Ohio Medicaid reimburses eligible providers for covered behavioral health (BH) services.
Payment rates and billing requirements are determined under applicable Ohio Medicaid rules, provider manuals, and fee schedules.
These services may include mental health and substance use disorder services provided by eligible practitioners and provider organizations.
For community behavioral health services, reimbursement requirements are established under Ohio Administrative Code Chapter 5160-27.
In simple terms, the Ohio Medicaid Behavioral Health Fee Schedule provides payment information for covered services. Depending on the service, the relevant billing code, payment rate, units, provider type, and billing or coverage requirements may vary.
In this guide, we will discuss selected BH health CPT and HCPCS codes, their Ohio Medicaid reimbursement rates, and the rules governing billing and payment.
Ohio Medicaid BH Abbreviation Guide
This guide explains common abbreviations used for practitioner types in Ohio Medicaid behavioral health billing.
| MD/DO | Physician (Medical Doctor or Doctor of Osteopathic Medicine) | LSW | Licensed social worker |
| CNS | Clinical nurse specialist | LMFT | Licensed marriage and family therapist |
| CNP | Certified nurse practitioner | LPC | Licensed professional counselor |
| PA | Physician assistant | LCDC II or LCDC III | Licensed chemical dependency counselor II or III |
| RN | Registered nurse | SW-A | Social worker assistant |
| LPN | Licensed practical nurse | SW-T | Social worker trainee |
| PSY | Psychologist | MFT-T | Marriage and family therapist trainee |
| LISW | Licensed independent social worker | C-T | Counselor trainee |
| LIMFT | Licensed independent marriage and family therapist | CDC-A | Chemical dependency counselor assistant |
| LPCC | Licensed professional clinical counselor | CMS | Care management specialist |
| LICDC | Licensed independent chemical dependency counselor | QMHS | Qualified mental health specialist |
| Lic school PSY | Board licensed school psychologist | QMHS +3 | Qualified mental health specialist with 3 years’ experience |
| PSY assistant | Psychology assistant | CPS | Certified peer supporter |
| RPH | Pharmacist |
Ohio Medicaid fee schedule for behavioral health services
Search a code to see its rate, which practitioners can bill it, and the rules that apply.
Office Visits (E&M)9 codes
99202New patient office visit15–29 mins$35.08–$93.14
- MD/DO, CNS, CNP, PA$93.14per visit
- RPH (Pharmacist)$35.08per visit
New patient visits pay more than established patient visits. Under Ohio Administrative Code 5160-8-52, a pharmacist (RPH) may also bill this code, at a lower rate. RPH billing is limited to codes 99202 and 99203.
99203New patient office visit30–44 mins$52.04–$135.22
- MD/DO, CNS, CNP, PA$135.22per visit
- RPH (Pharmacist)$52.04per visit
New patient visits pay more than established patient visits. A pharmacist (RPH) may also bill this code, at a lower rate. RPH billing is limited to codes 99202 and 99203.
99204New patient office visit45–59 mins$207.36
- MD/DO, CNS, CNP, PA$207.36per visit
New patient visits pay more than established patient visits, based on the complexity of the visit.
99205New patient office visit60–74 mins$260.61
- MD/DO, CNS, CNP, PA$260.61per visit
The highest-paying new patient visit code, used for the most complex initial visits.
99211Established patient visit5 mins$13.06–$24.54
- MD/DO, CNS, CNP, PA / RN, LPN$24.54per visit
- RPH (Pharmacist)$13.06per visit
Established patient visits pay less than new patient visits. Registered nurses and LPNs can bill this code at the same $24.54 rate as a physician.
99212Established patient visit10–19 mins$24.42–$53.87
- MD/DO, CNS, CNP, PA$53.87per visit
- RPH (Pharmacist)$24.42per visit
Established patient visit, straightforward complexity.
99213Established patient visit20–29 mins$39.30–$91.14
- MD/DO, CNS, CNP, PA$91.14per visit
- RPH (Pharmacist)$39.30per visit
Established patient visit, low complexity — one of the most commonly billed office-visit codes.
99214Established patient visit30–39 mins$134.50
- MD/DO, CNS, CNP, PA$134.50per visit
Established patient visit, moderate complexity.
99215Established patient visit40–54 mins$181.67
- MD/DO, CNS, CNP, PA$181.67per visit
Established patient visit, high complexity — the highest-paying code in this group.
Preventive & Care Management8 codes
99401Preventive counseling, 15 min$23.61–$27.78
- Physician / CNM / NP / CNS$27.78per visit
- PA$23.61per visit
A short counseling visit for prevention, billed by time.
99402Preventive counseling, 30 min$35.95–$42.29
- Physician / CNM / NP / CNS$42.29per visit
- PA$35.95per visit
Preventive counseling; the rate rises with the length of the visit.
99403Preventive counseling, 45 min$49.90–$58.70
- Physician / CNM / NP / CNS$58.70per visit
- PA$49.90per visit
Preventive counseling; the rate rises with the length of the visit.
99404Preventive counseling, 60 min$64.25–$75.59
- Physician / CNM / NP / CNS$75.59per visit
- PA$64.25per visit
The longest, highest-paying tier of preventive counseling.
99406Smoking cessation, 3–10 minutes$8.50–$10.00
- Physician / CNM / NP / CNS$10.00per visit
- PA$8.50per visit
Smoking cessation codes pay more the longer the counseling lasts.
99407Smoking cessation, 10+ minutes$25.06–$29.48
- Physician / CNM / NP / CNS$29.48per visit
- PA$25.06per visit
The longer smoking cessation code, paid at a higher rate than the 3–10 minute version.
99483Cognitive assessment & care plan$166.87–$196.32
- Physician / CNM / NP / CNS$196.32per visit
- PA$166.87per visit
A detailed cognitive assessment with a written care plan, one of the higher-paying codes in this group.
99484BH care management, first 20 minNot paid
- All provider typesNot paidper month
This code is not currently paid by Ohio Medicaid FFS ($0.00), even though Medicare pays $51.31 for the same code — a real gap in Ohio behavioral health billing.
Psychiatric Diagnostic Evaluation2 codes
90791Diagnostic evaluation (no medical component)$125.28–$147.39
- MD/DO, PSY, CNS, CNP, PA$147.39per visit
- LISW, LIMFT, LPCC, LICDC$125.28per visit
- LSW, LMFT, LPC, LCDC III/II$125.28per visit
Covers a client’s initial diagnostic assessment. Supervised staff (like an LSW) bill this code too, but get paid less unless a supervisor’s name is on the claim.
90792Diagnostic evaluation (with medical component)$162.75
- MD/DO, CNS, CNP, PA$162.75per visit
Only medical staff can bill this code, and it pays more than 90791 because it includes a medical examination.
Individual Psychotherapy3 codes
90832Individual psychotherapy, 30 minutes$60.49–$71.16
- MD/DO, PSY$71.16per sessionCrisis (KX) $92.50
- LISW, LIMFT, LPCC$60.49per sessionCrisis (KX) $78.63
- LSW, LMFT, LPC$60.49per sessionCrisis (KX) $78.63
Has a special “KX” modifier for crisis sessions between 16 and 30 minutes, which pays a higher rate.
90834Individual psychotherapy, 45 minutes$78.63–$92.51
- MD/DO, PSY$92.51per session
- LISW, LIMFT, LPCC$78.63per session
The rate rises with session length: 45-minute sessions pay more than 30-minute sessions.
90837Individual psychotherapy, 60 minutes$115.35–$135.71
- MD/DO, PSY$135.71per session
- LISW, LIMFT, LPCC$115.35per session
- LSW, LMFT, LPC$115.35per session
The highest-paying individual psychotherapy code, for full 60-minute sessions.
Psychotherapy + E&M Add-On3 codes
+90833Psychotherapy add-on, 30 minutes (with E&M visit)Add-on$62.65–$73.70
- MD/DO$73.70add-on
- CNS / CNP / PA$62.65add-on
Used when a provider does both a medical office visit and talk therapy in the same appointment. Cannot be billed alone — must accompany an E&M office visit code.
+90836Psychotherapy add-on, 45 minutes (with E&M visit)Add-on$79.58–$93.62
- MD/DO$93.62add-on
- CNS / CNP / PA$79.58add-on
Used when a provider does both a medical office visit and talk therapy in the same appointment. Cannot be billed alone — must accompany an E&M office visit code.
+90838Psychotherapy add-on, 60 minutes (with E&M visit)Add-on$104.98–$123.50
- MD/DO$123.50add-on
- CNS / CNP / PA$104.98add-on
Used when a provider does both a medical office visit and talk therapy in the same appointment. Cannot be billed alone — must accompany an E&M office visit code.
Crisis, Group & Family Therapy4 codes
90839Crisis therapy, first 60 minutes$164.55–$193.59
- MD/DO, PSY$193.59per session
- LISW, LIMFT, LPCC$164.55per session
For an urgent mental health emergency. Pays much more than routine therapy because of the acute, immediate nature of the visit.
+90840Crisis therapy, each additional 30 minutesAdd-on$78.54–$92.40
- MD/DO, PSY$92.40add-on
- LISW, LIMFT, LPCC$78.54add-on
This is an add-on code and cannot be billed as a standalone service. It must be reported together with primary code 90839.
90853Group therapy$31.71–$37.31
- MD/DO, PSY$37.31per client
- LISW, LIMFT, LPCC$31.71per client
Billed once per client in the group, no matter how many people attend the session.
+90785Interactive complexity (add-on)Add-on$13.23–$15.57
- MD/DO, PSY$15.57add-on
- LISW, LIMFT, LPCC$13.23add-on
Used when a session is harder than normal, such as when a family conflict makes communication difficult. Must be reported with an eligible primary evaluation or psychotherapy code performed in the same session.
Family Psychotherapy3 codes
90846Family therapy without patient (50 min)$98.02–$115.32
- MD/DO, PSY$115.32per session
- LISW, LIMFT, LPCC$98.02per session
Used when the family meets without the patient present.
90847Family therapy with patient present (50 min)$96.53–$113.56
- MD/DO, PSY$113.56per session
- LISW, LIMFT, LPCC$96.53per session
Used when the patient joins the family session.
90849Multiple-family group psychotherapy$38.96–$45.84
- MD/DO, PSY$45.84per session
- LISW, LIMFT, LPCC$38.96per session
For group sessions involving several families at once.
Community-Based & High-Intensity MH2 codes
H0036Community Psychiatric Supportive Treatment (CPST)$10.14–$22.03
- MD/DO, PSY, LISW, and other eligible practitioners — Individual$22.03per 15 min
- Eligible practitioners + HQ modifier — Group$10.14per 15 min
CPST helps clients with daily living skills and community support. Billed in 15-minute units, for either an individual or a group session (using the HQ modifier).
H0040Assertive Community Treatment (ACT)$179.54–$694.13
- MD/DO — modifier AM$694.13per diem
- CNP — modifier UC$397.73per diem
- CNS, PA — modifier SA$397.73per diem
- Licensed practitioner (per OAC 5160-27-04) — modifier HO$284.03per diem
- Unlicensed practitioner — modifier HN$225.16per diem
- Certified peer supporter — modifier HM$179.54per diem
ACT is intensive, team-based care for people with serious mental illness. Billed as one per-diem payment covering the whole day of service — the modifier used shows which staff member led that day’s visit.
SUD Assessment and Counseling6 codes
H0001SUD assessment$87.07
- PSY assistant, SW-T, MFT-T, CDC-A, C-T$87.07per visit
The initial diagnostic assessment for substance use disorder services. Ohio Medicaid requires ASAM placement criteria (OAC 5160-27-09) to decide the level of SUD care a client needs.
H0004Individual SUD counseling$21.77
- PSY assistant, SW-T, MFT-T, CDC-A, C-T$21.77per 15 minCrisis (KX) $28.30
One-on-one drug and alcohol counseling, with an optional KX modifier for crisis sessions that pays a higher rate per 15-minute unit.
H0005Group SUD counseling$9.44–$12.43
- MD/DO, CNS, CNP, PA, PSY — modifier AF$12.43per 15 min
- LISW, LIMFT, LPCC, LICDC — modifier HK$10.56per 15 min
- Assistants / trainees$9.44per 15 min
Group counseling for substance use disorder, billed in 15-minute units. A minimum of four units (one hour) is required to be reimbursed when billed with the AF or HK modifier.
H0006SUD case management$22.03
- MD/DO, LISW, LIMFT, LPCC, LICDC$22.03per 15 min
Case management support for SUD clients, billed in 15-minute units.
H0048SUD drug screening$16.33
- Eligible SUD practitioners$16.33per encounter
Covers a drug test used to check for substance use, billed once per encounter.
H0015SUD Intensive Outpatient (IOP) group counseling$116.18–$168.99
- Modifier HK$168.99daily rate
- Assistants / trainees$116.18daily rate
A more structured, multi-hour SUD group program, paid once per day instead of per 15 minutes. The March 2026 manual update clarified that H0015 is billed as separate, unbundled pieces, not a single bundled rate.
Nursing and Lab Services4 codes
93000ECG, 12 leads, full report$14.87–$17.49
- MD/DO$17.49per test
- CNS, CNP, PA$14.87per test
Billed when a client needs a heart test, often before starting certain psychiatric medications.
93005ECG, tracing only$7.59
- MD/DO$7.59per test
A lower-paying ECG code for the tracing portion only, without full interpretation.
93010ECG, interpretation only$8.69
- MD/DO$8.69per test
Covers only the interpretation of an ECG that was performed elsewhere.
H0038Peer support service$2.19–$17.49
- Certified peer supporter — modifiers HM, HN, HO$17.49per 15 min
- Certified peer supporter — modifier HQ, group$2.19per 15 min
Delivered by a certified peer supporter in recovery, billed in 15-minute units for individual or group sessions.
Prolonged Office Visit Add-Ons4 codes
+99415Prolonged visit, clinical staff timeAdd-on$12.03
- Clinical staff$12.03first 60 minutes
Cannot be billed alone — must be added on top of a regular office visit code, for visits running longer than usual.
+99416Prolonged visit, clinical staff timeAdd-on$6.18
- Clinical staff$6.18each extra 30 minutes
Cannot be billed alone — must be added on top of a regular office visit code, for time beyond the first 60 minutes.
+99417Prolonged office visitAdd-on$42.38
- MD/DO, NP, PA$42.38each extra 15 minutes
Cannot be billed alone — must be added on top of a regular office visit code, for visits running longer than usual.
+G2212Prolonged office visit (Medicare/Medicaid specific)Add-on$42.38
- MD/DO, NP, PA$42.38each extra 15 minutes
Cannot be billed alone — must be added on top of a regular office visit code, for visits running longer than usual.
Psychological & Neuropsychological Testing10 codes
96136Test administration & scoring$34.79
- Eligible testing practitioner$34.79first 30 minutes
Covers formal test administration and scoring, like IQ or memory tests.
+96137Additional test administration & scoringAdd-on$32.01
- Eligible testing practitioner$32.01each extra 30 minutes
Add-on code for extra time spent on test administration and scoring beyond the first 30 minutes.
96130Psychological testing evaluation$66.82
- Eligible testing practitioner$66.82first 60 minutes
Covers the evaluation portion of psychological testing.
+96131Additional psychological testing evaluationAdd-on$66.82
- Eligible testing practitioner$66.82each extra 60 minutes
Add-on code for extra time spent on psychological testing evaluation.
96132Neuropsychological testing evaluation$109.78
- Eligible testing practitioner$109.78first 60 minutes
Covers the evaluation portion of neuropsychological testing.
+96133Additional neuropsychological testing evaluationAdd-on$88.29
- Eligible testing practitioner$88.29each extra 60 minutes
Add-on code for extra time spent on neuropsychological testing evaluation.
96112Developmental testing$63.26
- Eligible testing practitioner$63.26first 60 minutes
Covers formal developmental screening, often used with children.
+96113Additional developmental testingAdd-on$31.64
- Eligible testing practitioner$31.64each extra 30 minutes
Add-on code for extra time spent on developmental testing.
96116Neurobehavioral status exam$72.27
- Eligible testing practitioner$72.27first 60 minutes
Covers a formal exam of neurobehavioral status.
+96121Additional neurobehavioral status examAdd-on$72.27
- Eligible testing practitioner$72.27each extra 60 minutes
Add-on code for extra time spent on a neurobehavioral status exam.
TBS & Nursing Services4 codes
H2019Therapeutic Behavioral Services (TBS) and RN Nursing$7.32–$46.23
- TBS — Individual, office$25.33per 15 min
- TBS — Individual, community$32.24per 15 min
- TBS — Individual, office, crisis (KX)$32.93per 15 min
- TBS — Individual, community, crisis (KX)$41.91per 15 min
- TBS — Group, higher-level practitioners (HQ)$10.14per 15 min
- TBS — Group, master’s-level supervised (HQ)$8.24per 15 min
- TBS — Group, bachelor’s-level (HQ)$7.32per 15 min
- Nursing — RN individual, office$35.99per 15 min
- Nursing — RN individual, community$46.23per 15 min
- Nursing — RN group (HQ)$11.69per 15 min
H2019 covers two different services in the manual: hands-on TBS behavioral coaching (often for kids) and RN nursing visits. Community visits pay more than office visits. A 50% payment reduction applies to TBS units beyond the sixth delivered by the same agency on the same day.
H2017LPN Nursing and Psychosocial Rehabilitation (PSR)$17.86–$32.84
- LPN individual nursing, office$25.41per 15 min
- LPN individual nursing, community$32.84per 15 min
- PSR, office$17.86per 15 min
- PSR, community$22.91per 15 min
- PSR, crisis (KX), office$23.22per 15 min
- PSR, crisis (KX), community$29.79per 15 min
H2017 covers two different services: LPN nursing visits and Psychosocial Rehabilitation (PSR), which helps clients rebuild daily living skills. Community visits pay more than office visits for both.
H2012TBS Day Treatment (Hourly)$27.17–$41.19
- Standard-level provider$41.19per hour
- Master’s-level provider$30.86per hour
- Bachelor’s-level provider$27.17per hour
Day treatment billed by the hour. The provider’s license level changes the rate.
H2020TBS Day Treatment (Per Diem)$153.25–$205.95
- Standard-level provider$205.95per diem
- Master’s-level provider$171.57per diem
- Bachelor’s-level provider$153.25per diem
Day treatment billed as one flat daily payment instead of by the hour. The provider’s license level changes the rate.
No codes match that search. Try the code number on its own, or pick a category above.
Source: Ohio Medicaid Behavioral Health Provider Manual and physician fee schedule, version 1.28.1, effective March 24, 2026. Rates are for fee-for-service billing and may differ from managed care plan rates. Confirm current rates with ODM before billing.
How the Ohio BH Fee Schedule Works
Ohio Medicaid uses CPT codes and HCPCS codes to bill for mental health and substance use disorder (SUD) services. Each code has:
- A rate, which is the dollar amount Medicaid pays per unit.
- A rendering provider type (who can bill it, like an MD, LISW, or LPC).
- A practitioner modifier, an additional code added to the claim to show the exact license level.
- A unit value, which tells you how much time equals one unit (often 15 minutes).
Reimbursement rates depend directly on practitioner credentials. OH Medicaid pays a higher rate to independently licensed practitioners (such as an MD, PSY, LISW, or LPCC) and a lower rate to practitioners working under supervision (such as an LSW or a trainee).
When permitted for a specific behavioral care service, the KX modifier may be used to indicate that the service was provided to a member experiencing a behavioral health crisis. The provider must meet the applicable crisis-service requirements for the code and modifier.
Important: Ohio Medicaid reimbursement rates and billing requirements may change due to rule amendments. These rates can also vary due to fee schedule updates and revisions to the Behavioral Health Manual. The rates below should be read together with the specific effective date, provider type, modifier, place of service, and Medicaid coverage requirements.
Office Visits (Evaluation & Management)
These codes cover regular doctor office visits for mental health care. New patient visits (99202–99205) pay more than established patient visits (99211–99215). A pharmacist (RPH) also bills these codes, but at a lower rate than the practitioner rate. Under Ohio Administrative Code (OAC) 5160-8-52 and the Ohio Medicaid Behavioral Health Provider Manual, pharmacists (RPHs) are allowed to bill for low- to moderate-complexity new-patient E&M visits: CPT 99202 and CPT 99203.
| Code | Service | MD/DO, CNS, CNP, PA | RPH (Pharmacist) |
| 99202 | New patient office visit, 15-29 mins | $93.14 | $35.08 |
| 99203 | New patient office visit, 30-44 mins | $135.22 | $52.04 |
| 99204 | New patient office visit,45-59 mins | $207.36 | — |
| 99205 | New patient office visit, 60-74 mins | $260.61 | — |
| 99211 | Established patient visit, 5 mins | $24.54 | $13.06 |
| 99212 | Established patient visit, 10-19 mins | $53.87 | $24.42 |
| 99213 | Established patient visit, 20-29 mins | $91.14 | $39.30 |
| 99214 | Established patient visit,30-39 mins | $134.50 | — |
| 99215 | Established patient visit, 40-54 mins | $181.67 | — |
Preventive Counseling, Tobacco Cessation, and Cognitive Assessment Codes
These are shorter, add-on-style visits, mostly used for counseling and prevention. Smoking cessation codes (99406/99407) pay more the longer the counseling lasts.
| Code | Service | Physician / CNM | NP / CNS | PA |
| 99401 | Preventive counseling, 15 min | $27.78 | $27.78 | $23.61 |
| 99402 | Preventive counseling, 30 min | $42.29 | $42.29 | $35.95 |
| 99403 | Preventive counseling, 45 min | $58.70 | $58.70 | $49.90 |
| 99404 | Preventive counseling, 60 min | $75.59 | $75.59 | $64.25 |
| 99406 | Smoking cessation, 3–10 min | $10.00 | $10.00 | $8.50 |
| 99407 | Smoking cessation, 10+ min | $29.48 | $29.48 | $25.06 |
| 99483 | Cognitive assessment & care plan | $196.32 | $196.32 | $166.87 |
Psychiatric Diagnostic Evaluation
These rates are for the first visit, during which a provider determines a client’s diagnosis. CPT Code 90791 is the standard version. CPT 90791 is a psychiatric diagnostic evaluation without medical services. CPT 90792 includes medical services and is limited to practitioners who meet the established requirements for that code. Supervised staff (like an LSW) bill 90791 too, but get paid less unless a supervisor’s name is on the claim.
| Code | Service | Provider Type | Rate |
| 90791 | Diagnostic eval, no medical part | MD/DO, PSY, CNS, CNP, PA | $147.39 |
| 90791 | Diagnostic eval, no medical part | LISW, LIMFT, LPCC, LICDC | $125.28 |
| 90791 | Diagnostic eval, no medical part | LSW, LMFT, LPC, LCDC III/II | $125.28 |
| 90792 | Diagnostic eval, with medical part | MD/DO, CNS, CNP, PA | $162.75 |
Individual Psychotherapy (Talk Therapy)
This table includes reimbursement rates for standard one-on-one talk therapy. The rate increases with session length (30, 45, or 60 minutes). Certain eligible behavioral health services may be billed with the KX modifier when provided to address a qualifying crisis and the related requirements are met.
Think of this like paying for a taxi ride by the mile. A short ride (30 minutes) costs less than a long ride (60 minutes). If the ride turns urgent, like rushing someone to help, the “crisis” fare (KX) pays more for that same short trip.
| Code | Length | Provider Type | Rate | Crisis Rate (KX) |
| 90832 | 30 minutes | MD/DO, PSY | $71.16 | $92.50 |
| 90832 | 30 minutes | LISW, LIMFT, LPCC | $60.49 | $78.63 |
| 90832 | 30 minutes | LSW, LMFT, LPC | $60.49 | $78.63 |
| 90834 | 45 minutes | MD/DO, PSY | $92.51 | — |
| 90834 | 45 minutes | LISW, LIMFT, LPCC | $78.63 | — |
| 90837 | 60 minutes | MD/DO, PSY | $135.71 | — |
| 90837 | 60 minutes | LISW, LIMFT, LPCC | $115.35 | — |
| 90837 | 60 minutes | LSW, LMFT, LPC | $115.35 | — |
Crisis, Group, and Family Therapy
Crisis therapy (90839/90840) is for an urgent mental health emergency and pays much more than routine therapy. CPT 90853 is group psychotherapy and is generally reported for each participating patient, subject to Ohio Medicaid’s required coverage, provider, group-size, and same-day billing requirements. Interactive complexity (90785) is an add-on code used when a session is more complex than usual, for example, due to family conflict that makes communication difficult.
| Code | Service | Provider Type | Rate |
| 90839 | Crisis therapy, first 60 min | MD/DO, PSY | $193.59 |
| 90839 | Crisis therapy, first 60 min | LISW, LIMFT, LPCC | $164.55 |
| +90840 | Crisis therapy, each extra 30 min | MD/DO, PSY | $92.40 |
| +90840 | Crisis therapy, each extra 30 min | LISW, LIMFT, LPCC | $78.54 |
| 90853 | Group therapy | MD/DO, PSY | $37.31 |
| 90853 | Group therapy | LISW, LIMFT, LPCC | $31.71 |
| +90785 | Interactive complexity (add-on) | MD/DO, PSY | $15.57 |
| +90785 | Interactive complexity (add-on) | LISW, LIMFT, LPCC | $13.23 |
Codes marked with a plus sign (+) are add-on codes and cannot be billed as a standalone service. They must be reported in conjunction with an eligible primary service code performed during the same session (e.g., +90840 requires primary code 90839; +90785 requires a primary evaluation or psychotherapy code).
Community-Based and High-Intensity Mental Health Services
Ohio Medicaid covers several community-based mental health services under HCPCS Level II codes. Two important services are Community Psychiatric Supportive Treatment (CPST) and Assertive Community Treatment (ACT). CPST is billed in 15-minute units, while ACT is billed as a per-diem payment, meaning one payment covers the service for the day.
| Code | Service | Provider Type | Rate |
| H0036 | Community Psychiatric Supportive Treatment (CPST), individual | MD/DO, PSY, LISW | $22.03 per 15 min |
| H0036 HQ | CPST, group | Same as above | $10.14 per 15 min |
| H0040 AM | ACT, MD/DO | MD/DO | $694.13 per diem |
| H0040 UC | ACT, nurse practitioner | CNP | $397.73 per diem |
| H0040 SA | ACT, nurse specialist / physician assistant | CNS, PA | $397.73 per diem |
| H0040 HO | ACT, licensed practitioner (per OAC 5160-27-04) | Licensed practitioner | $284.03 per diem |
| H0040 HN | ACT, unlicensed practitioner | Unlicensed practitioner | $225.16 per diem |
| H0040 HM | ACT, certified peer supporter | Certified peer supporter | $179.54 per diem |
SUD Assessment and Counseling (Substance Use Disorder)
These codes cover drug and alcohol counseling. H0001 is used for a substance use disorder assessment. H0004 covers individual counseling, with an optional KX modifier for crisis sessions. H0005 is group counseling, billed in 15-minute units based on actual session time. H0006 provides case management support for SUD clients.
| Code | Service | Provider Type | Rate |
| H0001 | SUD assessment | PSY assistant, SW-T, MFT-T, CDC-A, C-T | $87.07 |
| H0004 | Individual SUD counseling | Same as above | $21.77 per 15 min |
| H0004 KX | Individual SUD counseling, crisis | Same as above | $28.30 per 15 min |
| H0005 AF | Group SUD counseling, MD/DO | MD/DO, CNS, CNP, PA, PSY | $12.43 per 15 min |
| H0005 HK | Group SUD counseling, licensed clinician | LISW, LIMFT, LPCC, LICDC | $10.56 per 15 min |
| H0006 | SUD case management | MD/DO, LISW, LIMFT, LPCC, LICDC | $22.03 per 15 min |
Prolonged Office Visit Add-On Codes
These “+” codes are add-ons for office visits that run longer than usual. They can never be billed on their own; they must be added to a regular office visit code.
You still have to pay for the original visit; this is just the extra charge for staying longer.
| Code | Service | Unit | Rate |
| +99415 | Prolonged visit, clinical staff time | First 60 minutes | $12.03 |
| +99416 | Prolonged visit, clinical staff time | Each extra 30 minutes | $6.18 |
| +99417 | Prolonged visit; for use with 99205/99215 | Each extra 15 minutes | $42.38 |
| +G2212 | Prolonged visit; for use with 99205/99215 | Each extra 15 minutes | $42.38 |
Psychotherapy Billed with an E&M Add-On
These codes are used when a provider does both a medical office visit and talk therapy in the same appointment. The add-on covers the therapy portion, in addition to the regular office visit fee.
This is like an office visit being the main dish, and the therapy add-on is a side item ordered at the same time, billed and priced separately from the main dish.
| Add-on Code | Therapy Length (with E&M visit) | MD/DO Rate | CNS / CNP / PA Rate |
| +90833 | 30 minutes | $73.70 | $62.65 |
| +90836 | 45 minutes | $93.62 | $79.58 |
| +90838 | 60 minutes | $123.50 | $104.98 |
Family Psychotherapy
Family psychotherapy codes are for therapy sessions involving family members. Code 90846 is used when the family meets without the patient present. Code 90847 is used when the patient joins the family session. Code 90849 is for group sessions with several families at once.
Think of 90846 like a parent-teacher conference without the student in the room.
| Code | Service | Provider Type | Rate |
| 90846 | Family therapy without patient (50 min) | MD/DO, PSY | $115.32 |
| 90846 | Family therapy without patient (50 min) | LISW, LIMFT, LPCC | $98.02 |
| 90847 | Family therapy with patient present (50 min) | MD/DO, PSY | $113.56 |
| 90847 | Family therapy with patient present (50 min) | LISW, LIMFT, LPCC | $96.53 |
| 90849 | Multiple-family group psychotherapy | MD/DO, PSY | $45.84 |
| 90849 | Multiple-family group psychotherapy | LISW, LIMFT, LPCC | $38.96 |
Psychological and Neuropsychological Testing
These codes cover formal testing, like IQ tests, memory tests, or developmental screenings. Each has a “base” code for the first block of time, and an add-on “+” code for extra time spent scoring or evaluating.
| Code | Service | Unit | Rate |
| 96136 | Test administration & scoring | First 30 minutes | $34.79 |
| +96137 | Additional test administration & scoring | Each extra 30 minutes | $32.01 |
| 96130 | Psychological testing evaluation | First 60 minutes | $66.82 |
| +96131 | Additional psychological testing evaluation | Each extra 60 minutes | $66.82 |
| 96132 | Neuropsychological testing evaluation | First 60 minutes | $109.78 |
| +96133 | Additional neuropsychological testing evaluation | Each extra 60 minutes | $88.29 |
| 96112 | Developmental testing | First 60 minutes | $63.26 |
| +96113 | Additional developmental testing | Each extra 30 minutes | $31.64 |
| 96116 | Neurobehavioral status exam | First 60 minutes | $72.27 |
| +96121 | Additional neurobehavioral status exam | Each extra 60 minutes | $72.27 |
Therapeutic Behavioral Services (TBS)
Therapeutic Behavioral Services (TBS) are behavioral health services provided to eligible individuals in accordance with Ohio Medicaid requirements. Depending on the service, TBS may be provided in-office, in the community, or in other permitted settings. A special rule halves pay for extra units: For certain TBS services, additional units may be reimbursed at 50% when the daily-unit threshold is exceeded. Providers should follow the current BH Manual and specific OAC requirements for the service, place of service, and billing provider.
| Code | Service Details | Rate |
| H2019 | Individual TBS (15 min, office) | $25.33 |
| H2019 | Individual TBS (15 min, community) | $32.24 |
| H2019 KX | Individual TBS (15 min, office, crisis) | $32.93 |
| H2019 KX | Individual TBS (15 min, community, crisis) | $41.91 |
| H2019 HQ | Group TBS (15 min, higher-level eligible practitioners) | $10.14 |
| H2019 HQ | Group TBS (15 min, master’s-level supervised providers) | $8.24 |
| H2019 HQ | Group TBS (15 min, bachelor’s-level providers) | $7.32 |
Ohio Medicaid Rates for Nursing, Psychosocial Rehabilitation (PSR), and Day Treatment
These codes cover nursing visits, psychosocial rehab (help rebuilding daily living skills), and day treatment programs. Like TBS, community visits pay more than office visits, and the provider’s license level affects the day treatment rate.
| Code | Service | Unit | Rate |
| H2019 | RN individual nursing (office) | 15 min | $35.99 |
| H2019 | RN individual nursing (community) | 15 min | $46.23 |
| H2017 | LPN individual nursing (office) | 15 min | $25.41 |
| H2017 | LPN individual nursing (community) | 15 min | $32.84 |
| H2019 HQ | RN group nursing | 15 min | $11.69 |
| H2017 | Psychosocial Rehabilitation (PSR) | 15 min | $17.86 office / $22.91 community |
| H2017 KX | PSR, Crisis | 15 min | $23.22 office / $29.79 community |
| H2012 | TBS Day Treatment (Hourly) | Hour | $41.19 (Standard) / $30.86 (Master’s) / $27.17 (Bachelor’s) |
| H2020 | TBS Day Treatment (Per Diem) | Per diem | $205.95 (Standard) / $171.57 (Master’s) / $153.25 (Bachelor’s) |
Expanded Substance Use Disorder (SUD) Services
Ohio Medicaid requires that all SUD coverage decisions follow the ASAM placement criteria under Ohio Administrative Code 5160-27-09. ASAM is a standard tool used to decide what level of SUD care a patient needs.
| Code | Service | Unit | Rate |
| H0005 | Group SUD counseling (assistants / trainees) | 15 min | $9.44 |
| H0048 | SUD drug testing | Encounter | $16.33 |
| H0015 HK | SUD Intensive Outpatient (IOP) group counseling | Daily rate | $168.99 |
| H0015 | SUD IOP group counseling (assistants / trainees) | Daily rate | $116.18 |
What Changed in Ohio Medicaid BH Fee Schedule Version 1.28.1?
| Version | Major Ohio Medicaid Behavioral Health Update |
| Version 1.23 | CANS and MRSS updates and ODBH-related additions |
| Version 1.24 | Provider enrollment information was updated for PNM implementation |
| Version 1.25 | CPT changes, CANS rate updates, and changes to prolonged services |
| Version 1.26 | Practitioner enrollment information and additional MRSS/OTP information |
| Version 1.27 | Peer Support expansion to mental health and other coding and rate updates |
| Version 1.28 | CPT, modifier, provider, and service updates, including HP/HT supervision modifiers |
| Version 1.28.1 – 2026 | H0015 clarification, TBS description correction, MRSS end-date information, OHMAS-to-DBH terminology change, and psychological-testing PA update |
Version 1.28.1 is ODM’s updated Behavioral Health Provider Manual, effective March 24, 2026, with key billing and policy clarifications.
These changes have included the introduction of new BH services. They have also involved updates or changes to codes, payment rates, and appropriate modifiers. In addition, provider enrollment and billing requirements have also been updated.
Below are the most important changes introduced in this latest version.
➜ H0015 clarification
The BH manual 1.28.1 clarified information related to HCPCS code H0015, helping providers understand how the service should be described or billed.
➜ TBS description correction
The description for Therapeutic Behavioral Services (TBS) was corrected, reducing ambiguity in how the service is identified.
➜ MRSS end-date information
The 2026 updated manual provided information about the end date for Mobile Response and Stabilization Services (MRSS). This information is important for providers when determining whether and how the service may continue to be provided and billed.
➜ OHMAS to DBH terminology change
References to OhioMHAS were updated to reflect the Department of Behavioral Health (DBH) terminology. This is primarily an organizational/terminology update, but providers should use the current agency terminology in their documentation and references.
➜ Psychological testing prior authorization update
The manual has updated information on prior authorization (PA) for psychological testing, which can affect providers’ decisions about whether authorization is required before performing or billing certain testing services.
Eligible Providers to Bill Ohio Medicaid
Ohio Medicaid will only pay for BH services if the provider, group, and service meet the eligibility and billing rules. It depends on the service and type of provider. This could include individual practitioners, organizations certified by the Ohio Department of Behavioral Health (Ohio DBH), federally qualified health centers (FQHCs), rural health clinics (RHCs), and some providers from outside Ohio.
✅ Individual Behavioral Health Practitioners
Qualified practitioners may provide covered behavioral health services within their scope of practice. According to the service category, these may include psychiatrists, Psychiatric-Mental Health Nurse Practitioners (PMHNPs), psychologists, counselors, social workers, and other eligible practitioners.
Service rendering practitioners must satisfy the relevant professional requirements, enrollment, affiliation, NPI, and credentialing requirements that are specific to their provider type and the service being billed.
✅ Ohio DBH-Certified Behavioral Health Organizations
Behavioral health organizations must obtain the required Ohio DBH certification and enroll in the OH Medicaid program through the Provider Network Management (PNM) system.
OH Medicaid uses two provider types for mental health organizations:
- Provider Type 84: Mental health services
- Provider Type 95: Substance use disorder (SUD) services
Organizations providing both mental health and SUD services enroll under both Provider Type 84 and Provider Type 95. The specific provider specialty is selected during enrollment based on the organization’s certification or licensure.
✅ FQHCs and RHCs
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) may also be certified by Ohio DBH to provide community behavioral health services. They may enroll as Provider Type 84 and/or 95.
FQHCs and RHCs may have separate Medicaid enrollment and reimbursement requirements. When mental health services are provided under the current community behavioral health requirements, providers should follow the enrollment, billing, and payment methodology for the related entity and service.
✅ Out-of-State Behavioral Health Providers
Mental health agencies and programs operating outside OH may qualify to participate in OH Medicaid when they meet Ohio’s requirements. An out-of-state mental health or substance use disorder provider must be recognized or regulated by the state in which it operates as a provider of community-based behavioral care services and provide the required documentation with its Ohio Medicaid enrollment application.
✅ Paraprofessionals
Certain behavioral health services may also be provided by paraprofessionals who do not hold a professional license. These practitioners must enroll with OH Medicaid and affiliate with their employing or contracting agency. Ohio Medicaid uses Provider Type 96 for paraprofessionals, with appropriate specialties such as Qualified Mental Health Specialist (QMHS) and Care Management Specialist (CMS).
✅ Multi-Licensed Practitioners
A practitioner who holds multiple professional licenses or recognized credentials may be able to enroll with a multi-license specialty and render services under more than one credential. The required license or credential must be documented, and claims may require an additional modifier to identify the credential under which the service was provided.
Overall, eligibility to bill Ohio Medicaid depends on the provider’s or organization’s enrollment status, authorized certification or licensure, provider type, the practitioner’s qualifications, and the specific behavioral health service being billed.
