PA Lookup

If you have questions about prior authorizations, please call:

Member and Recipient Service Line: 1-877-685-2415

Provider Support Service Line: 1-855-250-1539

Filter By:
Clear Filters
12437 Results

Evaluation & Management

Service Code
99342 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99342 (CPT) Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordinati
Prior Authorization Required
No
Telehealth Billable
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99343 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99344 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99344 (CPT) Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with oth
Prior Authorization Required
No
Telehealth Billable
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99345 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99345 (CPT) Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other p
Prior Authorization Required
No
Telehealth Billable
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99346 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
No
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99347 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

Other Information

Modifier(s):

GT: Telehealth

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99347 (CPT) Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coor
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 1H

Service Code
99347 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99348 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

Other Information

Modifier(s):

GT: Telehealth

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99348 (CPT) Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity.
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 1H

Service Code
99348 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99349 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

Other Information

Modifier(s):

GT: Telehealth

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99349 (CPT) Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordinatio
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 1H

Service Code
99349 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99350 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
State-funded
Age Group
All
Diagnosis Group
Mental Health

Evaluation and Management services provided by a Psychiatrist / MD or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One CPT code = 1 unit of service.

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. State funds will not cover the same services provided by the same or different attending provider on the same day for the same individual
  • 3. Only 1 psychiatric CPT code from the State-Funded Outpatient Behavioral Health Services policy is allowed per individual per day of service from the same attending provider. Only 2 psychiatric CPT codes from this policy are allowed per individual per date of service.
  • 4. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 5. The provider will communicate and coordinate care with other professionals providing care to the recipient.
  • 6. Telehealth, Virtual Communication, and Hybrid Telehealth services must follow the guidelines and requirements detailed in the State-Funded Telehealth and Virtual Services service definition.

Other Information

Modifier(s):

GT: Telehealth

How to Submit

N/A - No authorization is required

Resources

Evaluation & Management

Service Code
99350 (CPT) Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling
Prior Authorization Required
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Intellectual/ Developmental Disability, Mental Health, Substance Use

Evaluation and Management provided by a Psychiatrist / MD/ DO or a Psych NP/PA.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Unit Value

One service code = 1 unit of service

Limits

  • 1. Outpatient BH does not cover: a) sleep therapy for psychiatric disorders; b) medical, cognitive, intellectual or development issue that would not benefit from outpatient treatment services, OR; c) when the focus of treatment does not address the symptoms of the diagnosis.
  • 2. Members w/ both MCD and Medicare, the provider shall bill Medicare as primary before submitting a claim to MCD. For members having both MCD and any other insurance coverage, the other insurance shall be billed prior to billing MCD. MCD is the payor of last resort.
  • 3. Physicians billing E/M codes with psychotherapy add-on codes must have documentation supporting that the E/M service was separate and distinct from the psychotherapy service.
  • 4. The provider will communicate and coordinate care with other professionals providing care to the member.

How to Submit

N/A - No authorization is required

Resources

Clinical Coverage Policy No. 1H

Service Code
99350 (CPT) Evaluation & Management
Prior Authorization Required
No
Telephonic Billable
No
Telehealth Billable
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Resources