These fees are payable for GP Mental Health Management required beyond the four MSP counselling fees (age-appropriate 00120 fees billable under the MSC payment schedule) for patients with a chronic mental health condition on whom a Mental Health Plan has been created and billed.
The following list of diagnosis and acceptable (ICD9) codes are applicable for the Mental Health Planning and Management Fee, fee items G14043, G14044 – G14048, and G14079:
Adjustment Disorders: (309)
Adjustment Disorder with Anxiety (309)
Adjustment Disorder with Depressed Mood (309)
Adjustment Disorder with Disturbance of Conduct (309)
Adjustment Disorder with Mixed Anxiety and Depressed Mood (309)
Adjustment Disorder with Mixed Disturbance of Conduct & Mood (309) Adjustment Disorder NOS (309)Anxiety Disorders: (300)
Acute Stress Disorder (308)
Anxiety Disorder Due to a Medical Condition (300)
Anxiety Disorder NOS (300)
Generalized Anxiety disorder (50B), (300)
Obsessive-Compulsive Disorder (300)
Panic Attack (300)
Post-Traumatic Stress Disorder 309
Social Phobia (300)
Specific Phobia (300)
Substance-Induced Anxiety disorder (300)
Attention Deficit Disorders:
Attention Deficit disorder (314)
Cognitive Disorders: Amnestic Disorder (294)
Depersonalization Disorder (300)
Dissociative Amnesia (300)
Dissociative Fugue (300)
Dissociative Identity Disorder (300)
Dissociative Disorder NOS (300)
Anorexia Nervosa (307.1), (783.0), (307)
Eating Disorder NOS (307)
Factitious Disorders: (300),(312)
Factitious Disorder; Physical & Psych Symptoms (300),(312)
Factitious Disorder; Predom Physical Symptoms (300),(312)
Factitious Disorder; Predominantly Psych Symptoms (300),(312)
Impulse Control Disorders: (312)
Impulse Control Disorder NOS (312)
Intermittent Explosive Disorder (312)
Schizophrenia and other Psychotic Disorders: (295),(296),(297),(298)
Paranoid Type (295),(297),(298)
Disorganized Type (295), (298)
Catatonic Type (295), (298)
Undifferentiated Type (295), (298)
Residual Type (295), (298)
Brief Psychotic Disorder (295), (298)
Delusional Disorder (295), (298)
Psychotic Disorder due to Medical Condition 293
Psychotic Disorder NOS (295), (298)
Schizoaffective Disorder (295), (298)
Schizophreniform Disorder (295), (298)
Substance-Induced Psychosis (295), (298)
Sexual and Gender Identity Disorder Paraphilias: (302)
Sexual Masochism (302)
Sexual Sadism (302)
Transvestic Fetishism (302)
Paraphilia NOS (302)
Sexual Dysfunction: (302)
Hypoactive Sexual Desire Disorder (302)
Female Orgasmic Disorder (302)
Male Orgasmic Disorder (302)
Premature Ejacualation (302)
Sexual Aversion Disorder (302)
Sexual Dysfunction due to a Medical Disorder (625)
Sexual Dysfunction due to a Substance (302)
Sexual Pain Disorders:
Dyspareunia (not due to a Medical Condition) (302)
Vaginismus (not due to a Medical Condition) (302)
Primary Insomnia (307)
Primary Hypersomnia (307)
Breathing-Related Sleep Disorder (780.5)
Circadian Rhythm Sleep Disorder (307.4)
Insomnia Related to Another Mental Disorder (307.4)
Nightmare Disorder (Dream Anxiety Disorder) (307.4)
Sleep Disorder Due to a Medical Condition (780.5)
Sleep Disorder Related to another Medical Condition (780.5)
Sleepwalking Disorder (780.5)
Substance-Induced Sleep Disorder (780.5)
Somatoform Disorders: Somatization Disorder ( 300.8)
Conversion Disorder ( 300.1)
Pain Disorder ( 307.8)
Hypochondriasis ( 300.7)
Body Dysmorphic Disorder ( 300.7)
Substance - Related Disorders: Substance-Induced Anxiety Disorder (303), (304), (305)
Substance-Induced Mood Disorder (303), (304), (305)
Substance-Induced Psychosis (292)
Substance-Induced Sleep Disorder (303), (304), (305)
Alcohol Dependence Syndrome (303)
Drug Dependence Syndrome (304)
Drug Abuse, Non-Dependent (305)
i) Payable a maximum of 4 times per calendar year per patient.
ii) Payable only if the Mental Health Planning Fee (G14043) has been previously billed and paid in the same calendar year by the same physician.
iii) Payable only to the physician paid for the GP Mental Health Planning Fee (G14043), unless that physician has agreed to share care with another delegated physician. To facilitate payment, the delegated physician should submit an electronic note.
iv) Not payable unless the age-appropriate 00120 series has been fully utilized.
v) Minimum time required is 20 minutes.
vi) Not payable on same day as G14043 (GP Mental Health Planning Fee), or G14079 GP telephone /e-mail management fee.
vii) G14016 (Community Patient Conferencing Fee) payable on same day for same patient if all criteria met.
viii) G14015 (Facility Patient Conferencing Fee) not payable on same day as facility patients not eligible.
ix) CDM fees (G14050, G14051, G14052, G14053) payable if all criteria met.
x) Not payable to physicians who are employed by or who are under contract to a facility and whose duties would otherwise include provision of this care.
xi) Not payable to physicians working under salary, service contract or sessional arrangements whose duties would otherwise include provision of this care.