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Effective for dates of service on or after January 1, 2020, Medicaid counseling codes have changed.
This includes counseling [provided by a licensed professional counselor (LPC); licensed clinical social worker (LCSW, formerly LMSW-ACP); or a licensed marriage and family therapist (LMFT)] and psychological services [counseling provided by a licensed specialist in school psychology (LSSP); licensed psychologist; or licensed psychiatrist].
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Service
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New Procedure Code
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Time of Service
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Daily Time LIMIT
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Individual counseling service
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96158/ UB modifier
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30 minutes/
1 unit
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30 mins./
1 unit
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Individual counseling service
(additional time on same day)
|
96159/ UB modifier
|
15 minutes/
1 unit
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30 mins. /
2 units
|
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Group counseling service
|
96164/ UB modifier
|
30 minutes/
1 unit
|
30 mins./
1 unit
|
|
Group counseling service
(additional time on same day)
|
96165/ UB modifier
|
15 minutes/
1 unit
|
30 mins./
2 units
|
|
|
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Individual psychological service
|
96158/
AH modifier
|
30 minutes/
1 unit
|
30 mins./
1 unit
|
|
Individual psychological service (additional time on same day)
|
96159/
AH modifier
|
15 minutes/
1 unit
|
30 mins. /
2 units
|
|
Group psychological service
|
96164/
AH modifier
|
30 minutes/
1 unit
|
30 mins./
1 unit
|
|
Group psychological service
(additional time on same day)
|
96165/
AH modifier
|
15 minutes/
1 unit
|
30 mins. /
2 units
|
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