Authorizations for Services that require an authorization must be submitted prior to services being delivered.

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Buddy Townsend
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1 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review 100 All inclusive room and board All inclusive room and board Anesthesia, ECT Room and Board- private psychiatric Room and Board- private room detoxification Room and Board- private rehabilitation Residential Treatment Room and Board -semi private psychiatric Room and Board - semi private rehabilitation Room and Board bed psychiatric Room and Board- 3-4 bed detoxification Room and Board bed rehabilitation Room and board private psychiatric Room and board private- detoxification Room and Board- ward psychiatric Room and Board- detoxification ward Room and Board- ward rehabilitation leave of absence from residential Therapeutic home time Sub Acute Inpatient Intensive Care -psychiatric Intensive Care -psychiatric 0 PRO_14033E Internal Approved NJ8PROLTR14033E_0000

2 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review 450 Emergency Room 451 Emergency Room 510 Clinic encounter all inclusive Facility 513 Psych clinic Facility 516 Urgent Care Clinic Facility Other clinic- med supervised withdrawal Facility Freestanding clinic Facility 521 Rural Clinic Facility 529 Other freestanding clinic Facility 900 BH treatment services 901 ECT- electroshock treatment Intensive Outpatient - providers should be instructed to use proper code with 915 Facility Intensive Outpatient - providers should be instructed to use proper code with 915 Facility BH treatment services Facility Substance abuse rehabilitation Facility 914 Psychiatric/Psychological Services- Individual therapy Facility 916 Psychiatric/Psychological Services- Family therapy Facility 917 Biofeedback Testing Facility Off Psychological Testing 919 Other BH treatment services Facility Off Medication Monitoring

3 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review 944 Drug Rehabilitation 945 Alcohol Rehabilitation 1001 Behavioral Health Residential- psychiatric Detox - Docimillary (DASA) Interactive complexity add-on code MD, NP 26, SA, 2A 26, Psychiatric diagnostic evaluation (no MD,NP,PHD, LICENSE UC medical Services) MASTER CLINICIAN Intake and Assessment: Psychiatric 26, SA, 2A 26, Diagnostic Evaluation (with no medical UC, HF services) 26, SA, 2A 26, Psychiatric diagnostic evaluation with UC, HF medical services MD, NP 26, SA, UC, MD,NP,PHD, LICENSE HF Psychotherapy, 30 mins MASTER CLINICIAN At visit min psychotherapy add on code when performed with E/M Service- (list MD,NP SA, UC, HF separately) , SA, UC, HF SA, UC, HF Psychotherapy, 45 mins 45 minute psychotherapy add on code when performed with E/M Service (list separately) Psychotherapy, 60 mins MD,NP,PHD, LICENSE MASTER CLINICIAN At visit 21 MD,NP MD,NP,PHD, LICENSE MASTER CLINICIAN At visit 21

Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review 60 min

4 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review 60 min psychotherapy when performed MD,NP,PHD, LICENSE with E/M service (list separately MASTER CLINICIAN MD,NP,PHD, LICENSE Psychotherapy for crisis, first 60 min. MASTER CLINICIAN At visit 21 crisis code add on for each additional 30 MD,NP,PHD, LICENSE min. MASTER CLINICIAN MD,NP,PHD, LICENSE Psychoanalysis MASTER CLINICIAN Family Psychotherapy, without patient PHD, LICENSED present MASTER CLINICIAN At visit 21 PHD, LICENSED UC, HF Family Psychotherapy, 45 min MASTER CLINICIAN At visit 21 PHD, LICENSED Multiple-family group psychotherapy MASTER CLINICIAN At visit 21 At visit 21 PHD, LICENSED 90 min & up to 12 people in substance abuse MASTER CLINICIAN SA, UC, HF Group psychotherapy facility Pharmacologic management, add on code MD,NP Narcosynthesis Therapeutic Repetitive Transcranial (TMS) Therapeutic Repetitive Transcranial (TMS) Therapeutic Repetitive Transcranial (TMS) 0

5 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Electroconvulsive Therapy 0 Ind psycho therapy incorporating bio MD feedback 30 min Ind psycho therapy incorporating bio MD feedback 45 min Hypnotherapy MD Complex care management Psych eval of hospital records MD Interpretation or explan of results of psych MD, NP, PHD, At visit 21 exam and procedures Outpatient LICENSED MASTER Group Therapy- 20 min; Family conference ( UC, SA, HF Collateral, 15 min. CLINICIAN min) Prep of report of pt psych status MD Unlisted Psychiatric procedure comp.comput.motion analysis Functional brain mapping Psychological testing after 5 Hours Psychological testing after 5 Hours Psychological testing after 5 Hours Assessment of Aphasia of speech/lang Developmental screening with interp Developmental testing after 5 Hours Neurobehavioral status exam w clin assess after 5 Hours Neuropsychological Testing per hour after 5 Hours Neuropsych Testing Admin by Technician per hour after 5 Hours

6 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Neuropsych Testing Admin by Computer per occurrence after 5 Hours Standardized cognitive perf testing after 5 Hours Brief emotional needs assessment Nursing Assessment and Care-Initial Nursing Assessment and Care-Re Assessment H&B individual intervention H&B group intervention Health & Behavior Intervention with patient present Health & Behavior Intervention without patient present Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument Medication administration Community integration counseling 0

7 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Services rendered after hours Office Emergency Services HF New Patient Office Visit Level 1 MD,NP HF New Patient Office Visit Level 2 MD,NP New Patient Office Visit Level 3 MD,NP New Patient Office Visit Level 4 MD,NP New Patient Office Visit Level 5 MD,NP HF Est Patient Office Visit Level 1 MD,NP Est Patient Office Visit Level 2 MD,NP Est Patient Office Visit Level 3 MD,NP Est Patient Office Visit Level 4 MD,NP Est Patient Office Visit Level 5 MD,NP Initial Hospital Care-comprehensive; low complexity MD,NP Initial Hospital Care-comprehensive; moderate complexity MD,NP Initial Hospital Care-comprehensive; high complexity MD,NP Subsequent observation Care Subsequent observation Care Subsequent observation Care Subsequent Hospital Care-focused; low complexity MD,NP Subsequent Hospital Care-focused; moderate complexity MD,NP

8 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Subsequent Hospital Care-focused; high complexity MD,NP Observation-comprehensive; low complexity MD,NP Observation-comprehensive; moderate complexity MD,NP Observation-comprehensive; high complexity MD,NP Discharge Day Management- 30 min or less MD,NP Discharge Day Management-more than min MD,NP Problem focused; straightforward-15 min Expanded; straightforward-30 min Detailed; low complexity-40 min Comprehensive; moderate complexity-60 min Comprehensive; high complexity-80 min Initial Consultation-focused, straightforward MD,NP Initial Consultation-expanded, straightforward MD,NP Initial Consultation-detailed, low complexity MD,NP

9 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Initial Consultation-comprehensive, moderate complexity MD,NP Initial Consultation-comprehensive, high complexity MD,NP ER Consultation-focused, straightforward MD,NP ER Consultation-expanded; low complexity MD,NP ER Consultation-expanded; moderate complexity MD,NP ER Consultation-detailed; moderate complexity MD,NP ER Consultation-comprehensive; high complexity MD,NP Nursing facility consultation 25 min Nursing facility consultation 35 min Nursing facility consultation 45 min Evaluation Management nursing facility 10 min Evaluation Management nursing facility 15 min Evaluation Management nursing facility 25 min Evaluation Management nursing facility 35 min Home visit, new patient

10 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Home visit, new patient Home visit, new patient Home visit, new patient Home visit, new patient Home visit, est patient Home visit, est patient Home visit, est patient Home visit, est patient Prolonged evaluation and mgmt psycho therapy svs Prolonged evaluation and mgmt psycho therapy svs Medical team conference Medical team conference with family Medical team conference without family MD,NP, PHD,MASTER Preventive counseling, individual LICENSED CLINICIAN Preventive counseling, individual 30 min Preventive counseling, individual 45 min MD,NP, PHD,MASTER Preventive counseling, individual LICENSED CLINICIAN Smoking cessation Smoking cessation Alcohol substance abuse BH change intervention

11 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Alcohol and substance abuse screening and brief intervention Preventive counseling, individual 60 min Preventive medicine group counseling min Home visit, single, family counseling 0359T Behavior Identification Assessment (ABA) 0 Observational Behavioral Follow-up 0360T & 0361T Assessment T, 0363T Exposure Behavioral Follow-up Assessment T, 0365T Adaptive Behavior Treatment By Protocol T Group adaptive behavior treatment by protocol, In-Clinic T Group adaptive behavior treatment by protocol, Additional 30 mins T & 0369T Adaptive Behavior Treatment With Protocol Modification T Family Adaptive Behavior Treatment Guidance T Multiple-family group adaptive behavior treatment guidance, In-Clinic T Adaptive behavior treatment social skills group, In-Clinic 0

12 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Exposure adaptive behavior treatment with 0373T protocol modification, In-Clinic 0 Exposure adaptive behavior treatment with protocol modification Additional 30 mins, 0374T In-Clinic 0 Community behavioral program (day 907, H2012 treatment) and G0410, G0411, or H0035 Partial Hospitalization 0 915, H0015 BH intensive outpatient substance abuse 0 915, S9480 BH intensive outpatient psychiatric 0 Recreation, related to the care and treatment of patients disabling mental health problems; per session (45 minutes G0176 or more) G0177 G0396 Training and educational services related to the care and treatment of patients disabling mental health problems per session (45 minutes or more) Alcohol/subs interv 15-30mn

13 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review G0397 Alcohol/subs interv >30 min Social work and psychological services, directly relating to and/or furthering the G0409 patient s rehabilitation goals Interactive group psychotherapy, in a partial hospitalization setting, G0410 approximately 45 to 50 minutes 0 Interactive group psychotherapy, in a partial hospitalization setting, G0411 approximately 45 to 50 minutes 0 G0436 Tobacco-use counsel 3-10 min G0437 Tobacco-use counsel>10min G0442 Annual alcohol misuse screening 15 min Alcohol mis use and screening -various markets; Iowa=face to face BH counseling- G min G0444 Depression Screening G0445 High intensity BH counseling 30 min G0446 Intensive BH therapy G0447 Face to face behavioral counseling-15 min G0451 Developmental testing with I & R G0463 Hospital outpatient clinic visit

14 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review G0473 Face to face behavioral counseling 15 min H0001 Alcohol and/or drug assessment Behavioral Health Screen to determine eligibility for admission to treatment H0002 program Alcohol and/or drug screening; laboratory analysis of specimens for presence of H0003 HF alcohol or drugs Behavioral health counseling and therapy; H0004 per 15 minutes Alcohol and/or drug services; group H0005 counseling by a clinician H0006 Alcohol and/or drug services; case management H0007 Alcohol and/or drug services; crisis intervention (outpatient) H0008 Alcohol and/or drug services; sub acute detoxification (outpatient) 0 H0009 Alcohol and/or drug services; acute detoxification (hospital inpatient) 0.

15 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Alcohol and/or drug services; sub-acute Med Nec Criteria = SUD - Residential (covered detoxification (residential addiction Medicaid recipients aged 21 and younger and 65 H0010 HF program inpatient) and older) Alcohol and/or drug services; acute detoxification (residential addiction H0011 program inpatient) 0 Alcohol and/or drug services; sub-acute detoxification (residential addiction H0012 program outpatient) 0 H0013 Alcohol and/or drug services; acute 0 Alcohol and/or drug services; ambulatory H0014 detoxification 0 H0015 H0016 H0017 HF HF Alcohol and/or drug services; intensive outpatient treatment (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan) including assessment, counseling, crisis intervention, and activity therapies or education 0 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) 0 Behavioral health; residential (hospital residential treatment program), without room and board; per diem 0

16 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review REQUIREMENT CODE MODIFIER LEVEL OF CARE PROVIDER TYPE Behavioral health; short-term residential (non hospital residential treatment program), without room and board; per H0018 HF diem Behavioral health; long term residential (non-medical, non-acute care in a U1, U1 52, residential treatment program where stay U2, U3, U3 is typically longer than 30 days), without H , U5 room and board; per diem Alcohol and/or drug services; methadone administration and/or service (provisions of the drug by a licensed program) Med Nec Criteria = SUD - Residential (covered Medicaid recipients aged 21 and younger and 65 and older) Group home, currently no MN criteria, managed by market for LTSS only. Opioid treatement methadone - wkly bundled rate & methadone medication/dispensing (per diem) H0020 HF, HF 26 H0021 U1, U1 52, U2, U3, U3 52, U5 Alcohol and Drug training service for staff Alcohol and/or drug intervention service H0022 HF, HF 26 (planned facilitation) H0023 Behavioral health outreach service Behavioral health prevention information dissemination service (one way direct or non-direct contact with service audiences H0024 to affect knowledge and attitude); 15 minutes

17 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Behavioral health prevention education service (delivered of services with target population to affect knowledge, attitude H0025 and/or behavior); 15 minutes Alcohol and/or drug intervention service H0026 (planned facilitation) H0027 Alcohol and drug prevention service H0028 Alcohol and/or drug prevention problem identification and referral service Alcohol and/or drug prevention alternatives service (services for H0029 populations that exclude alcohol and other drug use e.g. alcohol free social events) H0030 Behavioral health hotline service Mental health assessment, by nonphysician H0031 Mental health service plan development by H0032 non-physician **opioid treatment non-methadone - weekly Oral medication administration, direct bundled rate; AND **non-methadone H0033 HF, HF 26 observation Off medication/dispensing (per diem) Medication training and support; per 15 H0034 minutes

18 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review REQUIREMENT CODE MODIFIER LEVEL OF CARE PROVIDER TYPE Mental health partial hospitalization, H0035 HF, HF 26 treatment, less than 24 hours H0036 H0037 H0038 H0039 HQ 52, 52, HQ, HM, HM Community psychiatric supportive HQ treatment, face to face Community psychiatric supportive treatment program; per diem HQ 52, 52, HQ, HM, HM HQ HN HQ, HN, HQ TE, TE Self-help/peer services; per 15 minutes Assertive Community Treatment; per 15 min Partial Care (Per Hour; Max of 5 hours/day). 2 yr Associate degree group (15 min unit) & HS, peer group/indiv (15 min unit) 0 Bachelor group (15 min unit) & LPN individual (15 min unit) H Assertive Community Treatment; per diem Monthly rate; 2 hrs per month HN HQ, HN, H0041 HQ TE, TE Foster Care child, non therapeutic per diem H Foster Care child, non therapeutic per month H0043 Supported housing; per diem H0044 Supported housing; per month Respite care services, not in the home; per H0045 diem H0046 Mental Health Services NOS

19 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Alcohol and drug services not otherwise H0047 specified 0 Alcohol and/or other drug testing: collection and handling only, specimens H0048 other than blood H0049 Alcohol and/or drug Screening Alcohol and/or Drug Service, Brief H0050 Intervention; per 15 minutes H1000 Prenatal care, at-risk assessment Prenatal care, at-risk enhanced service; H1001 antepartum management Prenatal care, at risk enhanced service; H1002 care coordination Prenatal care, at-risk enhanced service; H1003 education Prenatal care, at-risk enhanced service; H1004 follow-up home visit Prenatal care, at-risk enhanced service H1005 package (includes H1001-H Non-medical family planning education; H1010 per session Family assessment by licensed behavioral health professional for state defined H1011 purposes

20 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review H2000 HE Comprehensive multidisciplinary evaluation APN individual, physician individual (15 min unit) H2001 Rehab program 1/2 day H2010 Comprehensive medication services; per 15 H2011 Crisis Intervention Services; per 15 Minutes. H2012 HE Behavioral health day treatment; per hour 0 H2013 H2014 H2015 He, HE HO, HE TD Psychiatric health facility service per diem Skills training and development; per 15 minutes Comprehensive community support services; per 15 minutes 0.. Master's, licensed professional of the healing arts indvidual, RN, psychologist

21 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review H2016 H2017 H2018 H2019 H2020 H2021 He, HE HO, HE TD Comprehensive community support services; per diem Psychosocial rehabilitation services; per 15 minutes Psychosocial rehabilitation services; per diem Therapeutic behavioral services; per 15 minutes Therapeutic behavioral services; per diem In NE Therapeutic group home Community-based wrap-around services; per 15 min. 0. Community-based wrap-around services; H2022 per diem (intensive in-home services) 0 H2023 Supported employment; per 15 minutes H2024 Supported employment; per diem going support to maintain employment; H2025 per 15 minutes going support to maintain employment; H2026 per diem

22 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review H2027 See Notes - per 15 minutes Off Use MN Criteria for Psych Education Sexual offender treatment service, per 15 H2028 minutes H2029 Sex Offend Tx Svc, Per Diem 0 H2030 Clubhouse services ; per 15 min FACILITY;CMHC H2031 Clubhouse services; per diem H2032 Activity Therapy Multi-systemic Therapy for Juveniles; per H minutes 0 Alcohol and/or drug abuse halfway house H2034 services; per diem H2035 H2036 Alcohol and/or drug treatment program; per hour Alcohol and/or other drug treatment program; per diem.. SUD: Partial care treatment in substance abuse facility (per diem)

23 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review H2037 Developmental delay prevention activities, dependent child of client, per 15 minutes 0 Brief Office Visit for the Sole Purpose of Monitoring or Changing Drug Prescriptions M0064 Used in the Treatment of Mental Psychoneurotic and Personality Disorders Q3014 Telehealth original site facility S0109 Methadone, oral, 5mg Alcohol and/or drug treatment program; S0201 per hour 0 Home care training to home care client, per S minutes 0 S5110 Home care training, family; per 15 minutes 0 S5145 Behavioral health specialized foster care 0 S5150 Unskilled respite care, not hospice; per 15 minutes 0 S9110 In home telemonitoring S9123 In home psychiatric nursing 0 S9475 Ambulatory setting substance abuse treatment or detoxification services; per diem 0

24 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Intensive outpatient psychiatric services; per diem; in IL use 913 in combination with S9480 this code 0 Family stabilization services; per 15 S9482 minutes 0 S9484 Crisis intervention mental health services; per hour S9485 Crisis intervention mental health services; per diem T1001 Nursing Assessment/ Evaluation 0 T1002 RN services up to 15 minutes T1003 LPN/ LVN services up to 15 minutes 0 T1005 Respite care services, up to 15 minutes Alcohol and/or substance abuse services, T1006 family/couple counseling Alcohol and/or substance abuse services, treatment plan development and/or T1007 modification Alcohol and/or substance abuse services, T1012 skills development Sign language or oral interpretive services; T1013 per 15 minutes T1014 Telehealth telemedicine

25 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review T1015 Clinic encounter all inclusive T1016 Case management, each 15 minutes Targeted Case Management with PATH Targeted case management, each 15 Homelessness Transition and Justice Services (15 T minutes min) T1019 Personal care services; per 15 minutes 0 T1020 Personal care services; per diem 0 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol; T1023 per encounter T Team evaluation & management T1027 Family training & counseling T1502 Psychotropic Medication Administration Non emergency transportation; patient T2001 attendant/escort 0 T2002 T2003 T2004 Non-emergency transportation; per diem Non-emergency transportation; encounter/trip Non-emergency transport; commercial carrier, multi-pass T2005 Non-emergency transportation; stretch van 0

26 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Preadmission screening and resident review (pasrr) level i identification T2010 screening; per screen Preadmission screening and resident T2011 review level ii evaluation; per evaluation T2012 Children s Day Treatment T2014 Pre-vocational Services - per diem T2015 Pre-Vocational Services - per hour T2017 Community integration counseling T2018 Supported Employment Job Development T2019 Supported Employment T2020 Day Habiliitation T2021 Pre admission PASSR assessment T2022 Other specified case management service not elsewhere classified 0 T2023 Targeted Case Management- per month 0 T2024 Service Assessment Plan of Care Dev T2025 Waiver Services; Not Otherwise Specified (NOS) T2027 Specialized childcare, waiver; per 15 minutes 0 T2033 Psychiatric residential treatment facilityper diem 0

27 Auth Required Key: = Authorization Required for Medical Necessity review; Off= No Authorization Required; Auto-Approve = Provider calls Intake for auto-approval but no medical necessity review Therapeutic camping, overnight, waiver; T2036 each session 0 Therapeutic camping, day, waiver; each T2037 session 0 Behavioral health; long-term care residential (non-acute care in a residential treatment program community based per T2048 diem 0

Medicare Behavioral Health Authorization List Effective 5/26/18

Medicare Behavioral Health Authorization List Effective 5/26/18 100 All inclusive room and board 101 All inclusive room and board 104 Anesthesia, ECT 114 Room and Board- private psychiatric 116 Room and Board- private room detoxification 118 Room and Board- private