1. Chapter 538 School- Based Health Services
Psychological Services
August 2019

2. Medicaid procedure code changes Effective August 1, 2019
90791 – Telehealth is now available for this code. Must use a GT modifier when billing, if telehealth was used.
96101 was replaced The new codes are : 96130, 96131, 96136, and 96137
96130 Psychological testing – 2 units per calendar year, 60- minute unit
96131 Psychological Testing; additional hour – 4 units per calendar year, 60- minute units. * Can only be used if billed with 96130*
96136 Test Administration and scoring - 1 unit per calendar year, minute units.
96137 Test Administration and scoring; additional 30 minutes- 4 units per calendar year, 30-minute units.

3. Medicaid procedure code changes continued
Example of how the new codes could be used:
unit (60 minutes)
units (120 minutes)
unit (30 minutes, can only use once, 1 unit max)
units (60 minutes)
However this is ONLY a suggestion. If you need more time on or 96131, the units are there to use. Also if additional time was used on scoring, has a max of 4 units.

4. Medicaid procedure code changes continued
90832 Units increased to 20 per calendar year
90834 Units increased to 20 per calendar year
90837 units increased to 20 per calendar year
90846 units increased to 20 per calendar year
90847 units increased to 20 per calendar year
90853 units increased to 20 per calendar year
All of these codes are also available as Telehealth. If billing telehealth, you must use the GT modifier on your billing to signify it was completed via telehealth.

5. Billing Form Medicaid Number Last Name First Name WVEIS Number
WVEIS Number
Date of Birth
Provider Name
County
School
Month/Year

6. Billing Form Suzanne Smith Medicaid Number Last Name First Name 
Doe
Aubrey
WVEIS Number
Date of Birth
Provider Name
Suzanne Smith
County
School
Month/Year
59 
501
Sept/2019

7. Diagnosis Codes
Enter the Psychological specific ICD 10 Diagnosis Codes on the form starting with box number one.
Enter the codes that are directly associated with the therapy sessions and/or assessments.

8. LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES
ICD 10 Diagnosis Codes
LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1. 2. 3. 4. 5. 6.

9. LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES
ICD 10 Diagnosis Codes
LIST ALL DIAGNOSIS CODES RELATED TO PSYCHOLOGICAL SERVICES 1.
F90.0 2.
F91.1 3. 4. 5. 6.

10. Procedure codes School Based Psychological Services Procedure
Service Unit
Psychiatric Diagnostic Evaluation (No Medical Services)
90791
An integrated bio-psychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.
2 events per calendar year
Event= Completed evaluation
Psychological Testing, Administration and Scoring
96130
Psychological Testing Includes
Integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment of planning and report and interactive feedback to the patient, family member (s) or caregiver(s); First Hour
2 units per calendar year
60-minute unit
96131
Psychological Testing:
Testing and evaluation by professional; Additional Hour
4 units per calendar year
* MUST USE to be able to bill for 96131
96136
Test Administration and Scoring:
First 30 minutes
1 unit per calendar year
30- minute unit
96137
Additional 30 minutes
30-minute unit
96110
Developmental Testing:
Limited to developmental testing with interpretation and report
2 events per calendar year.
Psychotherapy Services
90832
Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.
1 unit per minutes
20 units per calendar year
90834
1 unit per minutes
90837
1 unit per 53 or more minutes
Family Psychotherapy
90846
Family Psychotherapy (without the patent present)
Psychotherapy is the treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development
1 unit per minutes
90847
Family Psychotherapy (with the patient present)
Group Psychotherapy
90853
Group psychotherapy is treatment of mental illness and behavioral disturbances in which the psychologist through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patters of behavior, and encourage personality growth and development.
1 unit per 60 minutes
Maximum limit of 12 individuals in a group setting
Psychotherapy for Crisis
90839
4 per calendar year
90840
Additional 30 Minutes of psychotherapy for crisis, used in conjunction with 90839
1 unit per 30 minutes after the initial 60 minutes from 90839

11. Enter Claim Documentation
Use the procedure codes and caps to complete the claim documentation section of the billing form.
In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.)
Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2)
Column three - enter the CPT code including a GT modifier if being provided by telehealth.
Columns four and five - enter the start and end time.
In the last column enter the total number of units or event(s).

12. List Diagnosis Code Number(s)
Claim Documentation
Service Date
List Diagnosis Code Number(s)
Procedure code
Start Time
End Time
Units/Event

13. List Diagnosis Code Number(s)
Claim Documentation
Service Date
List Diagnosis Code Number(s)
Procedure code
Start Time
End Time
Units/Event 1
96130
9:00
10:00  
96131
12:00 2
96136
1:30
2:00  
96137
3:00    2
90583
1:00

14. Signature and Credentials
_____________________ ______________ Signature/Credentials Date

15. Kelley Johnson – Coordinator Office of Special Education kelley
Kelley Johnson – Coordinator Office of Special Education ext WVDE Medicaid Website: