Important Update Regarding Precertification and Behavioral Health CPT Codes
|
|
|
- Leo Bertram Davidson
- 5 years ago
- Views:
Transcription
1 Important Update Regarding Precertification and Behavioral Health CPT Codes Summary of change: Effective April 11, 2014, psychotherapy services beyond the first 10 sessions rendered in a member s home (POS 12) require precertification and concurrent Utilization Management (UM) review. Codes have been updated on the Amerigroup Georgia Community Service Board (CSB) Services Behavioral Health Fee Schedule for outpatient behavioral health clinic services. What is the impact of this change? On January 1, 2014, Amerigroup Community Care of Georgia updated the Amerigroup Georgia Community Service Board Services Behavioral Health Fee Schedule to the codes published in Table 1. Table 2 demonstrates the list of acceptable modifiers for the Amerigroup CSB Behavioral Health Schedule Fee. As of April 11, 2014, psychotherapy services beyond the first 10 sessions rendered in a member s home require pre-certification and concurrent Utilization Management review. The codes in Table 1 have been updated to reflect this change. All codes and modifiers contained in Tables 1 and 2 must be used in accordance with standard billing guidelines. Providers must use HIPAA compliant billing codes when billing or submitting encounter data. This applies to both electronic and paper claims. Amerigroup reserves the right to use code editing software to determine which service is considered part of, incidental to, or inclusive of the primary procedure. Any code billed that is not specifically listed in Table 1 will be denied as non-covered and not eligible for reimbursement. Pre-Certification A Yes in the Precertification requirement column denotes that a given procedure code requires precertification. How do I request precertification? Log-on to our provider self-service site at providers.amerigroup.com and select Precertification Lookup from the Quick Tools menu Call us at Fax your request to Check the status of your request through provider self-service website by logging on to our provider selfservice site at providers.amerigroup.com. Select Precertification Lookup on the Quick Tools menu and then select Status, or call Provider Services at What if I need assistance? If you have questions, please contact your local Provider Relations reative or call Provider Services at
2 Table 1: 2014 Amerigroup CSB Behavioral Health Schedule CPT Codes Description 2014 Precertification 90791U2* Psychiatric Diagnostic Evaluation (No Medical Services) 90791U3* Psychiatric Diagnostic Evaluation (No Medical Services) 90792U1* Psychiatric Diagnostic Evaluation with Medical Services 90792U2* Psychiatric Diagnostic Evaluation with Medical Services 90832U2 Psychotherapy, 30 Minutes 90832U3 Psychotherapy, 30 Minutes 90832U4 Psychotherapy, 30 Minutes 90833U1* Ind Psychotherapy w E&M (+30) 90833U2* Ind Psychotherapy w E&M (+30) 90834U2 Psychotherapy, 45 Minutes 90834U3 Psychotherapy, 45 Minutes 90834U4 Psychotherapy, 45 Minutes 90836U1* Ind Psychotherapy w E&M (+45) 90836U2* Ind Psychotherapy w E&M (+45) 90837U2 Psychotherapy, 60 Minutes 90837U3 Psychotherapy, 60 Minutes 90837U4 Psychotherapy, 60 Minutes 90839U1 Crisis Intervention, 60 Minutes 90839U2 Crisis Intervention, 60 Minutes 90839U3 Crisis Intervention, 60 Minutes 90840U1 Psychotherapy for crisis, each additional 30 minutes No 4 30 Minutes 90840U2 Psychotherapy for crisis, each additional 30 minutes 90840U3 Psychotherapy for crisis, each additional 30 minutes 90846U U U U U U4 Family Psychotherapy without the patient Family Psychotherapy without the patient Family Psychotherapy without the patient Conjoint Family Psychotherapy with the patient Conjoint Family Psychotherapy with the patient Conjoint Family Psychotherapy with the patient No 4 30 Minutes No 4 30 Minutes
3 90853U U U4 Group Psychotherapy other than of a multiple family group Group Psychotherapy other than of a multiple family group Group Psychotherapy other than of a multiple family group 96101U2 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 96102U2 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 96102U3 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 5 1 Hour 5 1 Hour 5 1 Hour 96150U2 Ambulatory Initial Assessment 96150U3 Ambulatory Initial Assessment 96150U4 Ambulatory Initial Assessment 96151U2 Ambulatory Re-Assessment 96151U3 Ambulatory Re-Assessment 96151U4 Ambulatory Re-Assessment 96372U2 (PA/CNP/CNS) 96372U3 (RN) 96372U4 (LPN) Therapeutic, prophylactic or diagnostic injection Therapeutic, prophylactic or diagnostic injection Therapeutic, prophylactic or diagnostic injection 99201U1* E&M New Patient - 10 Minutes 99201U2* E&M New Patient - 10 Minutes 99202U1* E&M New Patient - 20 Minutes 99202U2* E&M New Patient - 20 Minutes 99203U1* E&M New Patient - 30 Minutes 99203U2* E&M New Patient - 30 Minutes 99204U1* E&M New Patient - 45 Minutes 99204U2* E&M New Patient - 45 Minutes 99205U1* E&M New Patient - 60 Minutes 99205U2* E&M New Patient - 60 Minutes 99211U1* E&M Established Patient - 5 Minutes 99211U2* E&M Established Patient - 5 Minutes 99212U1* E&M Established Patient - 10 Minutes 99212U2* E&M Established Patient - 10 Minutes 99213U1* E&M Established Patient - 15 Minutes
4 99213U2* E&M Established Patient - 15 Minutes 99214U1* E&M Established Patient - 25 Minutes 99214U2* E&M Established Patient - 25 Minutes 99215U1* E&M Established Patient - 40 Minutes 99215U2* E&M Established Patient - 40 Minutes H0004HQHRU2 Group Skills Training Yes Minutes H0004HQHRU3 Group Skills Training Yes Minutes H0004HQHRU4 Group Skills Training Yes Minutes H0004HQHRU5 Group Skills Training Yes Minutes H0004HQHSU2 Group Skills Training Yes Minutes H0004HQHSU3 Group Skills Training Yes Minutes H0004HQHSU4 Group Skills Training Yes Minutes H0004HQHSU5 Group Skills Training Yes Minutes H0004HQU2 Group Skills Training Yes Minutes H0004HQU3 Group Skills Training Yes Minutes H0004HQU4 Group Skills Training Yes Minutes H0004HQU5 Group Skills Training Yes Minutes H0004HRU2 Family Skills Training Yes Minutes H0004HRU3 Family Skills Training Yes Minutes H0004HRU4 Family Skills Training Yes Minutes H0004HRU5 Family Skills Training Yes Minutes H0004HSU2 Family Skills Training Yes Minutes H0004HSU3 Family Skills Training Yes Minutes H0004HSU4 Family Skills Training Yes Minutes H0004HSU5 Family Skills Training Yes Minutes H0012TF Alcohol and/or drug services; Sub-acute (Residential Addiction Program Outpatient) H0012TG Alcohol and/or drug services; Sub-acute (Residential Addiction Program Outpatient) H0013 Alcohol and/or drug services; Acute (Residential Addiction Program Outpatient) H0014U2 H0014U3 H0014U4 H0015U2 H0015U3 H0015U4
5 H0020U2 (PA/CNP/CNS) H0020U3 (RN) H0020U4 (LPN) Alcohol and/or drug services, methadone administration and/or service Alcohol and/or drug services, methadone administration and/or service Alcohol and/or drug services, methadone administration and/or service H0031U2 Mental Health Assessment by a non-physician No 8 15 Minutes H0031U3 Mental Health Assessment by a non-physician No 8 15 Minutes H0031U4 Mental Health Assessment by a non-physician No 8 15 Minutes H0032U2 H0032U3 H0032U4 Mental Health Service Plan Development by a non-physician Mental Health Service Plan Development by a non-physician Mental Health Service Plan Development by a non-physician No 8 15 Minutes No 8 15 Minutes No 8 15 Minutes H0036U3 Intensive Family Intervention H0036U4 Intensive Family Intervention H0036U5 Intensive Family Intervention H0036U3U7 Intensive Family Intervention H0036U4U7 Intensive Family Intervention H0036U5U7 Intensive Family Intervention H0039HQU3 Assertive Community Treatment Yes Minutes H0039HQU4 Assertive Community Treatment Yes Minutes H0039HQU5 Assertive Community Treatment Yes Minutes H0039HT Assertive Community Treatment Yes Minutes H0039TNU3 Community Support Team Yes Minutes H0039TNU4 Community Support Team Yes Minutes H0039TNU5 Community Support Team Yes Minutes H0039U1* Assertive Community Treatment Yes Minutes H0039U2* Assertive Community Treatment Yes Minutes H0039U3 Assertive Community Treatment Yes Minutes H0039U4 Assertive Community Treatment Yes Minutes H0039U5 Assertive Community Treatment Yes Minutes H0039TNU3U7 Community Support Team Yes Minutes H0039TNU4U7 Community Support Team Yes Minutes H0039TNU5U7 Community Support Team Yes Minutes H0039U1U7 Assertive Community Treatment Yes Minutes H0039U2U7 Assertive Community Treatment Yes Minutes H0039U3U7 Assertive Community Treatment Yes Minutes H0039U4U7 Assertive Community Treatment Yes Minutes H0039U5U7 Assertive Community Treatment Yes Minutes
6 H2010U2 Medication Administration (PA/CNP/CNS) H2010U3 Medication Administration (RN) H2010U4 Medication Administration (LPN) H2011U1 Crisis Intervention Services No Minutes H2011U2 Crisis Intervention Services No Minutes H2011U3 Crisis Intervention Services No Minutes H2011U4 Crisis Intervention Services No Minutes H2014HQHRU4 Family - Skills training and development Yes 8 15 Minutes H2014HQHRU5 Family - Skills training and development Yes 8 15 Minutes H2014HQHSU4 Family - Skills training and development Yes 8 15 Minutes H2014HQHSU5 Family - Skills training and development Yes 8 15 Minutes H2014HQU4 Family - Skills training and development Yes 8 15 Minutes H2014HQU5 Family - Skills training and development Yes 8 15 Minutes H2014HRU4 Family - Skills training and development Yes 8 15 Minutes H2014HRU5 Family - Skills training and development Yes 8 15 Minutes H2014HSU4 Family - Skills training and development Yes 8 15 Minutes H2014HSU5 Family - Skills training and development Yes 8 15 Minutes H2015HFU4 H2015HFU5 H2015U4 H2015U5 H2015UKU4 H2015UKU5 H2015HFU4U7, H2015HFU5U7 H2015U4U7 H2015U5U7 H2015UKU4U7 H2015UKU5U7 H2017HQU4 Psychosocial Rehabilitation Group, H2017HQU5 Psychosocial Rehabilitation Group H2017U4 Psychosocial Rehabilitation H2017U5 Psychosocial Rehabilitation TeleHealth Site Fee No Minutes
7 Q3014GT T1001U2 Nursing Assessment/ Evaluation No Minutes T1001U3 Nursing Assessment/ Evaluation No Minutes T1001U4 Nursing Assessment/ Evaluation No Minutes T1002U2 RN Services No Minutes T1002U3 RN Services No Minutes T1003U4 LPN/LVN Services No Minutes * Indicates that a service is able to be rendered via interactive audio and video telecommunication systems. Refer to modifier GT in Table 2. Table 2: Schedule of Acceptable Modifiers for the Amerigroup CORE Behavioral Health Schedule Modifier U1 U2 U3 U4 U5 U7 HQ HR HS HT UK HA TN GT Description Level 1 Practitioner: Physician, Psychiatrist Level 2 Practitioner: Psychologist, Physician s Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist Level 3 Practitioner: Registered Nurse, Licensed Dietician, Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT) Level 4 Practitioner: Licensed Practical Nurse (LPN); Licensed Associate Professional Counselor (LAPC); Licensed Master s Social Worker (LMSW); Licensed Associate Marriage and Family Therapist (LAMFT); Certified/Registered Addictions Counselors, Certified Peer Specialists, Trained Paraprofessionals and Certified Psychosocial Rehabilitation Professionals (CPRP) with Bachelor s degrees or higher in the social sciences/helping professions Level 5 Practitioner: Trained Paraprofessionals, Certified/Registered Addiction Counselors (CAC-I, RADT), Certified Peer Specialists, Certified Psychosocial Rehabilitation Professionals, and Qualified Medication Aides with at least a high school diploma/equivalent Out of Clinic; If a service is provided out-of-clinic, then the U7 modifier must be appended to the CPT code in the sequence noted in Table 1. The U7 modifier may only be billed when the corresponding CPT code in Table 1 allows for it Group Setting Family/Couple with client Family/Couple with without client Multidisciplinary team Collateral Contact Child/Adolescent program Rural/outside providers customary service area Via interactive audio and video telecommunications systems. Informational modifier, no additional reimbursement allowed. Must be appended to the CPT code in the last position in a series of modifier combinations GAPEC Issued June 2014 by Amerigroup Georgia health plan
Peach State Health Plan Covered Services & Authorization Guidelines Programs for Behavioral Health
Peach State Health Plan Covered s & Guidelines Programs for Health n-participating providers (those that are not contracted and credentialed with Peach State Health Plan) require prior authorization for
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
Assertive Community Treatment
HIPAA Transaction Code Assertive Community Treatment Assertive Community Treatment Code Detail Code Mod 1 Mod 2 Mod 3 Mod 4 Rate Practitioner Level 1, In-Clinic H0039 U1 U6 $32.46 Practitioner Level 2,
LOUISIANA MEDICAID PROGRAM ISSUED: 06/09/17 REPLACED: CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.2: OUTPATIENT SERVICES PAGE(S) 8
Licensed Practitioner Outpatient Therapy includes: Individual; Family; Group; Outpatient psychotherapy; Mental health assessment; Evaluation; Testing; Medication management; Psychiatric evaluation; Medication
Partners Behavioral Health Management Third Party Liability/Medicare Bypass Codes
Partners Behavioral Health Management Third Party Liability/Medicare Bypass Codes 0181 Reserved 0183 - Revenue Code Therapeutic Leave 100 ICF/MR Hospital Admission & General Hospital 319 - JAIL ASSESSMENT
Attention Behavioral Health Providers:
To view this email as a web page, go here. 7/10/17 Medicaid Website Manuals & Bulletins Fee Schedules What's New Links IVR Navigation Tips Web Portal Tutorials Attention Behavioral Health Providers: In
Partners Behavioral Health Management TPL/Medicare Bypass List Service
Partners Behavioral Health Management TPL/Medicare Bypass List Service 0183 - Revenue Code Therapeutic Leave 100 ICF/MR Hospital Admission & General Hospital H0010 - NON-HOSPITAL MEDICAL DETOXIFICATION
Behavioral Health Covered Benefits
https://providers.amerigroup.com Behavioral Health Covered Benefits The matrix below lists the available behavioral health benefits for members enrolled in the Iowa Health and Wellness Plan. Outpatient
Behavioral Health Providers: Frequently Asked Questions (FAQs)
Behavioral Health Providers: Frequently Asked Questions (FAQs) Q. What has changed as far as behavioral health services? A1. Effective April 1, 2012, the professional and outpatient facility charges for
KANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. Non-PIHP Alcohol and Substance Abuse Community Based Services
Fee-for-Service Provider Manual Non-PIHP Alcohol and Substance Abuse Community Based Services Updated 08.2015 PART II Introduction Section 7000 7010 8100 8200 8300 8400 Appendix BILLING INSTRUCTIONS Alcohol
Outpatient Behavioral Health Services (OBH)-General Information
Outpatient Behavioral Health Services (OBH)-General Information 1 General Information Beneficiaries currently served by the RSPMI, LMHP, and SATS programs will begin transitioning to the Outpatient Behavioral
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
TBH Medicaid Participating Provider ARQ Page 1
TBH Medicaid Participating Provider ARQ Page 1 Room & Board Inpatient 90785 Interactive complexity code 90791 90792 90832 Room & Board Inpatient Psych Per Diem Psychiatric diagnostic evaluation Psychiatric
Telehealth. Administrative Process. Coverage. Indications that are covered
Telehealth These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information
Provider Handbooks. Telecommunication Services Handbook
Provider Handbooks December 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health
Volume 26 No. 05 July Providers of Behavioral Health Services For Action Health Maintenance Organizations For Information Only
Newsletter Published by the N.J. Dept. of Human, Div. of Medical Assistance & Health & the Division of and Volume 26 No. 05 July 2016 TO: SUBJECT: Providers of Behavioral Health For Action Health Maintenance
MAGELLAN UNIVERSAL SERVICES LIST - Includes Preferred HIPAA Compliant Codes. UB-04 Revenue Codes
Service Name & Detailed Magellan Description (see column heading explanations at end of this document) MAGELLAN UNIVERSAL SERVICES LIST - Includes Preferred HIPAA Compliant Codes Codes Used to Determine
Children Come First Covered Services Fee Schedule
Children Come First Covered Services Fee Schedule Covered Service: Assessment Inpatient Billing Unit Rate: [per hour] 99221 99222 99223 Neurological, psychiatric, developmental, functional behavioral,
Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook
Texas Medicaid Provider Procedures Manual Provider Handbooks December 2017 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid
All ten digits are required when filing a claim.
34 34 Psychologists Licensed psychologists are enrolled only for services provided to QMB recipients or to recipients under the age of 21 referred as a result of an EPSDT screening. The policy provisions
OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL
OUTPATIENT BEHAVIORAL HEALTH CSHCN SERVICES PROGRAM PROVIDER MANUAL APRIL 2018 CSHCN PROVIDER PROCEDURES MANUAL APRIL 2018 OUTPATIENT BEHAVIORAL HEALTH Table of Contents 29.1 Enrollment......................................................................
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS)
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services (DMAHS) Outpatient Facility Behavioral Health Integration Billing Frequently Asked Questions (FAQs) 1.
Medicaid Rehabilitation Option Provider Manual
EDS Provider Relations Unit INDIANA HEALTH COVERAGE PROGRAMS Medicaid Rehabilitation Option Provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R P R 1 0 0 0 6 R E V I S I O N D A T E : D E
Behavioral Health Billing and Coding Guide for Montana FQHCs & Primary Care Providers. Virna Little, PsyD, LCSW-R, SAP, CCM Laura Leone, MSSW, LMSW
Behavioral Health Billing and Coding Guide for Montana FQHCs & Primary Care Providers Virna Little, PsyD, LCSW-R, SAP, CCM Laura Leone, MSSW, LMSW Objectives Answer questions specific to FQHC and Primary
OUTPATIENT SERVICES. Components of Service
OUTPATIENT SERVICES Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications. Additionally, providers contracted
Behavioral Health Covered Benefits
https://providers.amerigroup.com Behavioral Health Covered Benefits The matrix below lists the available behavioral health benefits for members enrolled in Medicaid programs. Iowa Health and Wellness enrollees
BEHAVIORAL HEALTH Section 13. Introduction. Behavioral Health Benefit Overview
Introduction Ohana Health Plan s Clinical Services Program is designed to coordinate medically necessary care at the most appropriate level of service. The goal is to provide the right service in the right
TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL
TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................
Mental Health Updates. Presented by EDS Provider Field Consultants
Mental Health Updates Presented by EDS Provider Field Consultants October 2007 Agenda Session Objectives Outpatient Mental Health Medicaid Rehabilitation Option (MRO) Somatic Treatment Assertive Community
Sandhills Center Care/Utilization Management Service Certification Request Reviews. Legend
= Comprehensive Clinical Assessment Sandhills Center Care/Utilization Management Legend = Service Authorization Request = Individual Support PA=Prior Approval = Person-Centered LOC = Level of Care Form
Legend. SAR = Service Authorization Request
= Comprehensive Clinical Assessment Sandhills Center Care/Utilization Management Legend = Service Authorization Request = Individual Support PA=Prior Approval = Person-Centered LOC = Level of Care Form
SERVICE CODE CLARIFICATIONS
SERVICE CODE CLARIFICATIONS Service Description Assertive Community Treatment (ACT) Assisted Outpatient Treatment (AOT) HCPCS Code Description Explanation of Code Utilization H0039 ACT Report only face-to-face
Account Management, Coding, Customer Service, Legal, Medical Management, Finance, Claims, Underwriting, Network Management
DEPARTMENT: Coding Reimbursement APPROVED DATE: POLICY DESCRIPTION: Telemedicine/Telehealth/Telecommunications/Televideo EFFECTIVE DATE: 6-24-04 PAGE: 1 of 4 REPLACES POLICY DATED: REFERENCE NUMBER: P-30
Medicaid Rehabilitation Option Provider Manual
H P P r o v i d e r R e l a t i o n s U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Medicaid Rehabilitation Option Provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R
DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH & ADDICTION SERVICES
DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH & ADDICTION SERVICES ADDENDUM to Attachment 3.1-A Page 13(d).10 Service Description Community Support Services consist of mental health rehabilitation
TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018
TELEMEDICINE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 114.28 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES
Reimbursement Policy. Subject: Consultations Effective Date: 05/01/05
Reimbursement Policy Subject: Consultations Effective Date: 05/01/05 Committee Approval Obtained: 06/06/16 Section: Evaluation and Management *****The most current version of the Reimbursement Policies
As of June. Psychiatric Rehabilitation. referred to. ARIZONAA officially FLORIDA. Certification GEORGIA. for each service: and advocacy. community.
State Recognitionn of the CPRPP Credential As of June 2013, the Certified Psychiatric Rehabilitation Practitioner (CPRP) credential is recognized by the statess listed below. Please note: The Psychiatric
DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10. October 1, 2017
DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10 October 1, 2017 General Information Overview Thank you for your willingness to serve clients of the Medicaid Program and other medical assistance programs
ARIZONA DEPARTMENT OF HEALTH SERVICES DIVISION OF BEHAVIORAL HEALTH SERVICES
ARIZONA DEPARTMENT OF HEALTH SERVICES DIVISION OF BEHAVIORAL HEALTH SERVICES COVERED BEHAVIORAL HEALTH SERVICES GUIDE Release date September 1, 2001 Applicable for Services Provided on 10/03/01 or later
FQHC Wrap Payment Guidelines. NM Rev. 1 09/17
FQHC Wrap Payment Guidelines NM 10.001014 Rev. 1 09/17 Overview of Methodology Managed care organizations (MCO s) will concurrently pay contracted rate, wrap payment, and any fee for service (FFS) payments
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE ISSUE DAT E: DRAFT
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: DRAFT ISSUE DAT E: DRAFT EFFECTIVE DATE: DRAFT SUBJECT: Behavioral Health Services:
Molina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014
Molina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014 1 Headline Goes Here Mental Health/Behavioral Health Services Cont. Mental and emotional well-being is essential
Ages Ages 3 through 64.
Medicaid: Follow-Up After Discharge from Community Hospitals, State Psychiatric Hospitals, and Facility Based Crisis Services for Mental Health Treatment The percentage of discharges for individuals ages
STATE OF CONNECTICUT. Department of Mental Health and Addiction Services. Concerning. DMHAS General Assistance Behavioral Health Program
Page 1 of 81 pages Concerning Subject Matter of Regulation DMHAS General Assistance Behavioral Health Program a The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to
IV. Clinical Policies and Procedures
A. Introduction The role of ValueOptions NorthSTAR is to coordinate the delivery of clinical services. There are three parties to this care coordination process: the Enrollee, the Provider(s), and the
907 KAR 10:025. Reimbursement provisions and requirements regarding outpatient psychiatric hospital services.
907 KAR 10:025. Reimbursement provisions and requirements regarding outpatient psychiatric hospital services. RELATES TO: KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23) STATUTORY AUTHORITY:
907 KAR 10:014. Outpatient hospital service coverage provisions and requirements.
907 KAR 10:014. Outpatient hospital service coverage provisions and requirements. RELATES TO: KRS 205.520, 42 C.F.R. 447.53 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.560, 205.6310,
Provider Manual Behavioral Health Addendum
Provider Manual Behavioral Health Addendum Georgia 1-800-454-3730 GAPEC-1420-16 https://providers.amerigroup.com/ga https://providers.amerigroup.com Behavioral Health Services Provider Manual Addendum
LOUISIANA MEDICAID PROGRAM ISSUED: 04/20/18 REPLACED: 07/06/17 CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.3: OUTPATIENT SERVICES PAGE(S) 2
PAGE(S) 2 Behavioral Health Services in a Federally Qualified Health Center or Rural Health Center Provider Qualifications Federally qualified health centers (FQHCs) must be certified by the federal government.
Outpatient Mental Health Services
Outpatient Mental Health Services Summary of proposed changes being made to the Outpatient Mental Health Services Policy: Allow pre-doctoral psychology interns to perform psychological services when delegated
LOUISIANA MEDICAID PROGRAM ISSUED: 06-09/17 REPLACED: 03/14/17 CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.1: PROVIDER REQUIREMENTS PAGE(S) 15
PROVIDER REQUIREMENTS A provider must be enrolled in the Medicaid Program and meet the provider qualifications at the time service is rendered to be eligible to receive reimbursement through the Louisiana
PSYCHIATRY SERVICES: MD FOCUSED
PSYCHIATRY SERVICES: MD FOCUSED CY2013 Risk Based Scheduled Review Agenda 2 Overview of New Risk Based Scheduled Reviews Initial review findings PhD summary MD summary Examples Template/Psychotherapy Time
State-Funded Enhanced Mental Health and Substance Abuse Services
and and Contents 1.0 Description of the Service... 3 2.0 Individuals Eligible for State-Funded Services... 3 3.0 When State-Funded Services Are Covered... 3 3.1 General Criteria... 3 3.2 Specific Criteria...
Medicaid Adult Mental Health (MH) Services
Assessment/Intake Codes: 90791-90792 GT; DJ; TK +90875 (Interactive complexity add-on code) Medicaid Adult Mental Health (MH) Services 4 visits per year per consumer. 1 unit per episode Prior authorization
CADC-T CLINICALLY SUPERVISED EXPERIENCE (PAGE 1 of 5) APPLICANT S NAME SUPERVISOR S NAME AGENCY PROFESSIONAL LICENSES AND/OR CERTIFICATES YOU HOLD
CADC-T CLINICALLY SUPERVISED EXPERIENCE (PAGE 1 of 5) APPLICANT S NAME SUPERVISOR S NAME AGENCY PROFESSIONAL LICENSES AND/OR CERTIFICATES YOU HOLD *Supervisors must include a photocopy of a state or federal
Chapter 7 Section 22.1
TRICARE Policy Manual 6010.57-M, February 1, 2008 Medicine Chapter 7 Section 22.1 Issue Date: April 17, 2003 Authority: 32 CFR 199.4 and 32 CFR 199.14 1.0 DESCRIPTION 1.1 refers to the use of information
Oklahoma Health Care Authority. Telemedicine
Oklahoma Health Care Authority Telemedicine Telemedicine Policy: OAC 317:30-3-27 Billing Technology 2 Telemedicine Applicability & Scope The purpose of the SoonerCare telemedicine is to improve access
JMOC Update: Behavioral Health Redesign. December 15 th, 2016
JMOC Update: Behavioral Health Redesign December 15 th, 2016 2 Implementation Schedule BH Redesign 7/1/2017: Medicaid requires rendering (NPI) practitioner*, ORP, and/or supervisor on claims Go Live for
Treatment Planning. General Considerations
Treatment Planning CBH Compliance has been tasked with ensuring that our providers adhere to documentation standards presented in state regulations, bulletins, CBH contractual documents, etc. Complying
Approved Curriculum and Equivalency Standards. Parent Support and Training/Youth Support and Training
Approved Curriculum and Parent Support and Training/Youth Support and Training Introduction to Wraparound This initial training introduces new parent support and training and youth support and training
Telemedicine and Telehealth Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Telemedicine and Telehealth Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 8 P U B L I S H E D : J A N U A R Y 1
Magellan of Virginia: Effective CPT Coding 2013 and Beyond January 10, Gary M. Henschen, MD Chief Medical Officer-Behavioral Health
Magellan of Virginia: Effective CPT Coding 2013 and Beyond January 10, 2014 Gary M. Henschen, MD Chief Medical Officer-Behavioral Health What are CPT Codes? Magellan must buy licenses from AMA to use CPT
LOUISIANA MEDICAID PROGRAM ISSUED: 08/24/17 REPLACED: 07/06/17 CHAPTER 2: BEHAVIORAL HEALTH SERVICES APPENDIX B GLOSSARY/ACRONYMS PAGE(S) 5 GLOSSARY
GLOSSARY The following is a list of abbreviations, acronyms and definitions used in the Behavioral Health Services manual chapter. Ambulatory Withdrawal Management with Extended On-Site Monitoring (ASAM
Behavioral Health Provider Training: BHSO updates
Behavioral Health Provider Training: BHSO updates Agenda Diagnosis Code 799 Laboratory Work CPT Code Q3014- Telehealth BHSO Claims submission Process Targeted Case Management Diagnosis Codes Diagnosis
MEDICAL POLICY No R2 TELEMEDICINE
Summary of Changes Clarifications: Page 1, Section I. A 6, additional language added for clarification. Deletions: Additions Page 4, Section IV, Description, additional language added in regards to telemedicine.
STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH AND ADDICTION SERVICES REQUEST FOR INFORMATION
STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES DIVISION OF MENTAL HEALTH AND ADDICTION SERVICES REQUEST FOR INFORMATION PURPOSE The Division of Mental Health and Addiction Services (DHMAS) is seeking
Reimbursement Policy. Subject: Modifier Usage
https://providers.amerigroup.com Reimbursement Policy Subject: Modifier Usage Effective Date:08/01/16 Committee Approval Obtained: 08/01/16 Section: Coding ***** The most current version of our reimbursement
Telemedicine Policy. Approved By 4/08/2015
Telemedicine Policy Policy Number 2016R0046B Annual Approval Date 4/08/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
Weekly Provider Q&A Session 3 rd Quarter 2017
Weekly Provider Q&A Session 3 rd Quarter 2017 Type Issue/Agenda Item Response/Outcome/Updates Are providers allowed to bill for the MHSS service while a member is in hospital/acute care? It is important
Mental Health Certified Family Peer Specialist (CFPS)
Mental Health Certified Family Peer Specialist (CFPS) Policy Number: SC170065A1 Effective Date: May 1, 2018 Last Updated: PAYMENT POLICY HISTORY VERSION DATE ACTION / DESCRIPTION Version 1 5/1/2018 The
CLINICALLY SUPERVISED EXPERIENCE for CADC I, CADC II and CAADC (PAGE 1 of 4) APPLICANT S NAME SUPERVISOR S NAME AGENCY
CLINICALLY SUPERVISED EXPERIENCE for CADC I, CADC II and CAADC (PAGE 1 of 4) APPLICANT S NAME SUPERVISOR S NAME AGENCY PROFESSIONAL LICENSES AND/OR CERTIFICATES YOU HOLD *Supervisors must include a photocopy
Outpatient Behavioral Health Basics 1
7/5/2018 1 Outpatient Behavioral Health Basics July 2018 Webinar 1 Description: This class will review the SoonerCare Outpatient Behavioral Health Program. It will include an overview of commonly asked
I. POLICY: DEFINITIONS:
GEORGIA DEPARTMENT OF JUVENILE JUSTICE Applicability: { } All DJJ Staff {x} Administration { } Community Services {x} Secure Facilities (RYDCs and YDCs) Transmittal # 18-1 Policy # 12.1 Related Standards
Telehealth Reimbursement Policy in
Telehealth Reimbursement Policy in New York State Greater New York Hospital Association Telehealth Webinar Series July 11, 2016 July 2016 2 Agenda Telehealth NY State Telehealth Parity Statutory Changes
Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Injection and Infusion Administration and Related Services & Supplies IN, KY, MO, OH, WI Policy: 0015 Effective: 05/01/2017 Coverage is subject to the terms, conditions, and limitations of an
Reimbursement Policy. Subject: Consultations. Committee Approval Obtained: Section: Evaluation and 07/01/17. Effective Date:
Subject: Consultations https://providers.amerigroup.com Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 07/01/17 06/06/16 Management *****The most current version
Telemedicine allows a specialist physician located at a medical center to communicate with a patient
Georgia Medicaid reimburses for Telehealth Useful summary of GA Telehealth Law Georgia Medicaid Telemedicine Appendix R TELEMEDICINE CONSULTATIONS Telemedicine allows a specialist physician located at
Telemedicine Policy. 7/12/2017 Approved By
Telemedicine Policy Policy Number 2018R0046A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
APPENDIX A-8 Credentialing Criteria
APPENDIX A-8 Credentialing Criteria Introduction Credentialing criteria The general eligibility criteria for individual practitioners, individual practitioners in a group, and organizational providers
Working with Amerigroup Kansas:
Working with Amerigroup Kansas: Procedures and Answers for Behavioral Health Providers, Facilities and Community Mental Health Centers UPDATED December 2012 These are updates to the most common questions
Medicaid Rehabilitation Option Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Medicaid Rehabilitation Option Services LIBRARY REFERENCE NUMBER: PROMOD00016 PUBLISHED: DECEMBER 14, 2017 POLICIES AND PROCEDURES AS OF SEPTEMBER
AHCCCS BEHAVIORAL HEALTH SERVICES GUIDE
2005-2006 INDEX INDEX... GLOSSARY.. ELIGIBILITY GROUPS AND DELIVERY SYSTEMS.. BEHAVIORAL HEALTH PROVIDER TYPES.. COVERED SERVICES. Inpatient Hospital Services Non-Hospital Inpatient Psychiatric Facility
SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery. o--,-.m-a----,laa~-d-c~~~~~~~~~~-
Page 11 of 8 SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery Departmental Policy and Procedure Section Sub-section Alcohol and Drug Program (ADP) Policy Drug Medi-Cal
Telehealth and Telemedicine Policy
Reimbursement Policy CMS 1500 Telehealth and Telemedicine Policy Policy Number 2018R0046B Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT
AHCCCS BEHAVIORAL HEALTH SERVICES GUIDE 2008
2008 INDEX INDEX... GLOSSARY.. ELIGIBILITY GROUPS AND DELIVERY SYSTEMS.. BEHAVIORAL HEALTH PROVIDER TYPES.. COVERED SERVICES. Inpatient Hospital Services Non-Hospital Inpatient Psychiatric Facility Services
Primary Care Mental Health for Veterans: Integrating Care. October 25, 2017
Primary Care Mental Health for Veterans: Integrating Care October 25, 2017 Integrated Care Mental Health Specialty Care Location On site, embedded in the primary care clinic A different floor,
JMOC Update: Behavioral Health Redesign. June 22, 2017
JMOC Update: Behavioral Health Redesign June 22, 2017 2 Progress Since Last JMOC Update ODM and OhioMHAS communicated the actions below at the March JMOC update: Next Steps: March 2017 Rules process, Trainings
Behavioral health provider overview
Behavioral health provider overview KSPEC-1890-18 February 2018 Agenda Provider manual and provider website Behavioral Health (BH) program goals Access and availability standards Care coordination and
Mental Health and Addiction Services
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Mental Health and Addiction Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 3 9 P U B L I S H E D : A P R I L 1 8, 2
Managed Medi-Cal Behavioral Health Benefits. Alliance Board Meeting October 23, 2013
Managed Medi-Cal Behavioral Health Benefits Alliance Board Meeting October 23, 2013 Purpose Discuss role of ACA in expanding benefits Review philosophy of integrated health care Review State policy process
Chapter 7 Section 22.1
Medicine Chapter 7 Section 22.1 Issue Date: April 17, 2003 Authority: 32 CFR 199.4 and 32 CFR 199.14 Copyright: CPT only 2006 American Medical Association (or such other date of publication of CPT). All
SoonerCare Master Provider Numbers and Individual Rendering Provider Information
SoonerCare 2011 Outpatient Behavioral Health Agency Master Provider Numbers and Individual Rendering Provider Information 1 Upcoming changes in 2011 for OPBH agencies will be discussed: 10/01/2011: Master
JOB OPENINGS PIEDMONT COMMUNITY SERVICES
JOB OPENINGS PIEDMONT COMMUNITY SERVICES Our Excellent full time benefits package offers: Virginia Retirement with Employer match Paid Life Insurance = 2X Your Salary Partially Paid Medical Insurance +
Clinical Utilization Management Guideline
Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review
MARYLAND MEDICAID TELEHEALTH PROGRAM Telehealth Provider Manual
Telehealth Provider Manual Updated May 3, 2016 Table of Contents Table of Contents Scope Service Model Covered Services Program Eligibility Provider Registration Technical Requirements Reimbursement Confidentiality
907 KAR 1:044. Coverage provisions and requirements regarding community mental health center behavioral health services.
907 KAR 1:044. Coverage provisions and requirements regarding community mental health center behavioral health services. RELATES TO: KRS 194A.060, 205.520(3), 205.8451(9), 422.317, 434.840-434.860, 42
Telemedicine Policy Annual Approval Date
Policy Number 2017R0046A Telemedicine Policy Annual Approval Date 7/13/2016 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
Arkansas Department of Human Services
Arkansas Department of Human Services Stakeholder Webinar May 31, 2018 Agenda OBH Certification Update Billing Update ConnectCare Services Transition Plan Tier 2 and Tier 3 New Services Q&A OBH CERTIFICATION
FQHC Behavioral Health Billing Codes
FQHC s Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though process clearly reflected in assessment