Medicare Behavioral Health Authorization List Effective 5/26/18

Transcription

1 100 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 rehabilitation 120 Residential Treatment 124 Room and Board -semi private psychiatric 126 Room and Board- semi- private room detoxification 128 Room and Board - semi private rehabilitation 134 Room and Board bed psychiatric 136 Room and Board- 3-4 bed detoxification 138 Room and Board bed rehabilitation 144 Room and board private psychiatric 146 Room and board private- detoxification 154 Room and Board- ward psychiatric 156 Room and Board- detoxification ward 158 Room and Board- ward rehabilitation 180 leave of absence from residential 183 Therapeutic home time 190 Sub Acute Inpatient 204 Intensive Care -psychiatric 240 Intensive Care -psychiatric 450 Emergency Room 451 Emergency Room 510 Clinic encounter all inclusive PRO_13346E Internal Approved NA8PROLTR13346E_0000

2 513 Psych clinic 516 Urgent Care Clinic 519 Other clinic- med supervised withdrawal 520 Freestanding clinic 521 Rural Clinic 529 Other freestanding clinic 900 BH treatment services 901 ECT- electroshock treatment Intensive Outpatient - providers should be instructed to 905 use proper code with 915 Intensive Outpatient - providers should be instructed to 906 use proper code with BH treatment services 911 Substance abuse rehabilitation 914 Psychiatric/Psychological Services- Individual therapy 916 Psychiatric/Psychological Services- Family therapy 917 Biofeedback 918 Testing 919 Other BH treatment services 944 Drug Rehabilitation 945 Alcohol Rehabilitation 1001 Behavioral Health Residential- psychiatric 1002 Detox - Docimillary (DASA) Interactive complexity add-on code Psychiatric diagnostic evaluation (no medical Services) Psychiatric diagnostic evaluation with medical services

3 90832 Psychotherapy, 30 mins Auth required as of visit min psychotherapy add on code when performed with E/M Service- (list separately) Psychotherapy, 45 mins Auth required as of visit minute psychotherapy add on code when performed with E/M Service (list separately) Psychotherapy, 60 mins Auth required as of visit min psychotherapy when performed with E/M service (list separately Psychotherapy for crisis, first 60 min. Auth required as of visit crisis code add on for each additional 30 min Psychoanalysis Family Psychotherapy, without patient present Auth required as of visit Family Psychotherapy, 45 min Auth required as of visit Multiple-family group psychotherapy Auth required as of visit Group psychotherapy Auth required as of visit Pharmacologic management, add on code Narcosynthesis Therapeutic Repetitive Transcranial (TMS) Therapeutic Repetitive Transcranial (TMS) Therapeutic Repetitive Transcranial (TMS) Electroconvulsive Therapy Ind psycho therapy incorporating bio feedback 30 min Ind psycho therapy incorporating bio feedback 45 min Hypnotherapy Complex care management

4 90885 Psych eval of hospital records Interpretation or explan of results of psych exam and procedures Outpatient Collateral, 15 min Prep of report of pt psych status Unlisted Psychiatric procedure comp.comput.motion analysis Functional brain mapping Psychological testing Auth required after 5 hours of testing Psychological testing Auth required after 5 hours of testing Psychological testing Auth required after 5 hours of testing Assessment of Aphasia of speech/lang Developmental screening with interp Developmental testing Auth required after 5 hours of testing Neurobehavioral status exam w clin assess Auth required after 5 hours of testing Neuropsychological Testing per hour Auth required after 5 hours of testing Neuropsych Testing Admin by Technician per hour Auth required after 5 hours of testing Neuropsych Testing Admin by Computer per occurrence Auth required after 5 hours of testing Standardized cognitive perf testing Auth required after 5 hours of testing 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

5 Medicare Behavioral Health Authorization List 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 Services rendered after hours Office Emergency Services New Patient Office Visit Level New Patient Office Visit Level New Patient Office Visit Level New Patient Office Visit Level New Patient Office Visit Level Est Patient Office Visit Level Est Patient Office Visit Level Est Patient Office Visit Level Est Patient Office Visit Level Est Patient Office Visit Level Initial Hospital Care-comprehensive; low complexity

6 Medicare Behavioral Health Authorization List Initial Hospital Care-comprehensive; moderate complexity Initial Hospital Care-comprehensive; high complexity Subsequent observation Care Subsequent observation Care Subsequent observation Care Subsequent Hospital Care-focused; low complexity Subsequent Hospital Care-focused; moderate complexity Subsequent Hospital Care-focused; high complexity Observation-comprehensive; low complexity Observation-comprehensive; moderate complexity Observation-comprehensive; high complexity Discharge Day Management- 30 min or less Discharge Day Management-more than 30 min 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 Initial Consultation-expanded, straightforward Initial Consultation-detailed, low complexity Initial Consultation-comprehensive, moderate complexity Initial Consultation-comprehensive, high complexity

7 99281 ER Consultation-focused, straightforward ER Consultation-expanded; low complexity ER Consultation-expanded; moderate complexity ER Consultation-detailed; moderate complexity ER Consultation-comprehensive; high complexity 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 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

8 99401 Preventive counseling, individual Preventive counseling, individual 30 min Preventive counseling, individual 45 min Preventive counseling, individual Smoking cessation Smoking cessation Alcohol substance abuse BH change intervention Alcohol and substance abuse screening and brief intervention Preventive counseling, individual 60 min Preventive medicine group counseling- 60 min Home visit, single, family counseling 907, H2012 Community behavioral program (day treatment) 915 and G0410 or G0411/ or H0035 Partial Hospitalization 915, H0015 BH intensive outpatient substance abuse 915, S9480 BH intensive outpatient psychiatric Recreation, related to the care and treatment of patients disabling mental health problems; per session (45 minutes G0176 or more) Training and educational services related to the care and treatment of patients disabling mental health problems per G0177 session (45 minutes or more) G0396 Alcohol/subs interv 15-30mn G0397 Alcohol/subs interv >30 min

9 Social work and psychological services, directly relating to G0409 and/or furthering the patient s rehabilitation goals G0410 Partial Hospitalization G0411 BH intensive outpatient substance abuse 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 G0443 to face BH counseling-15 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 G0473 Face to face behavioral counseling 15 min H0001 Alcohol and/or drug assessment Behavioral Health Screen to determine eligibility for H0002 admission to treatment program Alcohol and/or drug screening; laboratory analysis of H0003 specimens for presence of alcohol or drugs H0004 Behavioral health counseling and therapy; per 15 minutes Alcohol and/or drug services; group counseling by a H0005 clinician

10 H0006 Alcohol and/or drug services; case management Alcohol and/or drug services; crisis intervention H0007 (outpatient) Alcohol and/or drug services; sub acute detoxification H0008 (outpatient) Alcohol and/or drug services; acute detoxification (hospital H0009 inpatient) Alcohol and/or drug services; sub-acute detoxification H0010 (residential addiction program inpatient) Alcohol and/or drug services; acute detoxification H0011 (residential addiction program inpatient) Alcohol and/or drug services; sub-acute detoxification H0012 (residential addiction program outpatient) Alcohol and/or drug services; acute detoxification H0013 (residential addiction program outpatient) H0014 Alcohol and/or drug services; ambulatory detoxification H0015 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 H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)

11 Medicare Behavioral Health Authorization List H0017 Behavioral health; residential (hospital residential treatment program), without room and board; per diem H0018 Behavioral health; short-term residential (non hospital residential treatment program), without room and board; per diem H0019 Behavioral health; long term residential (non-medical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board; per diem H0020 Alcohol and/or drug services; methadone administration and/or service (provisions of the drug by a licensed program) H0021 Alcohol and Drug training service for staff Alcohol and/or drug intervention service (planned H0022 facilitation) Behavioral health outreach service (planned approach to H0023 reach a targeted population) auth requirement up to 200 units. Prior Authorization Request =ON after 200 Units Total of all HCPC Series Codes H0024 H0025 Behavioral health prevention information dissemination service (one way direct or non-direct contact with service audiences to affect knowledge and attitude); 15 minutes Behavioral health prevention education service (delivered of services with target population to affect knowledge, attitude and/or behavior); 15 minutes

12 Alcohol and/or drug intervention service (planned H0026 facilitation) H0027 Alcohol and drug prevention service Alcohol and/or drug prevention problem identification and H0028 referral service Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other H0029 drug use e.g. alcohol free social events) H0030 Behavioral health hotline service H0031 Mental health assessment, by non-physician H0032 Mental health service plan development by non-physician H0033 Oral medication administration, direct observation H0034 Medication training and support; per 15 minutes H0035 Mental health partial hospitalization, treatment, less than 24 hours H0036 Community psychiatric supportive treatment, face to face H0037 Community psychiatric supportive treatment program; per diem H0038 Self-help/peer services; per 15 minutes H0039 Assertive Community Treatment; per 15 min H0040 Assertive Community Treatment; per diem H0041 Foster Care child, non therapeutic per diem H0042 Foster Care child, non therapeutic per month

13 H0043 Supported housing; per diem H0044 Supported housing; per month H0045 Respite care services, not in the home; per diem H0046 Mental Health Services NOS H0047 Alcohol and drug services not otherwise specified Alcohol and/or other drug testing: collection and handling H0048 only, specimens other than blood H0049 Alcohol and/or drug Screening Alcohol and/or Drug Service, Brief Intervention; per 15 H0050 minutes H1000 Prenatal care, at-risk assessment Prenatal care, at-risk enhanced service; antepartum H1001 management H1002 Prenatal care, at risk enhanced service; care coordination H1003 Prenatal care, at-risk enhanced service; education H1004 Prenatal care, at-risk enhanced service; follow-up home visit H1005 Prenatal care, at-risk enhanced service package (includes H1001-H H1010 n-medical family planning education; per session H1011 Family assessment by licensed behavioral health professional for state defined purposes H2000 Comprehensive multidisciplinary evaluation H2001 Rehab program 1/2 day

14 H2010 Comprehensive medication services; per 15 minutes H2011 Crisis Intervention Services; per 15 Minutes H2012 Behavioral health day treatment; per hour H2013 Psychiatric health facility service per diem H2014 Skills training and development; per 15 minutes Comprehensive community support services; per 15 H2015 minutes H2016 Comprehensive community support services; per diem H2017 Psychosocial rehabilitation services; per 15 minutes H2018 Psychosocial rehabilitation services; per diem H2019 Therapeutic behavioral services; per 15 minutes Therapeutic behavioral services; per diem In NE H2020 Therapeutic group home H2021 Community-based wrap-around services; per 15 min Community-based wrap-around services; per diem H2022 (intensive in-home services) H2023 Supported employment; per 15 minutes H2024 Supported employment; per diem H2025 Ongoing support to maintain employment; per 15 minutes H2026 Ongoing support to maintain employment; per diem H2027 See tes - per 15 minutes H2028 Sexual offender treatment service, per 15 minutes H2029 Sex Offend Tx Svc, Per Diem

15 Medicare Behavioral Health Authorization List H2030 Clubhouse services ; per 15 min H2031 Clubhouse services; per diem H2032 Activity Therapy H2033 Multi-systemic Therapy for Juveniles; per 15 minutes Alcohol and/or drug abuse halfway house services; per H2034 diem H2035 Alcohol and/or drug treatment program; per hour H2036 Alcohol and/or other drug treatment program; per diem H2037 Developmental delay prevention activities, dependent child of client, per 15 minutes M0064 Brief Office Visit for the Sole Purpose of Monitoring or Changing Drug Prescriptions Used in the Treatment of Mental Psychoneurotic and Personality Disorders Q3014 Telehealth original site facility S0109 Methadone, oral, 5mg auth requirement up to 200 units. Prior Authorization Request =ON after 200 Units Total of all HCPC Series Codes auth requirement up to 200 units. Prior Authorization Request =ON after 200 Units Total of all HCPC Series Codes S0201 Alcohol and/or drug treatment program; per hour S5108 Home care training to home care client, per 15 minutes

16 S5110 Home care training, family; per 15 minutes S5145 Behavioral health specialized foster care S5150 Unskilled respite care, not hospice; per 15 minutes S9110 In home telemonitoring S9123 In home psychiatric nursing Ambulatory setting substance abuse treatment or S9475 detoxification services; per diem Intensive outpatient psychiatric services; per diem; in IL use S in combination with this code S9482 Family stabilization services; per 15 minutes S9484 Crisis intervention mental health services; per hour S9485 Crisis intervention mental health services; per diem T1001 Nursing Assessment/ Evaluation T1002 RN services up to 15 minutes T1003 LPN/ LVN services up to 15 minutes T1005 Respite care services, up to 15 minutes Alcohol and/or substance abuse services, family/couple T1006 counseling Alcohol and/or substance abuse services, treatment plan T1007 development and/or modification Alcohol and/or substance abuse services, skills T1012 development T1013 Sign language or oral interpretive services; per 15 minutes T1014 Telehealth telemedicine

17 T1015 Clinic encounter all inclusive T1016 Case management, each 15 minutes T1017 Targeted case management, each 15 minutes T1019 Personal care services; per 15 minutes T1020 Personal care services; per diem Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol; per T1023 encounter T1024 Team evaluation & management T1027 Family training & counseling T1502 Psychotropic Medication Administration T2001 n emergency transportation; patient attendant/escort T2002 n-emergency transportation; per diem T2003 n-emergency transportation; encounter/trip T2004 n-emergency transport; commercial carrier, multi-pass T2005 n-emergency transportation; stretch van T2010 Preadmission screening and resident review (pasrr) level i identification screening; per screen T2011 Preadmission screening and resident review level ii evaluation; per evaluation T2012 Children s Day Treatment T2014 Pre-vocational Services - per diem

18 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 Other specified case management service not elsewhere T2022 classified T2023 Targeted Case Management- per month T2024 Service Assessment Plan of Care Dev T2025 Waiver Services; t Otherwise Specified (NOS) T2027 Specialized childcare, waiver; per 15 minutes T2033 Psychiatric residential treatment facility- per diem T2036 Therapeutic camping, overnight, waiver; each session T2037 Therapeutic camping, day, waiver; each session Behavioral health; long-term care residential (non-acute care in a residential treatment program community based T2048 per diem