VALID PRIMARY DIAGNOSIS CODES FOR SUBSTANCE ABUSE HCPCS CODES

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1 SUBSTANCE ABUSE HCPCS CODES THESE CODES CANNOT BE BILLED ON THE SAME CLAIM WITH THE LIST (A) CODES FROM LIST (B) H0010 Alcohol and/or drug (Inpatient)sub-acute H0011 Alcohol and/or drug (Inpatient)acute H0012 Alcohol and/or drug (Outpatient)sub-acute H0013 Alcohol and/or drug (Outpatient)acute H0015 Alcohol and/or drug, intensivev outpatient including assessment,etc H0017* Alcohol and/or drug Residential without room and board H0043 Supported housing, per diem S9475 Ambulatory setting substance abuse treatment or detoxification services, per diem Note *H0017 is moving to EAPG 312 on as well as the valid primary diagnosis. LIST (B) H0017* H0018 H0035 H0037 H2029 S0201 S9485 MENTAL HEALTH HCPCS CODES THESE CODES CANNOT BE BILLED ON THE SAME CLAIM WITH THE CODES FROM LIST (A) Behavioral health; residential (hospital residential treatment program), without room and board, per diem (effective ) Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem Mental health partial hospitalization, treatment, less than 24 hours Community psychiatric supportive treatment program, per diem Sexual offender treatment service, per diem Partial hospitalization services, less than 24 hours, per diem Crisis intervention mental health services, per diem P /15 1

2 90791 Psychiatric Diagnostic Evaluation Psychiatric Diagnostic Eval W/Medical Services Psychotherapy Patient &/ Family 30 Minutes Psychotherapy Pt&/Family W/E&M Srvcs 30 Min Psychotherapy Patient &/ Family 45 Minutes Psychotherapy Pt&/Family W/E&M Srvcs 45 Min Psychotherapy Patient &/ Family 60 Minutes Psychotherapy Pt&/Family W/E&M Srvcs 60 Min Psychotherapy For Crisis Initial 60 Minutes Psychoanalysis Family Psychotherapy W/O Patient Present Family Psychotherapy W/Patient Present Multiple Family Group Psychotherapy Group Psychotherapy Pharmacologic Management W/Psychotherapy 2

3 90865 Narcosynthesis Psyc Dx&Ther Purposes Hypnotherapy Interpj/Explnaj Results Psychiatric Exam Family Unlisted Psychiatric Service/Procedure Test Select & Admn Functl Brain Map Phys/Qhp Psychological Testing Pr Hr With Patient Psychological Testing Admn By Tech Pr Hr Psychological Testing Computer W/Prof I&R Assessment Aphasia W/Interp & Report Per Hour Developmental Screen W/Scoring & Doc Std Instrm Developmental Testing W/Interp & Report Nubhvl Status Xm Pr Hr W/Pt Interpj&Prepj Nuropsyc Testing Pr Hr W/Pt & Interpj Time Neuropsyc Tstg W/Prof I&R Admn By Tech Pr Hr Neuropsycholog Testing Computer W/Prof I&R 3

4 96125 Standardized Cognitive Performance Testing Alcohol/Substance Screen & Interven Min Alcohol/Substance Screen & Intervention >30 Min G0176 G0177 G0396 G0397 G0410 G0411 G0442 G0443 G0444 G0445 H0001 Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes Annual alcohol misuse screening, 15 minutes Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Annual depression screening, 15 minutes High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes Alcohol and/or drug assessment 4

5 H0002 H0004 H0005 H0006 H0007 H0014 H0020 H0031 H0032 H0033 H0034 H0049 H0050 H2001 H2011 EAPG Behavioral Health Coding Guidance Behavioral health screening to determine eligibility for admission to treatment program Behavioral health counseling and therapy, per 15 minutes Alcohol and/or drug services; group counseling by a clinician Alcohol and/or drug services; case management Alcohol and/or drug services; crisis intervention (outpatient) Alcohol and/or drug services; ambulatory detoxification Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) Mental health assessment, by non-physician Mental health service plan development by non-physician Oral medication administration, direct observation Medication training and support, per 15 minutes Alcohol and/or drug screening Alcohol and/or drug services, brief intervention, per 15 minutes Rehabilitation program, per 1/2 day Crisis intervention service, per 15 minutes 5

6 H2027 H2028 H2032 H2033 H2035 H2036 M0064 S9480 S9482 S9484 T1006 T1007 T1023 Psychoeducational service, per 15 minutes EAPG Behavioral Health Coding Guidance Sexual offender treatment service, per 15 minutes Activity therapy, per 15 minutes Multisystemic therapy for juveniles, per 15 minutes Alcohol and/or other drug treatment program, per hour Alcohol and/or other drug treatment program, per diem Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders Intensive outpatient psychiatric services, per diem Family stabilization services, per 15 minutes Crisis intervention mental health services, per hour Alcohol and/or substance abuse services, family/couple counseling Alcohol and/or substance abuse services, treatment plan development and/or modification Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter 6

APPROVED HCPCS AND CPT CODES AND MODIFIERS RELATING TO SUBSTANCE ABUSE TREATMENT, MENTAL HEALTH, AND BEHAVIORAL HEALTH 1 (As of April 1, 2003)

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