DWMHA ASD Benefit Fee Schedule - Effective - 10/1/16

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Lizbeth Whitehead
6 years ago
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1 Psychiatric diagnostic evaluation witohout medical services. Assessmentes and Evaluations to determine eligibility for BHT/ABA Psychiatric diagnostic evaluation witohout medical services. Assessmentes and Evaluations to determine eligibility for BHT/ABA Encounter Psychiatrist or psychiatric mental health nurse practitioner $ Encounter Psychiatrist $ Add on code = Psychotherapy, 30 minutes with patient and/or Add-on Psychiatrist $ Add on code = Psychotherapy, 45 minutes with patient and/or Add-on Psychiatrist $ Add on code = Psychotherapy, 60 minutes with patient and/or Add-on Psychiatrist $ U5 Add on code = interactive complexity psychiatry services and procedures. (List separately in addition to the code for primary procedure.) Use with or Add-on Psychiatrist $ Psychological Testing, both face-to-face time administering tests to U5, AH the patient and time interpreting these tests and preparing the report. Hour Psychologist $ U5, HN Hour Psychological testing, with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face. U5, AJ Hour Mental health professional or Licensed bachelor s social worker or limited-licensed bachelor s acting within their scope of practice under the supervision of a Mental Health Professional who is a fully licensed master's social worker. Mental health professional or Master's social worker acting within their scope of practice under the supervision of a Mental Health Professional who is a fully licensed master's social worker. $ $ U5, AH Neuropsychological testing per hour of the psychologist's or physician's time, both face-to-face time administering tests to the Hour Psychologist $ patient and time interpreting these test results and preparing the report. U5, AH Neuropsychological testing with qualified health care professional Hour Psychologist $ interpretation and report, administered by technician, per hour of technician time, face-to-face.

2 0362X 0368X H0031 H T 0362T (+) 0363T 0368T (+) 0369T U5, AH Psychologist $ Evaluation to determine eligibility for BHT/ABA U5, AJ Encounter Clinical Social Worker $ (ADOS-2, ADIR, & DD-CGAS Combined) Doctoral Level Psychologist $ U5, AN, AH Psychologist $ Re-evaluation to determine eligibility for BHT/ABA U5, AN, AJ Encounter Clinical Social Worker $ (ADOS-2 & DD-CGAS Combined) U5, AN, HP Doctoral Level Psychologist $ U5, AH Psychologist $ U5, AJ Behavior Identification assessment: includes interprestation of Clinical Social Worker $ results and development of the behavioral plan of care. (ABLLS, Encounter Doctoral Level Provider $ U5, HO AFLS, VBMAPP) Other Master's Degree Provider $ U5, HN BCaBA $ U5, AJ Behavioral follow-up assessment (Functional Behavior First 30 Analysis/FBA) first 30 minutes U5, HO U5, AJ Behavioral follow-up assessment (Functional Behavior Each Additional 30 Analysis/FBA) (+) each additional 30 minutes U5, HO U5, AJ Adaptive behavior treatment with protocol modification and clinical observation & direction administered by qualified professional first First 30 U5, HO 30 minutes U5, AH, GT Psychologist $60.00 U5, AJ, GT Adaptive behavior treatment with protocol modification and clinical, GT observation & direction administered by qualified professional first First 30 U5, HO, GT 30 minutes - Delivered via telepractice U5 HN, GT BCaBA $42.50 U5, AJ Adaptive behavior treatment with protocol modification and clinical Each Additional 30 observation & direction administered by qualified professional (+) U5, HO each additional 30 minutes U5, AH, GT Psychologist $60.00 U5, AJ, GT Adaptive behavior treatment with protocol modification and clinical Each Additional 30, GT observation & direction administered by qualified professional (+) U5, HO, GT each additional 30 minutes - Delivered via telepractice U5 HN, GT BCaBA $42.50

3 0364X 0366X 0364T (+) 0365T 0366T (+) 0367T U5, TG, HM Behavior Technician (18+ Year Old) $27.50 U5, TG, HN Bachelor Degree Technician $27.50 U5, TG, AH Psychologist Technician $30.00 first 30 minutes (Comprehensive Treatment = 16+ Hours/Week First 30 U5, TG, AJ Clinical Social Worker Technician $30.00 U5, TG, HP Doctoral Level Technician $30.00 U5, TG, HO Other Master's Degree Technician $30.00 U5, TF, HM Behavior Technician (18+ Year Old) $27.50 U5, TF, HN Bachelor Degree Technician $27.50 U5, TF, AH Psychologist Technician $30.00 first 30 minutes (Focused Treatment = 1-15 Hours/Week First 30 U5, TF, AJ Clinical Social Worker Technician $30.00 U5, TF, HP Doctoral Level Technician $30.00 U5, TF, HO Other Master's Degree Technician $30.00 U5, TG, HM Behavior Technician (18+ Year Old) $27.50 U5, TG, HN Bachelor Degree Technician $27.50 U5, TG, AH Each Additional 30 Psychologist Technician $30.00 (+) each additional 30 minutes (Comprehensive Treatment = U5, TG, AJ Clinical Social Worker Technician $ Hours/Week U5, TG, HP Doctoral Level Technician $30.00 U5, TG, HO Other Master's Degree Technician $30.00 U5, TF, HM Behavior Technician (18+ Year Old) $27.50 U5, TF, HN Bachelor Degree Technician $27.50 U5, TF, AH Each Additional 30 Psychologist Technician $30.00 (+) each additional 30 minutes (Focused Treatment = 1-15 U5, TF, AJ Clinical Social Worker Technician $30.00 Hours/Week U5, TF, HP Doctoral Level Technician $30.00 U5, TF, HO Other Master's Degree Technician $30.00 U5, TG, HM Behavior Technician (18+ Year Old) $7.86 U5, TG, HN Bachelor Degree Technician $7.86 U5, TG, AH Psychologist Technician $8.57 technician first 30 minutes (8 consumer's max) (Comprehensive First 30 U5, TG, AJ Clinical Social Worker Technician $8.57 Treatment = 16+ Hours/Week U5, TG, HP Doctoral Level Technician $8.57 U5, TG, HO Other Master's Degree Technician $8.57 U5, TF, HM Behavior Technician (18+ Year Old) $7.86 U5, TF, HN Bachelor Degree Technician $7.86 U5, TF, AH Psychologist Technician $8.57 technician first 30 minutes (8 consumer's max) (Focused First 30 U5, TF, AJ Clinical Social Worker Technician $8.57 Treatment = 1-15 Hours/Week U5, TF, HP Doctoral Level Technician $8.57 U5, TF, HO Other Master's Degree Technician $8.57 U5, TG, HM Behavior Technician (18+ Year Old) $7.86 U5, TG, HN Bachelor Degree Technician $7.86 U5, TG, AH Each Additional 30 Psychologist Technician $8.57 technician (8 consumer's max) (+) each additional 30 minutes U5, TG, AJ Clinical Social Worker Technician $8.57 (Comprehensive Treatment = 16+ Hours/Week U5, TG, HP Doctoral Level Technician $8.57 U5, TG, HO Other Master's Degree Technician $8.57

4 (+) 0367T 0372T 0370T 0371T 0373T U5, TF, HM Behavior Technician (18+ Year Old) $7.86 U5, TF, HN Bachelor Degree Technician $7.86 U5, TF, AH Each Additional 30 Psychologist Technician $8.57 technician (8 consumer's max) (+) each additional 30 minutes U5, TF, AJ Clinical Social Worker Technician $8.57 (Focused Treatment = 1-15 Hours/Week U5, TF, HP Doctoral Level Technician $8.57 U5, TF, HO Other Master's Degree Technician $8.57 U5, AH Psychologist $51.43 U5, AJ Clinical Social Worker $51.43 Adaptive behavior treatment social skills group. Untimed typically Encounter Doctoral Level Provider $ (8 consumer's max) U5, HO Other Master's Degree Provider $51.43 U5, HN BCaBA $36.43 U5, AH Psychologist $ U5, AJ Clinical Social Worker $ Encounter professional. Untimed typically U5, HO Other Master's Degree Provider $ U5, HN BCaBA $85.00 U5, AH, HS Psychologist $ U5, AJ, HS Clinical Social Worker $120.00, HS Encounter professional. Untimed typically with Child Not Present U5, HO, HS Other Master's Degree Provider $ U5, HN, HS BCaBA $85.00 U5, AH, GT Psychologist $ U5, AJ, GT Clinical Social Worker $120.00, GT Encounter professional. Untimed typically Delivered via Telepractice U5, HO, GT Other Master's Degree Provider $ U5, HN, GT BCaBA $85.00 U5, AH, GT, HS Psychologist $ U5, AJ, GT, HS Clinical Social Worker $120.00, GT, HS professional. Untimed typically Delivered via Telepractice Encounter U5, HO, GT, HS with Child Not Present Other Master's Degree Provider $ U5, HN, GT, HS BCaBA $85.00 U5, AH Psychologist $72.00 U5, AJ Multiple family behavior treatment guidance administered by Clinical Social Worker $72.00 qualified professional. Untimed typically (8 consumer's Encounter Doctoral Level Provider $72.00 U5, HO max) Other Master's Degree Provider $72.00 U5, HN BCaBA $51.00 U5, AH, HS Psychologist $72.00 U5, AJ, HS Multiple family behavior treatment guidance administered by Clinical Social Worker $72.00, HS qualified professional. Untimed typically (8 consumer's Encounter Doctoral Level Provider $72.00 U5, HO, HS max) with Child Not Present Other Master's Degree Provider $72.00 U5, HN, HS BCaBA $51.00 U5, TG, HM Behavior Technician $ Exposure adaptive behavior treatment with protocol modification U5, TG, AH Clinical Psychologist Degree Behavior Technician $ requiring two or more technicians for severe maladaptive U5, TG, AJ Clinical Social Worker Degree Behavior Technician $ behavior(s); first 60 minutes of technician's time, face to face 1st 60 U5, TG, HN Bachelor Degree Behavior Technician $ with child. (Comprehensive Treatment = 16+ Hours/Week U5, TG, HP Doctoral Level Technician $ U5, TG, HO Other MA Degree Behavior Technician $120.00

5 0373X 0373T (+) 0374T (+) 0374T U5, TF, HM Behavior Technician $ Exposure adaptive behavior treatment with protocol modification U5, TF, AH Clinical Psychologist Degree Behavior Technician $ requiring two or more technicians for severe maladaptive U5, TF, AJ Clinical Social Worker Degree Behavior Technician $ behavior(s); first 60 minutes of technician's time, face to face 1st 60 U5, TF, HN Bachelor Degree Behavior Technician $ with child. (Focused Treatment = 1-15 Hours/Week U5, TF, HP Doctoral Level Technician $ U5, TF, HO Other MA Degree Behavior Technician $ U5, TG, HM Behavior Technician $55.00 U5, TG, AH Exposure adaptive behavior treatment with protocol modification Clinical Psychologist Degree Behavior Technician $60.00 & (+) each U5, TG, AJ requiring two or more technicians for severe maladaptive Clinical Social Worker Degree Behavior Technician $60.00 additional 30 U5, TG, HN behavior(s); (+) each additional 30 minutes. (Comprehensive Bachelor Degree Behavior Technician $55.00 minutes U5, TG, HP Treatment = 16+ Hours/Week Doctoral Level Technician $60.00 U5, TG, HO Other MA Degree Behavior Technician $60.00 U5, TF, HM Behavior Technician $55.00 U5, TF, AH Exposure adaptive behavior treatment with protocol modification Clinical Psychologist Degree Behavior Technician $60.00 & (+) each U5, TF, AJ requiring two or more technicians for severe maladaptive Clinical Social Worker Degree Behavior Technician $60.00 additional 30 U5, TF, HN behavior(s); (+) each additional 30 minutes. (Focused Bachelor Degree Behavior Technician $55.00 minutes U5, TF, HP Treatment = 1-15 Hours/Week Doctoral Level Technician $60.00 U5, TF, HO Other MA Degree Behavior Technician $60.00

SPECIALIZED BEHAVIORAL HEALTH SERVICES - CPT Codes (V2 Effective ) HA=Child. Modifier >

SPECIALIZED BEHAVIORAL HEALTH SERVICES - CPT Codes (V2 Effective 1.1.18) Code Description Age Psychiatrist APRN/CNS/PA Medical Psychologist Psychologist LCSW LPC LMFT LAC HA=Child Modifier > HB=Adult AF