Community Psychiatric Supportive Treatment (CPST)
DRAFT
- Fees also available in Portable Document Format (PDF)
| Rate Code Description | Unit Type | Productivity Adjustment 1st 6 mos of Waiver Downstate Fee |
Productivity Adjustment Months 7–12 of Waiver Downstate Fee |
Year 2+ Downstate Fee |
Productivity Adjustment 7/1/18–12/31/18 Upstate Fee |
Productivity Adjustment 1/1/19–6/30/19 Upstate Fee |
Year 2+ Upstate Fee |
|---|---|---|---|---|---|---|---|
| Licensed Practitioner CPST (RN, LMHC, LMFT, LCSW, LMSW) Registered Professional Nurses with 1 year of behavioral health experience, Licensed Occupational Therapists, and Licensed Creative Arts Therapists – on– site or non–travel off–site | 15 min | $ 47.18 | $ 41.85 | $ 37.80 | $ 42.07 | $ 37.32 | $ 33.70 |
| CPST Masters Level – MSW, Any MA or MS in Health – on–site or non–travel off–site | 15 min | $ 29.94 | $ 26.56 | $ 23.99 | $ 26.70 | $ 23.68 | $ 21.39 |
| CPST – (except counseling) Bachelors Level – on–site or non–travel off–site | 15 min | $ 19.96 | $ 17.71 | $ 15.99 | $ 17.80 | $ 15.79 | $ 14.26 |
| Licensed Practitioner CPST (RN, LMHC, LMFT, LCSW, LMSW) Registered Professional Nurses with 1 year of behavioral health experience, Licensed Occupational Therapists, and Licensed Creative Arts Therapists – Off– site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is one hour or more, use rate code XX79) Cannot submit claims for xx78 and xx79) for same client, same day. | 15 min | $ 64.87 | $ 57.55 | $ 51.98 | $ 57.84 | $ 51.31 | $ 46.34 |
| Licensed Practitioner CPST (RN, LMHC, LMFT, LCSW, LMSW) Registered Professional Nurses with 1 year of behavioral health experience, Licensed Occupational Therapists, and Licensed Creative Arts Therapists – Off– site 4–6 units. Use this code to claim for entire session when session is 1 hour or more. | 15 min | $ 51.90 | $ 46.04 | $ 41.58 | $ 46.27 | $ 41.05 | $ 37.07 |
| CPST Masters Level – MSW, Any MA or MS in Health – Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is one hour or more, use rate code XX81) Cannot submit claims for xx80 and xx81 for same client, same day. | 15 min | $ 38.92 | $ 34.53 | $ 31.19 | $ 34.71 | $ 30.79 | $ 27.81 |
| CPST Masters Level – MSW, Any MA or MS in Health – Off–site 4–6 units. Use this code to claim for entire session when session is 1 hour or more. | 15 min | $ 32.44 | $ 28.77 | $ 25.99 | $ 28.92 | $ 25.66 | $ 23.17 |
| CPST – (except counseling) Bachelors Level – Off–site – Use this code if total off–site session is 45 minutes or less (3 or less units). If session is more than 45 minutes use rate code XX83) Cannot submit claims for xx82 and xx83 for same client, same day. | 15 min | $ 25.95 | $ 23.02 | $ 20.79 | $ 23.14 | $ 20.52 | $ 18.54 |
| CPST – (except counseling) Bachelors Level – off–site 4–6 units | 15 min | $ 21.62 | $ 19.18 | $ 17.33 | $ 19.28 | $ 17.10 | $ 15.45 |
*Note: In acknowledgement of the need for checks against fraud and abuse, but to ensure a client´s access to services, service utilization in excess of the annual claim limits and "soft" unit limits will be based on medical necessity and subject to post–payment review. Documentation of the medical necessity for extended durations must be kept on file in the client´s record.
**What is non–travel off–site?
Services provided off–site are paid a significantly higher rate due to the amount of practitioner time spent in travel status; therefore, Medicaid will only reimburse one off–site travel claim per day, per location. This means that if a practitioner is providing a service to more than one individual at the same location, or if multiple services requiring separate claims are being provided to one individual at an off–site location, only one off–site claim may be submitted for any services provided at that off–site location. Any subsequent claims for services provided at the same location will require that the practitioner submit a claim using the appropriate "on–site/non–travel off–site" rate code.
