At DFW Physicians Medical Associates, transparency in healthcare isn’t just a goal: it’s a promise. As CEO, I believe every patient deserves to understand not only their care but also how it’s billed. Medical codes can be confusing, and we want to change that. That’s why we’ve created this resource to clearly explain the most common billing codes used across our Behavioral Health and Primary Care teams. Whether you’re new to our practice or a returning patient, my hope is that this guide helps you feel more confident, informed, and supported at every step of your care journey.
— D Brandt, CEO
DFW Physicians Medical Associates
DFWPMA BH of Corpus Christi
Q3014 / “Rural Health Code”: This code ensures proper reimbursement for care provided to underserved populations. Q3014 is billed to all patients, regardless of the specialty you see.
Why is this code billed?
DFWPMA serves Rural and non-rural counties. Q3014 identifies the locations of our clinics.
99203/99204/99205: These codes cover the evaluation and management of new patients, requiring a detailed history, comprehensive examination, and high-level medical decision-making for acute or chronic conditions.
Why is this code billed?
These codes are used for your first visit with DFWPMA. Whether you are seeing one of our behavioral health providers or any other specialty, this code is only used once within a three year period with DFWPMA. Each code is used for a different duration of time:
99203: 30 – 44 minute initial visit
99204: 45 – 59 minute initial visit
99205: 60 minutes or more initial visit
99213/99214/99215: These codes cover the evaluation and management (E/M) service for established patients in an office or outpatient setting.
Why is this code billed?
These codes are used for every subsequent visit after your first visit. Whether you are seeing one of our behavioral healthcare providers or any other specialty, these codes will be used for every visit. Each code is used for a different duration of time:
99213: 20 – 29 minute subsequent visit
99214: 30 – 39 minute subsequent visit
99215: 40 minute or more visit.
Please note that all codes listed in this section are never billed to the patient. They are only used to bill your insurance for the clinical and administrative sides of managing your healthcare.
Integrated Behavioral Health (IBH) refers to the process of blending mental and physical health. The goal is to improve health outcomes by providing coordinated care that considers the interplay between medical conditions and mental health factors.
99484: This code covers at least 20 minutes of clinical staff time per calendar month directed by a physician or qualified healthcare professional. This includes services like medication management, clinical decision-making, and continuity of care with a designated care team member.
Why is this code billed?
This code covers the time that your healthcare provider spends on your healthcare outside of your appointment. For example: Communicating with other providers both in and outside of DFWPMA, such as monitoring progress or coordinating treatment.
90792: This code covers a Psychiatric Diagnostic Interview Examination. This comprehensive assessment includes medical and psychiatric history, mental status examination, and recommendations for care and treatment.
Why is this code billed?
This code is billed when evaluation of a patient’s mental health is required. Some examples include: Prescribing medication and/or referring additional mental health services.
96127: This code covers brief emotional or behavioral assessments, such as depression screening or substance use evaluations. Proper documentation and scoring of standardized tools are essential for this code.
Why is this code billed?
This code is billed when a quick screening for conditions like anxiety, depression, anxiety, etc, is completed. These are typically done using standardized questionnaires or checklists to identify emotional or behavioral conditions that would require additional treatment.
96112: This code is used for developmental testing, including assessments of cognitive, motor, communication, and social skills. These evaluations are vital for diagnosing developmental delays and behavioral disorders.
Why is this code billed?
This code covers one hour of the administration of behavioral health, such as identifying disorders, and scoring tests that assist in diagnosing mental health disorders.
99492: This code covers the first 70 minutes of psychiatric collaborative care management in the first calendar year month, involving consultation with a psychiatric consultant and coordination by the treating physician.
Why is this code billed?
This code is billed where there is a high level of medical decision making and coordinating with other healthcare professionals to ensure you get the best possible care from all angles.
99493: This code follows 99492 through all subsequent months, covering the first 60 minutes of collaborative care management activities.
Why is this code billed?
This code is billed after the initial 99492 and reflects the continued and long term care we provide to our patients.
99494: This code covers each additional 30-minute increments of collaborative care management and is used alongside codes 99492 or 99493.
Why is this code billed?
This code is billed to properly account for the time spent on collaborative care management activities.
Please note that all codes listed in this section are never billed to the patient. They are only used to bill your insurance for the clinical and administrative sides of managing your healthcare.
Chronic Care Management (CCM) refers to the coordination of care for individuals with multiple chronic or long-term conditions through personalized wellness plans, ongoing education, and engagement.
99487: This code covers 60 minutes of complex chronic care management for patients with two or more chronic conditions requiring moderate or high complexity decision making.
Why is this code billed?
Like IBH, CCM requires a high level of collaborative care to ensure that our patients get the best possible care. This code is for our patients dealing with long-term conditions such as anxiety and depression.
99489: This code covers each additional 30-minute increments of complex chronic care management and is used alongside 99487.
Why is this code billed?
This code is billed to properly account for the time spent on collaborative care management activities.
We hope this breakdown helps you better understand the services and care provided by our team at DFW Physicians Medical Associates and our subsidiary DFWPMA BH of Corpus Christi. If you have any questions or concerns, please don’t hesitate to reach out to us at (903)957-0082.
