Sexual Abuse Case Management

General Behavioral Health Integration Care Management services (billable as CPT 99484) provided to individuals who have been sexually assaulted will now be eligible for reimbursement effective January 1, 2019 under HMSA commercial and QUEST Integration plans.

CPT code 99484 is defined as follows:

At least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

• Initial assessment or follow-up monitoring, including the use of applicable validated rating scales;
• Behavioral health care planning in relation to behavioral / psychiatric health problems including revision for patients who are not progressing or whose status changes;
• Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and
• Continuity of care with a designated member of the care team.

Billing Guidelines for Reimbursement

• Use CPT 99484 for patients receiving case management services who have been sexually assaulted.
• You may bill CPT 99484 once per calendar month, per patient.
• Use the most appropriate ICD-10-CM code from the following list:
  • T74.21XA thru T74.22XS [Sexual abuse, confirmed]
  • T76.21XA thru T76.22XS [Sexual abuse, suspected]
  • O9A.411 thru O9A4.19 [Sexual abuse complicating pregnancy]
  • O9A.42 [Sexual abuse complicating childbirth]
  • O9A.43 [Sexual abuse complicating the puerperium]
  • Z91.410 [Personal history of adult physical and sexual abuse]
• The patients behavioral health benefit will apply.
• Provider specialties eligible for reimbursement are: Psychiatry, Child Psychiatry, Psychology, Clinical Social Worker, Licensed Mental Health Counselor, Marriage and Family Therapist, Advanced Practice Registered Nurse, Physician Assistant, General Practice, Family Medicine, Internal Medicine, Emergency Medicine, Obstetrics and Gynecology, Pediatrics, Pediatric Oncology and Pediatric Specialist.

Note:

General behavioral health integration care management services billed under CPT 99484 for any other condition will continue to be integral with no additional reimbursement under HMSA commercial and QUEST Integration plans.

Revision History