Community Mental Health Services (Provider Type 84)

Transcription

1 Ohio Department of Mental Health and Addiction Services (ODMS) MyCare Ohio Billing Guide For members who have Molina MyCare Ohio for both and, providers will only need to bill a single claim and it will automatically be processed under both the and plan. If a non- certified provider is performing the services, providers will need to bill with the appropriate HCPC/CPT and Molina Healthcare will process the claim as a primary service. For MyCare Ohio only members, will not automatically cross over claims to the managed care plans for Molina MyCare Ohio members. If a service is covered by, an Explanation of Benefits (EOB) must be attached to the paper claim, or the appropriate Loop/Segments filled in for EDI claim submissions. If denies the claim as an administrative denial, Molina Healthcare will not pay as the secondary carrier. A EOB will not be for HCPC s not covered by. Service name Psychiatric Diagnostic Assessment Pharmacologic Management Services Community Mental Health Services (Provider Type 84) HE GT HE HQ GT APN Pharmacist MS in nursing Nurse practitioner may render ONLY WITH Physician assistant E&M Codes Unless otherwise indicated: -Psychiatrist -Physician -Psychiatrist -Physician 46935MMP1214 MHO-2253

2 Behavioral Health Counseling and Therapy H0004 HE GT HQ MS in nursing Nurse practitioner Independent social Independent marriage and Professional clinical counselor may render ONLY WITH Social trainee Social Assistant Psychology aide Aide School psychology assistant Marriage and family therapist Psychology intern Psychology fellow Psychology postdoctoral trainee Psychology resident Psychology trainee School psychology intern School psychology trainee * * * *These require E&M s. Codes related to partial hospitalization services: Physicians -Psychiatrists, -Clinical s -Clinical social s -CNS -NP -PA -CNM -IPP

3 Mental Health Assessment Services H0031 HE GT MS in nursing Nurse practitioner Independent social Independent marriage and Professional clinical counselor may render ONLY WITH Physician assistant Social trainee Social Marriage and family therapist Assistant Psychology aide Aide School psychology assistant School psychology intern School psychology trainee Psychology intern Psychology fellow Psychology postdoctoral trainee Psychology resident Psychology trainee Not covered

4 Partial Hospitalization Service S0201 HE MS in nursing Nurse practitioner Social Independent social Independent marriage and Marriage and family therapist Professional clinical counselor may render ONLY WITH Psychology intern Physician assistant Social work assistant Social trainee School psychology assistant School psychology intern School psychology trainee Assistant Psychology aide Aide Qualified mental health specialist Psychology fellow Psychology post-doctoral trainee Psychology resident Psychology trainee Partial hospitalization: G0129 G1076 G1077 Approved hospital or CMHC programs (requires physician certification of LOC needed) CSW services furnished to patients under a PHP that is provided by a hospital outpatient department or Community Mental Health Center (CMHC) are not covered and paid under the CSW benefit.

5 Crisis Intervention Mental Health Services S9484 HE MS in nursing Nurse practitioner Independent social Independent marriage and Professional clinical counselor may render ONLY WITH Physician assistant Social assistant Social trainee Social School psychology assistant School psychology intern School psychology trainee Psychology intern Psychology fellow Psychology postdoctoral trainee Psychology resident Psychology trainee Assistant Psychology aide Aide Qualified mental health specialist Marriage and family therapist

6 Community Psychiatric Supportive Treatment H0036 HE GT HQ MS of nursing Nurse practitioner Social Independent social Professional clinical counselor may render ONLY WITH Physician assistant Social assistant Social trainee School psychology assistant Psychology intern Psychology fellow Assistant Psychology aide Aide Psychology postdoctoral trainee Psychology resident Psychology trainee School psychology intern School psychology trainee Qualified mental health specialist Not covered

7 Community Alcohol and Other Drug Treatment Services Service name Alcohol/Drug Screening Analysis/Lab Urinalysis Paragraph R H0003 May order and request urinalysis: May request urinalysis (with order): Licensed social Social work assistant and Licensed marriage and family therapist Chemical assistant dependency counselor II dependency counselor III Certified school Student in an internship Not covered

8 Ambulatory Detoxification Paragraph X Assessment Paragraph K H0014 H0001 and Licensed marriage and Licensed social III Chemical dependency counselor assistant II Social work assistant Certified school Student intern Not covered G0396 G0397 Physician/ psychiatrist, clinical, clinical social, or other qualified behavioral health professional

9 Targeted Case Management Paragraph M H0006 and dependency counselor III Chemical dependency counselor assistant II Licensed social Social work assistant Licensed marriage and Certified school Student in an internship Care management specialist Not covered

10 Group Counseling Paragraph O H0005 and dependency counselor III Chemical dependency counselor assistant II Licensed social Licensed marriage and Certified school Student in an internship Group counseling in partial setting G0410 G0411 -Psychiatrist -CP -Physician -CSW -CNS -NP -PA -CNM -IPP

11 Individual Counseling Paragraph N H0004 and dependency counselor III Chemical dependency counselor assistant II Licensed social Licensed marriage and Certified school Student in an internship * * * *These require E&M s. Codes related to partial hospitalization Services: Psychiatrist -CP -Physician -CSW -CNS -NP -PA -CNM -IPP

12 Crisis Intervention Paragraph L H0007 With specialized training: and dependency counselor III With specialized training: Chemical dependency counselor assistant II Licensed social Social work assistant Licensed marriage and Certified school Student in an internship Physician/ psychiatrist, clinical, clinical social, or other qualified behavioral health professional

13 Intensive Outpatient Paragraph Q Medical/Somatic Paragraph S Methadone Administration Paragraph T H0015 H0016 H0020 and dependency counselor III with medication training Chemical dependency counselor assistant II Licensed social Licensed marriage and Certified school Student in an internship Not covered Not covered Not covered