Wisconsin Medicaid Maximum Allowable Fee Schedule for Outpatient Mental Health and Substance Abuse Services in the Home or Community for Adults

Wisconsin Medicaid-certified providers will be reimbursed the rates listed on this schedule for covered services provided to eligible recipients.

This maximum allowable fee schedule contains the following information:

Procedure Code The procedure code recognized by Wisconsin Medicaid to identify the service provided.
Description An abbreviated description of the procedure code.
Contracted Rate The uniform rate determined by the Division of Health Care Financing (DHCF). For medication management (90862), this is the rate for 15 minutes.
Reimbursement (federal share) The federal share of the contracted rate. This is the amount paid per unit by Wisconsin Medicaid.
Benchmark Covered Service Y/N indicator of whether or not the procedure is covered by the BadgerCare Plus Benchmark Plan.

The fee schedule does not address the various coverage limitations routinely applied by Wisconsin Medicaid before final payment is determined (e.g., recipient and provider eligibility, billing instructions, frequency of services, third-party liability, copayment, age restrictions, and prior authorization).

The preceding information is intended to help providers understand the Wisconsin Medicaid fee schedule. For questions about the fee schedule, providers should contact Provider Services at (800) 947-9627 or (608) 221-9883. For questions about rates, providers should contact the DHCF by writing to the following address:

Policy Analyst
Division of Health Care Financing
Mental Health and Substance Abuse Services
PO Box 309
Madison WI 53701-0309

Wisconsin Medicaid Maximum Allowable Fee Schedule for Outpatient Mental Health and
Substance Abuse Services in the Home or Community for Adults

Procedure Code

Procedure Code Description

Modifier and Description

Contracted Rate*

Reimbursement (Federal Share) Paid Through 9/30/07

Reimbursement (Federal Share) Paid on and After 10/1/07

Benchmark Covered Service

90801

 Psychiatric diagnostic interview examination
(quantity of 1 = 1 hour)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90802

 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication
(quantity of 1 = 1 hour)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90804

 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$75.02

$43.11

$43.23

 N

HP — Doctoral level

$56.27

$32.34

$32.42

 N

HO — Masters degree level

$45.02

$25.87

$25.94

 N

90805

 with medical evaluation and management services

UA — MD, Psychiatrist

$75.02

$43.11

$43.23

 N

90806

 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90807

 with medical evaluation and management services

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

90808

 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$225.06

$129.34

$129.68

 N

HP — Doctoral level

$168.80

$97.01

$97.26

 N

HO — Masters degree level

$135.06

$77.62

$77.82

 N

90809

 with medical evaluation and management services

UA — MD, Psychiatrist

$225.06

$129.34

$129.68

 N

90810

 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$75.02

$43.11

$43.23

 N

HP — Doctoral level

$56.27

$32.34

$32.42

 N

HO — Masters degree level

$45.02

$25.87

$25.94

 N

90811

 with medical evaluation and management services

UA — MD, Psychiatrist

$75.02

$43.11

$43.23

 N

90812

 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90813

with medical evaluation and management services

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

90814

 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient;

UA — MD, Psychiatrist

$225.06

$129.34

$129.68

 N

HP — Doctoral level

$168.80

$97.01

$97.26

 N

HO — Masters degree level

$135.06

$77.62

$77.82

 N

90815

with medical evaluation and management services

UA — MD, Psychiatrist

$225.06

$129.34

$129.68

 N

90845

 Psychoanalysis
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90846

 Family psychotherapy (without the patient present)
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90847

 Family psychotherapy (conjoint psychotherapy) (with patient present)
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90849

 Multiple-family group psychotherapy
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90853

 Group psychotherapy (other than of a multiple-family group)
(quantity of 1.0 = 60 minutes)

UA — MD, Psychiatrist

$37.51

$21.56

$21.61

 N

HP — Doctoral level

$28.11

$16.15

$16.20

 N

HO — Masters degree level

$22.51

$12.94

$12.97

 N

90857

 Interactive group psychotherapy
(quantity of 1.0 = 60 minutes)

UA — MD, Psychiatrist

$37.51

$21.56

$21.61

 N

HP — Doctoral level

$28.11

$16.15

$16.20

 N

HO — Masters degree level

$22.51

$12.94

$12.97

 N

90862

 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
(quantity of 1.0 = 15 minutes)

UA — MD, Psychiatrist

$37.51

$21.56

$21.61

 N

UB — Advanced Practice Nurse Prescriber with mental health specialty

$37.51

$21.56

$21.61

 N

HO — Masters degree level

$22.52

$12.94

$12.98

 N

90875

 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes

UA — MD, Psychiatrist

$75.02

$43.11

$43.23

 N

HP — Doctoral level

$56.27

$32.34

$32.42

 N

HO — Masters degree level

$45.02

$25.87

$25.94

 N

90876

approximately 45-50 minutes

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90880

Hypnotherapy
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90887

 Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

90899

 Unlisted psychiatric service or procedure
(quantity of 1 = 60 minutes)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

H0005

 Alcohol and/or drug services; group counseling by a clinician

UA — MD, Psychiatrist

$37.51

$21.56

$21.61

 N

HP — Doctoral level

$28.11

$16.15

$16.20

 N

HO — Masters degree level

$22.51

$12.94

$12.97

 N

HN — Bachelors degree level

$15.01

$8.63

$8.65

 N

H0022

 Alcohol and/or drug intervention service (planned facilitation)

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

HN — Bachelors degree level

$60.00

$34.48

$34.57

 N

T1006

 Alcohol and/or substance abuse services, family/couple counseling

UA — MD, Psychiatrist

$150.04

$86.23

$86.45

 N

HP — Doctoral level

$112.53

$64.67

$64.84

 N

HO — Masters degree level

$90.04

$51.75

$51.88

 N

HN — Bachelors degree level

$60.00

$34.48

$34.57

 N
* Contracted rates are effective for dates of service on and after October 1, 2003.