TBH Medicaid Participating Provider ARQ Page 1

Transcription

1 TBH Medicaid Participating Provider ARQ Page 1 Room & Board Inpatient Interactive complexity code Room & Board Inpatient Psych Per Diem Psychiatric diagnostic evaluation Psychiatric diagnostic evaluation with medical services Psychotherapy, 30 with patient and/or family member (16-37 ) Psychotherapy, 30 with patient and/or family member Psychotherapy, 45 with patient and/or family member ( ) Psychotherapy, 45 with patient and/or family member Psychotherapy, 60 with patient and/or family member. (53+ ) Psychotherapy, 60 with patient and/or family member Psychotherapy for crisis, first 60 Psychotherapy for crisis(each additional 30 ) separately in addition to primary service CPT code. Family Psychotherapy (without the patient present) (53+ Min) Family Psychotherapy (with the patient present) (53+ Min) Multiple-family group psychotherapy Multiple-family group psychotherapy Group psychotherapy (85+ Min) Electroconvulsive therapy (includes necessary monitoring) Environmental intervention for medical management purposes on a psychiatric patient's behalf with external agencies, employers, or institutions Explanation of psychiatric, medical examinations, procedures, and data to external sources other than patient Explanation of psychiatric, medical examinations, procedures, and data to other than patient Psychological testing with interpretation and report by psychologist or physician per hour Neuro-psychological testing with interpretation and report by psychologist or physician per hour Health and behavior assessment each Health and behavior re-assessment each Health and behavior intervention, individual each Health and behavior intervention, group each 15. Health and behavior intervention, family and patient each Acupuncture, 1 or more needles; without electrical stimulation, initial 15 of personal one-on-one contact with the patient. Acupuncture, 1 or more needles; without electrical stimulation, additional 15 of personal one-on-one contact with the patient, with re-insertion of the needle(s).

2 TBH Medicaid Participating Provider ARQ Page Acupuncture, 1 or more needles; with electrical stimulation, initial 15 of personal one-on-one contact with the patient. Acupuncture, 1 or more needles; with electrical stimulation, additional 15 of personal one-on-one contact with the patient, with reinsertion of the needle(s). Telephone assessment and management service, of medical discussion with patient Internet or similar electronic online patient assessment and management service by qualified non-physician health care professional, greater than New patient office or other outpatient visit, typically Newpatient office or other outpatient visit, typically New patient office or other outpatient visit, typically G0176 New patient office or other outpatient visit, typically 25 New patient office or other outpatient visit, typically 40 Established patient office or other outpatient visit, typically 5 Established patient office or other outpatient visit, typically 10 Established patient office or other outpatient visit, typically 15 Established patient office or other outpatient visit, typically 25 Established patient office or other outpatient visit, typically 40 up to 10 greater than 10 greater than 10 Telephone E&M service, 5-10 of medical discussion Telephone E&M service, of medical discussion Telephone E&M service, of medical discussion Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 or more), diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized G0177 Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 or more) H0001 H0002 H0004 Alcohol and/or Drug Assessment Behavioral Health screening to determine eligibility for admission to treatment program(s) Behavioral health counseling and therapy, per 15 H0004 H0005 Behavioral health counseling and therapy, per 15 Alcohol and/or drug services; group counseling by a clinician

3 TBH Medicaid Participating Provider ARQ Page 3 H0006 H0010 H0011 H0012 H0013 H0014 H0015 H0016 H0017 H0018 H0018 Alcohol and/or drug services; Case Management Alcohol/Drug services; sub-acute, medically monitored detoxification. (as an alternative to inpatient ASAM Level III.7-D) Alcohol/Drug services; Acute, medically monitored detoxification. (as an alternative to inpatient ASAM Level III.7-D) Alcohol/Drug services; Sub-acute, clinically managed detoxification. (outpatient ASAM Level III.2-D) Alcohol/Drug services; Acute clinically managed detoxification. (outpatient ASAM Level III.2-D) Ambulatory detoxification service for mild to moderate withdrawal from substance abuse (Ambulatory ASAM Level II-D) Alcohol and/or drug services; Intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan). Alcohol and/or drug services; Medical/somatic intervention in ambulatory setting Behavioral health, residential (hospital residential treatment program), without room and board, per diem Adolescent A&D residential treatment without room and board. Short term 30 days or less Adult A&D residential treatment without room and board. Short term 30 days or less. Adolescent A&D residential treatment without room and board. Long term longer than 30 days Adult A&D residential treatment without room and board. Long term longer than 30 days Behavioral health, long term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem H0020 H0023 H0031 H0032 Alcohol and/or drug services; Methadone administration and/or services (provision of the drug by licensed program) (Ambulatory) Behavioral Health Outreach (planned approach to reach a targeted population) Mental health assessment, by non-physician. Mental health service plan development by non-physician., diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized H0034 H0035 H0035 H0036 H0037 H0038 H0038 H0039 H0045 H0048 Medication training and support, per 15. Mental Health Partial Hospitalization, less than 24 hours Mental Health Partial Hospitalization, less than 24 hours Community psychiatric supportive treatment, face-to-face, per 15. Community psychiatric supportive treatment program, per diem Self-help/peer services, per 15 min Self-help/peer services, per 15 min Assertive community treatment, face-to-face, per 15. Respite care services, not in the home, per diem Alcohol and/or drug testing; Collection and handling only, specimens other than blood, diagnosis and service code must pair on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized

4 TBH Medicaid Participating Provider ARQ Page 4 H2000 H2000 H2010 H2011 H2012 H2013 Child and Adolescent Needs Survey (CANS) Mental health assessment, by non-physician with CANS. (Not allowed if there is a MH assessment or psychiatric diagnostic assessment within previous 90 days) Comprehensive medication services, per 15 min May also be provided by a specially trained and licensed Pharmacist Crisis intervention services, per 15 min Behavioral Health Day Treatment, per hour Psychiatric health facility service, per diem, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized H2014 H2016 H2016 H2021 H2022 H2023 Skills training and development, 15 min Comprehensive community support services, per diem Comprehensive community support services, per diem Community based wraparound services, per 15 min Community based wraparound services, per diem Supported employment, per 15 min, covered benefit with a funded diagnosis on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized H2027 H2032 H2033 S5151 S9453 S9480 S9484 T1005 T1006 T1016 T1502 T T 0362T 0363T 0364T Psycho-educational service, per 15 min Activity therapy, per 15 min Multi-systemic therapy for juveniles, (Evidenced Based) per 15 min Unskilled respite care, not hospice, per diem Smoking cessation classes, non-physician provider, per session Intensive outpatient psychiatric services, per diem Crisis Intervention Mental Health Services, per hour Respite care services, up to 15 min Alcohol and/or substance abuse services; Family/couple counseling, (60 min) Case management, external contact only, per 15 min Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter Description Behavior identification assessment + plan of care Exposure behavioral follow-up assessment first 30 Exposure behavioral follow-up assessment each additional 30 Behavior treatment by protocol administered by technician first 30, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized, diagnosis and service code must pair on OHP Prioritized, covered benefit with a funded diagnosis on OHP Prioritized No Prior auth APPLIED BEHAVIOR ANALYSIS PROCEDURE S

5 TBH Medicaid Participating Provider ARQ Page T 0366T 0368T 0369T 0370T Behavior treatment by protocol administered by technician each additional 30 first 30 additional 30 / Two recipients additional 30 /Three recipients additional 30 / Four recipients additional 30 / Five recipients Behavior treatment with protocol modification administered by physician or other qualified health care professional first 30 Behavior treatment with protocol modification administered by physician or other qualified health care professional each additional 30 health care professional min health care professional min. / One Family health care professional min. / Two Families health care professional min. / Three Families health care professional min. / Four Families health care professional min. / Five Families Medical team conference with patient and/or family, and nonphysician health care professionals, 30 or more Medical team conference with nonphysician health care professionals, 30 or more