Updated: July 1, 2008
Specialized Services for Nursing Facility Participants – Idaho Medicaid
Psychotherapy (Mental Health Clinic Providers)
Procedure Code / Mod / Description / Allowed Amt.90847 / U4 / Family Medical Psychotherapy for Nursing Facility Participants (1 unit = 15 minutes) / $13.52
90847 / U4/U1 / Family Medical Psychotherapy for Nursing Facility Participants (by Physician) (1 unit = 15 minutes) / $29.33
90853 / U4 / Group Medical Psychotherapy for Nursing Facility Participants (1 unit = 15 minutes) / $4.10
90853 / U4/U1 / Group Medical Psychotherapy for Nursing Facility Participants (by Physician) (1 unit = 15 minutes) / $8.90
90857 / U4 / Group Interactive Psychotherapy for Nursing Facility Participants (1 unit = 15 minutes) / $4.38
90857 / U4/U1 / Group Interactive Psychotherapy for Nursing Facility Participants (by Physician) (1 unit = 15 minutes) / $9.50
90899 / U4 / Individual Interactive Psychotherapy – Nursing Facility Participants (1 unit = 15 minutes) / $17.62
H0004 / U4 / Individual Psychotherapy – Nursing Facility Participants
(1 unit = 15 minutes) / $13.52
H0004 / U4/U1 / Individual Psychotherapy for Nursing Home Participants
(by Physician) (1 unit = 15 minutes) / $29.33
Developmental Therapy/Psychotherapy (Rehab Mental Health Providers)
Procedure Code / Mod / Description / Allowed Amt.90847 / U4 / Family Psychotherapy for Nursing Facility Participants
(1 unit = 15 minutes) / $13.52
90847 / U4/U1 / Family Psychotherapy for Nursing Facility Participants
(by Physician) (1 unit = 15 minutes) / $29.33
90853 / U4 / Group Medical Psychotherapy for Nursing Facility Participants
(1 unit = 15 minutes) / $4.10
90853 / U4/U1 / Group Medical Psychotherapy for Nursing Facility Participants
(by Physician) (1 unit = 15 minutes) / $8.90
90857 / U4 / Group Interactive Psychotherapy for Nursing Facility Participants (1 unit = 15 minutes) / $4.38
90857 / U4/U1 / Group Interactive Psychotherapy for Nursing Facility Participants (by Physician) (1 unit = 15 minutes) / $9.50
90899 / U4 / Individual Interactive Psychotherapy – Nursing Facility Participants (1 unit = 15 minutes) / $17.62
H0004 / U4 / Individual Psychotherapy for Nursing Home Participants / $13.52
H0004 / U4/U1 / Individual Psychotherapy for Nursing Home Participants
(by Physician) (1 unit = 15 minutes) / $29.33
If you have any questions please contact Gynna Loper, Idaho Medicaid Office of Reimbursement Policy, at (208) 364-1994 or email at