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 363 - REC MH ASSESSMENT 364 - REC INDIVIDUAL T 365 - REC GROUP T 366 - REC FAMILY T W/O CLIENT 387 - REC ASSESSMENT 388 - REC FAMILY T W/ CLIENT 389 - REC ASSERTIVE ENGAGEMENT 395 - SAIP GROUP T 398 - GROUP T-JAIL SETTING 406 - REC PEER SUPPORT INDIVIDUAL 407 - REC PEER SUPPORT GROUP 408 - REC TARGETED CASE MGMT MH/SA 409 - DVIP SAIP TARGETED CASE MGMT MH/SA 628 - SAFETY & SUPERVISION DAILY 629 - SAFETY & SUPERVISION HOURLY
655 - Bridge Case Management 809 - DD DIVERSION EMERGENCY RESPITE 96372 - THERAPEUTIC INJECTION 96372 53 - THERAPEUTIC INJECTION 96372-59 THERAPEUTIC INJECTION 96372 CC - THERAPEUTIC INJECTION 96372 FP - THERAPEUTIC INJECTION 96372 Q6 - THERAPEUTIC INJECTION 96373 - therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial H0001 - ALCOHOL AND/OR DRUG ASSESSMENT H0004 - BEHAVIORAL HEALTH COUNSELING H0004HQ - BEHAVIORAL HEALTH GROUP THERAPY H0004HR - BEHAVIORAL HEALTH FAMILY THER W/ CLIENT H0004HS - BEHAVIORAL HEALTH FAMILY THER W/O CLIENT H0005 - ALCOHOL AND/OR DRUG GROUP COUNSELING H0010 - NON-HOSPITAL MEDICAL DETOIFICATION H0012HB - SA Non-Medically Monitored Community Residential Tx H0013 - SA Medically Monitored Community Residential Tx H0014 Ambulatory Detox H0015 - SUBSTANCE ABUSE INTENSIVE OUTPATIENT H0015 AD - Adolescent SAIOP
H0019 - RESIDENTIAL LEVELS 3 AND 4 H0019 HK - Residential IV, 4 beds or less H0019 HQ - Residential Level III, 4 beds or less H0019 TJ - Residential III, 5 beds or more H0019 UR - Residential IV 5 beds or more H0019U5 - Level 4, Secure, More Than 5 beds H0019UQ - Level 3 4 beds or less H0019US Level 3, 5+beds H0020 -Methadone Administration H0031 - MENTAL HEALTH ASSESSMENT H0032 - TARGETED CASE MANAGEMENT MH/SA H0032 EP - TARGETED CASE MANAGEMENT MH/SA H0032 U5 - Critical Time Intervention (CTI) H0032FV Case Management Incentive H0032U5DJ Critical Time Intervention (CTI) H0035 - MENTAL HEALTH PARTIAL HOSPITALIZATION H0038HQU4 (B3) - Peer Supports - Group H0038HQU4DJ - (B3) Peer Support Group H0038U4 (B3) - Peer Supports - Individual H0038U4DJ (B3) Peer Suppors Individual H0040 - ASSERTIVE COMMUNITY TREATMENT TEAM
H0040DJ - ACTT Assertive Comm Treatment Team H0045HQU4HA (B3) Child Group Respite H0045HQU4HB (B3) Adult Group Respite H0045U4HA (B3) Child Individual Respite H0045U4HB (B3) Adult Individual Respite H0046 - Level I Family Type H2011 - MOBILE CRISIS MANAGEMENT H2011HI - MOBILE CRISIS MANAGEMENT Innovations Rate H2011HK - Mobile Crisis Management Enhanced Rate H2011U4HI (B3) IDD - Crisis Services - Primary Response H2012HA - CHILD/ADOLESCENT DAY TREATMENT H2014 - DEVELOPMENTAL THERAPIES - PROFESS IND H2014HM - DEVELOPMENTAL THERAPIES - PARAPROF IND H2014HQ Home Support-Group H2015 Community Networking H2015HQ Community Networking Group H2015HQU4 (B3) - Community Networking - Group H2015HT - COMMUNITY SUPPORT TEAM H2015HTDJ - Community Support Team H2015U1 - CN Class &Conference H2015U1U4 (B3) - Community Networking - Class and Conference
H2015U2U4 (B3) - Community Networking - Transportation H2015U4 (B3) - Community Networking - Individual H2016 Residential Supports Level I H2016HI Residential Supports Level IV H2016HIU2 AFL Residential Supports Level IV AFL H2016HIU4 (B3) - Level 4-Residential Supports H2016HIU4U2 (B3) - Level 4 AFL-Residential Supports H2016U2 AFL Residential Supports Level 1-AFL H2016U4 (B3) -Level 1-Residential Supports H2016U4U2 (B3) - Level 1 AFL Residential Supports H2017 - PSYCHOSOCIAL REHABILITATION H2017 DJ - Psyshosocial Rehabiliation H2020 - Level II Program Type H2022 - INTENSIVE IN-HOME SERVICES H2022 HE - FCT CORE H2022 Z1 - FCT ENGAGEMENT AND TRANSITION H2023HQU4 (B3) - Initial Group Supported Employment H2023U4 (B3) - Initial Individual Supported Employment H2023U4 HH (B3)Supported Employment Initial MHSA H2023U4HE (B3) Supported Emloyemnt MHSA Initial H2023U4HHDJ (B3) Supported Employment Initial MHSA
H2025 Support Employment Services: Individual H2025HO - Specialized Consult H2025HQ Support Employment Serfices: Group H2025HQU4 (B3) - Supported Employment - Group H2025U4 (B3) - Supported Employment - Individual H2026HQU4 (B3) - Maintenance Group Supported Employment H2026U4 (B3) - Maintenance Individual Supported Employment H2026U4HE (B3)Supported Emloyemnt MHSA Maintance H2026U4HH (B3) Supported Employment Maintenance MHSA H2026U4HHDJ (B3) Supported Employment Maintenance MHSA (DJ) H2033 - MULTI-SYSTEMIC THERAPY (MST) H2033 M1 - MULTI-SYSTEMIC THERAPY (MST) 1 MONTH H2033 M2 - MULTI-SYSTEMIC THERAPY (MST) 2 MONTHS H2033 M3 - MULTI-SYSTEMIC THERAPY (MST) 3 MONTHS H2033 M4 - MULTI-SYSTEMIC THERAPY (MST) 4 MONTHS H2033 M5 - MULTI-SYSTEMIC THERAPY (MST) 5 MONTHS H2034 - SA HALFWAY HOUSE H2035 - SA COMPREHENSIVE OUTPAT TT PROGRAM Q3014 - ORIGINATING SITE FEE Q3014GT - TELEMEDICINE ORIGINATING SITE FEE S5110 Natural Suports Education: Individual
S5110U4 (B3) - Natural Supports Education - Individual S5111 Natural Supports Education Conference S5111U4 (B) - Natural Supports Education - Conference S5125 Personal Care Services S5125U4 (B3) - Personal Care Services S5145 - Level II Family Type - TFC S5145 TF - Level II Family Type TFC Trauma Focused S5145HA - IAFT Intensive Alternative Family Treatment S5145HATL - IAFT Intensive Alternative Family Treatment Theraputic Leave S5145TL -Level II Family Type - TFC TL S5150 B3 - Respite B3 Service S5150 Respite: Individual S5150HQ Respite: Group S5150HQU4 Respite Group IDD S5150U4 Respite Individual IDD S5150US Respite Facility S5150USU4 Respite Facility IDD S5165 Home Modifications S5165U4 (B3) - Home Modifications S9484 - CRISIS INTERVENTION (FACILITY BASED) T1005TD Respite Nursing
T1005TDU4 Respite Nursing RN IDD T1005TE Nursing Respite T1005TEU4 Respite Nursing LPN IDD T1015 In-Home Intensive Supports-Individaul T1015U4 (B3) - In-Home Intensive Supports T1017 - Targeted Case Management T1017HE - TARGETED CASE MANAGEMENT IDD T1017HEEP -Targeted Case Management - EPSDT T1019U4 (B3) - Individual Support T1019U4DJ (B3) Individual Supports T1023 - DIAGNOSTIC ASSESSMENT (MH/SA) T1023GT - TELEMEDICINE DIAGNOSTIC ASSESSMENT T1999 Individual goods and Services T2013 In-Home Skill Building Individual T2013HQ In-Home Skill Building Group T2013HQU4 (B3) - In-Home Skill Building - Group T2013U4 (B3) - In-home Skill Building - Individual T2014 Residential Supports Level ll T2014U2 AFL Residential Supports Level ll T2014U4 (B3) - Level 2 - Residential Supports T2014U4U2 (B3) - Level 2 AFL - Residential Supports
T2016HIU4 (B3) Level 5 - Residential Supports T2016HIU4U2 (B3) - Level 5 AFL Residential Supports T2020 Residential Supports Level III T2020U2 -AFL Residential Supports Level III - AFL T2020U4 (B3) - Level 3 - Residential Supports T2020U4U2 (B3) - Level 3 AFL - Residential Supports T2021 Day Supports Individual T2021HQ Day Supports Group T2021HQU4 (B3) - Day Support - Group T2021U4 (B3) - Day Supports - Individual T2025 Specialized Consultation Services T2025HO Specialized Consultative Service (BCBA) T2025HOU4 (B3) - Specialized Consultative Services - BCBA T2025U3 Behavioral Consultation T2025U3U4 (B3) - Behavioral Consult T2025U4 (B3) - Specialized Consultative Services T2027 Day Supports Developmental Day T2027U4 (B3) - Developmental Day T2029 00 Enteral Formula T2029 50 Enteral Formula T2029 52 Enteral Formula
T2029 53 Enteral Formula T2029 54 Enteral Formula T2029 55 Enteral Formula T2029 57 Enteral Formula T2029 60 Enteral Formula T2029-Assistive Services Equipment and Supplies T2029U4 (B3) - Assistive Technology Equipment and Supplies T2034 Out of Home Crisis T2034U4 (B3) - Crisis Services - Out of Home T2039 Vehicle Modification T2039U4 (B3) - Vehicle Modifications T2041 B3 - Community Guide Monthly B3 Service T2041 Community Guide Monthly T2041U1 Community Guide Start Up Training T2041U1 DO NOT USE Community Guide Periodic diff code not know now T2041U1U4 (B3) - Community Guide - Periodic T2041U4 (B3) - DI Community Guide - Monthly T2041U4EP - (B3) Community Guide EPSDT T2041U4U5 (B3) - Community Guide - Monthly