CPT Coding for Follow-Up MAT Patients in Psychiatry
For follow-up Medication-Assisted Treatment (MAT) patients in psychiatry, use CPT codes 99212-99215 for established patient office visits, with the specific code level determined by the complexity of medical decision-making and time spent. 1
Primary CPT Codes for MAT Follow-Up Visits
The appropriate established patient office visit codes for MAT follow-up in psychiatry include: 1
- 99212: Straightforward medical decision-making or 10-19 minutes
- 99213: Low complexity medical decision-making or 20-29 minutes
- 99214: Moderate complexity medical decision-making or 30-39 minutes (detailed evaluation)
- 99215: High complexity medical decision-making or 40-54 minutes (comprehensive evaluation)
For visits involving primarily counseling and coordination of care where more than half the time is spent on these activities, time becomes the controlling factor for code selection. 1
Additional Psychiatric-Specific Codes
Beyond standard E/M codes, psychiatrists treating MAT patients can bill for specific psychiatric services: 1
- 90832-90838: Individual psychotherapy codes (with or without E/M services)
- 90863: Pharmacologic management (though this code is being phased out in favor of integrated E/M codes)
The psychotherapy codes can be billed separately or as add-on codes to the E/M visit, depending on whether distinct psychotherapy was provided beyond medication management. 1
Telemedicine Modifier
If providing MAT follow-up via telemedicine, append modifier "95" to the CPT code to indicate services were delivered through interactive audio-video telecommunications. 1 This modifier is required for reimbursement and can only be used with real-time, synchronous communication—not asynchronous "store and forward" technology. 1
Common Pitfalls in MAT Coding
Undercoding is extremely common in primary care and psychiatry settings, with studies showing that 72% of visits coded as 99213 could have been billed at higher levels. 2 This occurs more frequently with resident physicians but affects faculty as well. 2
To avoid undercoding for MAT follow-up visits:
- Document the complexity of managing opioid use disorder, including assessment of withdrawal symptoms, medication adjustments, monitoring for diversion, coordination with behavioral health providers, and addressing comorbid psychiatric conditions 3, 4
- Count time spent on counseling and care coordination, as MAT inherently involves substantial counseling about medication adherence, side effects, and recovery support 3
- Consider 99214 as the baseline for most MAT follow-ups given the moderate complexity of managing controlled substances and monitoring for substance use 4, 2
Documentation Requirements
For proper reimbursement, documentation must support the code level selected: 1
- Medical decision-making complexity is determined by the number of diagnoses/management options, amount of data reviewed, and risk of complications
- Time-based coding requires documentation of total face-to-face time and that more than 50% was spent on counseling/coordination
- MAT-specific elements to document include urine drug screening results, prescription drug monitoring program checks, assessment of diversion risk, and coordination with addiction counselors 3, 4
Billing Considerations for Integrated Care
MAT in primary care or psychiatry typically involves multidisciplinary teams with nurses, pharmacists, or care managers providing support services. 4 While these team members cannot bill independently for MAT services without appropriate credentials, their work supports higher-level physician billing when properly supervised and documented. 4
Federal law mandates that psychotherapy services be available to patients receiving MAT, though the prescribing clinician need not provide it directly. 3 If referring for separate psychotherapy, this does not affect the E/M code selection for the medication management visit. 3