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  • Claims > Adolescent Mental Health Checkup Reimbursement

    Providers will be reimbursed for administering a mental health checkup during a well-child exam or a routine office visit by using the codes noted in the chart below. The codes must indicate that a separately identifiable evaluation and management service was performed.

    Reimbursement Codes* for All EmblemHealth Networks and Plans
    Well-Child Visit Reimbursement Codes for Mental Health Screening
    CPT Codes for
    Well-Child Visit
    CPT Codes
    (E/M Codes
    Based on Time)
    Modifier Developmental Screening Code ICD Codes


    5-11 est. patient


    5 minutes,
    est. patient


    Note - Modifier 25 should append the E/M codes and not the developmental screening code.


    V20.2 - well-child/ preventive health visits

    V79.8 - special screening exam for mental disorders and developmental handicaps (negative screening

    V40.0 - mental and behavioral health problems (positive screening)


    12-17 est. patient


    10 minutes,
    est. patient


    18 + est. patient


    15 minutes,
    est. patient


    5-11 new patient


    25 minutes,
    est. patient


    12-17 new patient


    40 minutes,
    est. patient


    18 + new patient


    10 minutes,
    new patient

    These well-child codes may be used in conjunction with mental health screenings.


    20 minutes,
    new patient


    30 minutes,
    new patient


    45 minutes,
    new patient


    60 minutes,
    new patient

    *Providers must refer to their provider contract for office visit reimbursement rates.

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    Glossary terms found on this page:

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

    A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.


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