The Most Common MSP Billing Codes for Mental Health Care

In British Columbia, family physicians provide the majority of mental health care services. With the challenges and difficulties brought on by the COVID-19 pandemic, physicians are becoming overwhelmed with increasing mental health visits and understanding how to bill them. This post breaks down the most common MSP billing codes to help physicians bill for mental health care visits. 

We have broken down the post into four sections: 

  1. MSP Billing Codes for Counselling 
  2. Mental Health Planning Fee 
  3. Mental Health Management Fees 
  4. Eligible Diagnoses and ICD-9 Codes 

1. MSP Billing Codes for Counselling  

Physicians can deliver counselling via Telehealth or in-person visits. Fee codes are billed for any general counselling provided by the physicians, including conversations relating to a patient’s mental health. 

Please note: As a general practitioner, you will be mainly using the counselling codes for billing your mental health visits. If you are a specialist or are receiving referrals from other doctors, you should bill the Telehealth consultation fee codes. 

Temporary Telehealth Counselling Billing Codes  

On June 1, 2020, the Ministry introduced six temporary Telehealth fee codes that can be used for billing counselling services. These visits can be done via phone or videoconferencing. The Provincial Health Officer will determine the cancellation date. 

Fee Code Description Value  
T13238 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 0-1) $62.05 
T13438 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 2-49) $56.41 
T13538 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 50-59) $62.05 
T13638 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 60-69) $64.86 
T13738 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 70-79) $73.32 
T13838 Telehealth FP Individual counselling for a prolonged visit for counselling (minimum time per visit – 20 minutes) (age 80+) $84.60 

Notes: 

  • MSP will pay for up to four (4) individual counselling visits (any combination of age-appropriate in-office, out of office, and Telehealth) per patient per year.  
  • Start and end times must be entered into both the billing claims and the patient’s chart.  
  • Documentation of the effect(s) of the condition on the patient and what advice or service was provided is required. 

If you would like to learn more about the MSP Telehealth codes, read our full blog here

In-Office Counselling Billing Codes  

Six codes can be billed for in-office counselling. The fee codes are time-based, with a minimum time required of 20 minutes. 

Fee Code  Description Value 
12120 Individual counselling – in office (age 0-1) $62.05 
00120  Individual counselling – in office (age 2-49) $56.41 
15320 Individual counselling – in office (age 50-59) $62.05 
16120 Individual counselling – in office (age 60-69) $64.86 
17120 Individual counselling – in office (age 70-79) $73.32  
18120 Individual counselling – in office (age 80+) $84.60 

Notes:  

  • MSP will pay for up to four (4) such visits per patient per year.  
  • Items 12120, 00120, 15320, 16120, 17120, and 18120 are subject to the daily volume payment rules.  

2. Mental Health Planning Fee 

The mental health planning fee is the completion and documentation of a care plan for patients with a confirmed eligible mental health diagnosis warranting the development of a care plan. This code can be billed after the four MSP counselling fees (any combination of age-appropriate 00120 or telehealth counselling codes) have been paid in the same calendar year. This fee code is time-based with a minimum required time of 30 minutes for total planning.  

Patient Eligibility: 

  • Eligible patients must be living at home or in assisted living. 
  • Patients in Acute and Long-Term Care Facilities are not eligible. 
Fee Codes Description Value 
14043  Mental Health Planning Fee  $100 

Notes:  

  • Payable to the family physician who is most responsible for the majority of the patient’s longitudinal care and who has successfully submitted and met the requirements for PG14070 in the same calendar year. 
  • Payable once per calendar year per patient. They are not intended as a routine annual fee.  
  • Chart documentation must include 
    • The care plan;
    • Total planning time (minimum 30 minutes); and
    • Physician face-to-face planning time (minimum 16 minutes).

3. Mental Health Management Fees 

Five mental health management fee codes are payable for prolonged counselling with patients on whom a Mental Health Planning fee (14043) has been successfully billed. The fee code is time-based, with a minimum time required of 20 minutes. 

Fee Codes  Description Value 
14044 Mental Health Management Fee (age 2-49) $56.41 
14045 Mental Health Management Fee (age 50-59) $62.05 
14046 Mental Health Management Fee (age 60-69) $64.86 
14047 Mental Health Management Fee (age 70-79) $73.32 
14048 Mental Health Management Fee (age 80+) $84.60 

Notes: 

  • Payable a maximum of 4 times per calendar year per patient.  
  • Counselling may be provided face-to-face or videoconferencing. 
  • Not payable unless the four age-appropriate 00120 or telehealth counselling (13018, 13038) fees have already been paid in the same calendar year in any combination. 

4. Eligible Diagnoses and ICD-9 Codes 

In addition to submitting the claims for the mental health planning fee and the management fees, physicians must also document the diagnostic code (ICD-9 code) related to the patient. 

Category

Diagnosis

ICD-9

Anxiety Disorders

Anxiety Disorders

300, 308, 50B

Bipolar and Related Disorders

Bipolar

296

Cyclothymia

301.13

Depressive Disorders

Depressive Disorders

311

Dissociative Disorders

Dissociative Disorders

300

Eating Disorders

Eating Disorders

307, 307.1

Gender Dysphoria

Gender Dysphoria

302

Impulse Control Disorders

Impulse Control Disorders

312

Neurocognitive Disorders

Delirium

293

Dementia

290, 331, 331.0, 331.2

Neurodevelopmental Disorders

Attention Deficit Disorder

314

Autism Spectrum Disorder

299.0

Pervasive Development Disorder

299.0

Obsessive-Compulsive & Related Disorders

Obsessive-Compulsive Disorder

300

Body Dysmorphic Disorder

300.7

Schizophrenia and other Psychotic Disorders

Schizophrenia and other Psychotic Disorders

293, 295, 297, 298

Sexual Dysfunction

Sexual Dysfunction

302

Sleep Disorders

Sleep Wake Disorders: Insomnia/Hypersomnolence, Narcolepsy

307.4, 347

Parasomnias

307.4

Breathing-Related Sleep Disorders

780.5

Somatic Symptom & Related Disorders

Factitious Disorder

300, 312

Pain Disorder with Affective Symptoms

338

Somatic Symptom Disorder

300.8

Conversion Disorder

300.1

Substance Use Disorders

Substance Use Disorder: Alcohol

303

Substance Use Disorders: Drugs

304

Trauma and stressor-related Disorders

Adjustment Disorders

309

Post-Traumatic Stress Disorder

309

Notes:  

  • When entering the diagnostic codes into the claim record, be sure to left justify the code without the decimal point but including leading zeros and blank fill the remaining spaces. Decimal points and other special characters are not recognized by the Telepan system and cause claims to be rejected. 

We have created a quick reference guide for the mental health billing codes. You can download it here

Need further assistance with billing for mental health visits? We can help! 

 

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