2026 Psychiatry Coding and Coverage Guide
Aetna Commercial and Aetna Medicare Advantage - Las Vegas, Nevada
Use the exact member product, current eligibility and benefit, network, authorization, provider eligibility, service definition, POS, telehealth modality, diagnosis support, MUE, CCI, and documentation. A diagnosis or rate row alone does not establish payment.
99204
A - Active CodeNew-patient office visit with moderate-complexity decision making or at least 45 minutes
Medically appropriate history and/or examination plus moderate medical decision making, or select by at least 45 minutes of qualifying physician/QHP time on the date of service. Original Medicare recognizes this active office/outpatient E/M code when the service, patient status, medical necessity, POS, and documentation requirements are met.
1 covered diagnoses60 CCI relationshipssupplemental context
Scope and sources
MUE is a code-level CMS unit edit. It is not a benefit, coverage, authorization, diagnosis, or contracted-rate determination.
- Aetna CPB-0049 - Nutritional Counseling
- Aetna CPB-0158 - Neuropsychological and Psychological Testing
- Aetna CPB-0426 - Attention Deficit/Hyperactivity Disorder
- Aetna CPB-0469 - Transcranial Magnetic Stimulation and Cranial Electrical Stimulation
- Aetna CPB-0480 - Tourette's Syndrome
- Aetna CPB-0511 - Eating Disorders
- Aetna CPB-0512 - Premenstrual Syndrome and Premenstrual Dysphoric Disorder
- Aetna CPB-0648 - Autism Spectrum Disorders
- CMS Behavioral Health Integration Services, MLN909432, January 2026
- CMS Medicare and Mental Health Coverage, MLN1986542, March 2026
- CMS Advanced Primary Care Management Services
- Medicare NCD 210.8, Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
Broader reference material lives in the BH Resource Solution library.