Behavioral Health Covered Benefits
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- Valerie Eaton
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1 Behavioral Health Covered Benefits The matrix below lists the available behavioral health benefits for members enrolled in the Iowa Health and Wellness Plan. Outpatient Urinalysis Interactive complexity add-on code Psychiatric diagnostic interview Psychiatric diagnostic interview with medical Individual psychotherapy (20-30 ) Psychotherapy, with patient and/or family member with evaluation and management (E&M) Individual psychotherapy (45-50 ) Psychotherapy, with patient and/or family member with E&M Psychotherapy, Psychotherapy, with patient and/or family member with E&M Crisis psychotherapy (first 60 ) Crisis psychotherapy (each additional 30 ) Family therapy without patient Family therapy with patient IAPEC April 2017
2 Outpatient (cont.) Multi-family group counseling Group therapy Theralactic, prophylactic or diagnostic injection H0007 Alcohol and/or drug ; crisis intervention (outpatient and/or mobile) H0014 HG Alcohol and/or drug ; ambulatory detoxification H0037 Community psychiatric supportive treatment program (low intensity) H0037 TF Community psychiatric supportive treatment H0038 program (high intensity) Self-help/peer support: mental health per month H0038 HF Self-help/peer support: substance abuse (SA) per month H0040 Assertive community treatment H0049 Alcohol and/or drug Monthly per diem, per documents Monthly per diem, per documents screening S9123 Home health nursing One hour S9123 TF Psychiatric nursing visit One hour T1013 Interpreter 15 Q3014 GT Telemedicine Alcohol and/or SA structured screening and brief intervention ; Alcohol and/or SA structured screening and brief intervention ; greater than Home health nursing; Post-inpatient follow-up Per item Per item Page 2 of 6
3 Outpatient (cont.) U1 Mobile counseling, one hour Mobile counseling, single, family counseling TG Initial mobile counseling, follow-up S9485 TD Emergency nursing assessment One hour authorization if SA mental health (MH) diagnosis authorization if SA MH diagnosis authorization if SA MH diagnosis Intensive outpatient/partial hospitalization 0905 Intensive outpatient program (IOP), psychiatric 0906 IOP, SA/chemical dependency H0015 TG Intensive outpatient, SA with housing H0015 Intensive outpatient, SA H2012 Intensive outpatient day treatment, per hour One hour 0912 Partial hospitalization H0035 Partial hospitalization (MH, SA, eating disorder) Page 3 of 6
4 Applied behavioral analysis/behavioral health intervention (BHIS) G9012 HO/HP Case oversight and management of treatment team by licensed mental health professional or Board Certified Behavioral Analyst (BCBA), per 15 H0031 HO/HP Functional behavioral One hour assessment, per hour H2014 HO/HP/HN Skill development H2019 HO/HP/HN Skills training, child and adolescent H2019 HO/HP/HN Direct applied behavioral analysis, by a paraprofessional or BCBA provider, per 15 S5108 HO/HP/HN Home care training to home care client, per 15 H0032 HO/HP Functional behavioral 15 assessment, per 15 H2011 BHIS crisis intervention 15 H2014 HB Skill development, adult (individual > 21) H2014 HQ Skill development, adult (group > 21) H2019 HA Skill development, adult (individual < 21) H2019 HQ Skill development, adult (group < 21) H2019 HR Skills training, child and adolescent (family < 21) Page 4 of 6
5 Psychological testing Psychological testing with interpretation and report Developmental testing, limited Developmental testing, extended Neurobehavioral status examination Neuropsychological testing battery Neuropsychological testing administered by computer, after three units ER and inpatient 0450 ER MH and substance use (SU) 190 Inpatient psychiatric sub-acute hour observation 100, 114, 120, 124, 134, 144, 154, , 126, 136, 138, 146, 156, , 128, 138, bed Inpatient psychiatric (institutions of mental disease are allowed for members age 21 and under or 65 and older) 148, /90870 Electroconvulsive treatment Inpatient detoxification Inpatient SU treatment Page 5 of 6
6 Evaluation and management Procedure code Modifiers Service description Unit/event Authorization New patient Established patient Observation Hospital initial care Hospital subsequent care Hospital observation care Hospital discharge Inpatient consultation/evaluation Emergency department Page 6 of 6
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