verify payer policy before establishing medication management schedules.
Use modifier 25 on the E/M code when therapy and medication management are billed on the same date. Modifier 95 indicates telehealth E/M. Modifier 93 indicates audio-only where allowed. Do not bill E/M and psychiatric evaluation codes on the same date without modifier 25 on one of them. E/M time spent on medication management counts separately from therapy time in determining E/M level.
List all current psychiatric medications with dosages and frequencies. Document medications reviewed, side effects assessed, therapeutic response, and any medication changes. Include clinical rationale for dosage adjustments, new medications, or discontinuations. Document patient adherence to medication regimen. Note patient's subjective response (symptom improvement, side effects, functional changes). Include assessment of mental status and current symptoms.
Medication management uses E/M codes 99213 (low complexity), 99214 (moderate), or 99215 (high). Never use therapy codes for medication-only visits.
Yes. Use modifier 25 on the E/M code to indicate a distinct service separate from the therapy code. Time spent on medications counts toward E/M level, not therapy code.
E/M level is based on complexity and medical decision-making. Time spent on medication review, side effect assessment, and dosage adjustment contributes to overall visit complexity.
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