Wiki 96202 & 96203

lori.l.thompson@state.or.us

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Local Chapter Officer
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Good afternoon.
I am curious to CPT codes 96202 & 96203. These codes are for Caregiver Behavior Management Training. I am working to help develop a Social-Emotional Health Metric. With the ages of patients on this metric which is ages 0-6 would this code even be used? Currently it isn't and I believe in the work we do. I believe our state covers this code but its not being utilized.

It states on the AAPC Website that
96202:
The provider trains multiple sets of parents, guardians, and caregivers without patients present. The provider covers areas such as how to create an environment that supports desired behaviors and adherence to the patient’s plan of care while reducing the negative impacts of the patient’s diagnosis on their daily life. A physician or other qualified healthcare provider administers the training, which is face–to–face. This code represents the first 60 minutes.

96203:
The provider trains multiple sets of parents, guardians, and caregivers without patients present. The provider covers areas such as how to create an environment that supports desired behaviors and adherence to the patient’s plan of care while reducing the negative impacts of the patient’s diagnosis on their daily life. A physician or other qualified healthcare provider administers the training, which is face–to–face. This code represents each additional 15 minutes after the first 60 minutes.

In your experience does this code get used for a specific provider type? Such as a Community Health Worker, Primary Care Provider, LPC, LMFT, LCSW, psychologist, QMHP or QMHA? Or any other provider types?
Curious if anyone has any experience in this code?

Thanks!
Lori
 
I am also researching this code for my company to see if we are able to utilize it and I am having trouble in finding the provider requirements for this as well. I live in MI and the state website has a link to the mental health codes and requirements used and this is not on it. Your state may have this as well and is worth a look. if you find anything please let me know!!
 
Per CMS Health Equity services 2024 Physician fee schedule final rule: ● Nurse practitioners
● Clinical nurse specialists (CNSs)
● Certified nurse-midwives (CNMs)
● Physician assistants (PAs)
● Clinical psychologists
● Therapists, including physical therapists (PTs), occupational therapists (OTs), and speech-language
pathologists (SLPs)
 
I will let you know what I find out Amanda. Thank you for sharing the information from CMS. We are in talks with other Medicaid staff about how to properly utilize this code if at all as part of our metric.
 
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