Acute Care & Outpatient Facility Services. Facility 101, 110, 114, 124, 134, 21, 51, 55, 56 Yes. Facility 905, , 52, L

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1 Behavioral Health Covered Services & orization Guidelines Ohio Covered Families and Children (CFC), Age Blind and Disabled (ABD) and Ohio MyCare Medicare/Medicaid (MMP) Please refer to your Agreement with Cenpatico to identify additional services you are contracted and eligible to provide. n-participating providers (those that are not contracted and credentialed with Cenpatico) require prior authorization, unless otherwise noted. Service Description Inpatient - Crisis Inpatient - Behavioral Health Inpatient Substance Use Disorder Inpatient Eating Disorder Must be billed with an eating disorder diagnosis as define by current ICD. Inpatient or Outpatient ECT Intensive Out Patient Services Reimbursed under Medicare payment rules only; t covered by Medicaid Day Reimbursed under Medicare payment rules only; t covered by Medicaid Partial Hospitalization (PHP)- Behavioral Health/Substance Use Disorder. Reimbursed under Medicare payment rules only; t covered by Medicaid Outpatient Observation Limit Discharge Follow-Up Anesthesia for ECT Limited to 4 per day Acute Care & Outpatient Facility Services Billing Codes Allowed Locations Facility , 51, 55, 56 Facility 101, 110, 114, 124, 134, 21, 51, 55, , 154 Facility 116, 126, 136, 146, , 51, 55, 56 Facility 120, 130, 140, , 55, 56 Facility , 22, 51, 52, 56, 57 Facility 905, , 52, L Facility , 52, Facility 912, , 50, 52, 53, 57 Facility 760, 761, 762, , 52, Facility , 22, 51, 52 Facility 370, 379, , 22, 51, 52, 55, 56, 57

2 Professional Behavioral Health Services Medication management provided at FQHC does not require prior auth. Service Description Billing Codes Add-On Code Allowed Locations Psychiatric diagnostic with or 03, 04, 11, 12, 20, 21, evaluation, CNS, LMFT, 22, 23, 31, 32, 49, 50, LISW, LPC 51, 52, 55, 56, 57, 71, 72, 99 Diagnostic evaluation, interactive, CNS, LMFT, LISW, LPC with or 03, 04, 11, 12, 20, 21, 22, 23, 31, 32, 49, 50, 51, 52, 55, 56, 57, 71, 72, 99 Professional Behavioral Health Services Medication management provided at FQHC does not require prior auth. Service Description Billing Codes Add-On Code Allowed Locations Individual psychotherapy Family Therapy Individual psychotherapy with medication management Group Psychotherapy Pharmacological Management List separately in addition to the primary procedure for psychotherapy, CNS, LMFT, LISW, LPC, CNS, LMFT, LISW, LPC 90832, 90834, , 90846, 90847, MD, PA, , CNS, LMFT, LISW, LPC, CNS, LMFT, LISW, LPC with or with or 90833/ 90836/ 90838/ with or 03, 04, 11, 12, 20, 21, 22, 03, 04, 11, 12, 20, 21, 22, 03, 04, 11, 12, 20, 21, 22, 03, 04, 11, 12, 20,21, 22, , 04, 11, 12, 20, 21, 22,

3 Professional Behavioral Health Services Medication management provided at FQHC does not require prior auth. Service Description Billing Codes Add-On Code Allowed Locations Therapeutic Repetitive Transcranial Magnetic Stimulation for 90867, limit for Unlisted Psychiatric Service Electroconvulsive (ECT) Therapy Limits Psych Testing, Aphasia Assessment Per Hour = 1 unit Unlimited, medical necessity Developmental Screening/Testing Per visit = 1 unit Unlimited, medical necessity Neurobehavioral Status Exam / Neuropsychological Testing Per Hour = 1 unit Unlimited, medical necessity Emergency Office Visit Limit - Bundled procedure with no separate payment Emergency Department Services, CNS, LMFT, LISW, LPC, CNS, LMFT, LISW,LPC 90867, , 20, 21, 22, 23, 31, 32, 49, 50, 51, 52, 56, 71, 72, , 04, 11, 12, 20, 21, 22, MD , 22 MD, PhD 96101, , 04, 11, 12, 20, 31, 32, 49, 50, 51, 52, 55, 56, 57, 71, 72, 99 MD, PhD 96110, , 04, 11, 12, 20, 31, 32, 49, 50, 51, 52, 55, 56, 57, 71, 72, 99 MD, PhD 96116, , 04, 11, 12, 20, 31, 32, 49, 50, 51, 52, 55, 56, 57, 71, 72, 99 MD, PA, , 04, 11, 12, 20, 22, 49, 50, 52, 71, 72, 99 MD Initial Observation Care Initial Facility Care MD, PA, , 22, 23, 51, 52, 53, 57 MD, PA, , 51, 55, 56, 57

4 Professional Behavioral Health Services Medication management provided at FQHC does not require prior auth. Service Description Billing Codes Add-On Allowed Locations Code Subsequent Facility MD, PA, , 51, 55, 56, 57 Care Facility Discharge MD, PA, 99238, , 51, 55, 56, 57 Management Office Consults MD, PA, , 04, 11, 12, 20, 22, 23, 49, 50, 52, 53, 57, 71, 72, 99 Inpatient Consults MD, PA, , 51, 55, 56, 57 Initial Nursing Facility Coordination of Care Counseling Subsequent Nursing Facility - Coordination of Care Counseling Home Visit Therapeutic, Prophylactic or Diagnostic Injection Limit MD , 32 MD , 32 MD, PA, , 31, 32 MD, PA, All Locations Telepsychiatry Originating Site Fee See note 1 MD/DO Office, Local Health Department, Mental Health, Federally Qualified Health, Outpatient Hospital Q , 22, 23, 50, 53, 72 Telepsychiatry Distant Site providers must be a medical doctor, doctor of osteopathic medicine, a licensed psychologist, or a federally qualified health center. The Originating Site is the location where the member receiving the telepsychiatry service is located. The Distant Site is the site where the provider rendering the telehealth service is located and must be billed with the GT Modifier.

5 Service Description Mental Health Assessment Per visit = 1 unit limits New patient Evaluation/Management Per visit = 1 unit limits Established patient Evaluation/Management 1 Per visit = 1 unit limits Mental Health Assessment 1 Per visit = 1 unit limits Behavioral Health Counseling- Individual Psychotherapy Per Visit = 1 Unit Limit Behavioral Health Counseling Group Per Visit = 1 Unit Limit Crisis Intervention psychotherapy 60 min = 1 unit limits Crisis Intervention psychotherapy Each additional 30 min = 1 unit limits COMMUNITY MENTAL HEALTH SERVICES Medicare Certified types - Only Covered for MyCare Members (Services billable to Medicare) Billing Codes Add-on Code MD with or MD 99204, with or 90833/ 90836/ 90838/ MD 99213, 99214, PhD,, CNS, LMFT, LISW PhD,, CNS, LMFT, LISW PhD,, CNS, LMFT, LISW PhD,, CNS, LMFT, LISW PhD,, CNS, LMFT, LISW with or 90833/ 90836/ 90838/ with or 90832, 90834, with or with or Allowed Locations All except All except All except All except All except All except All except 3 hours without prior auth All except 3 hours without prior auth

6 Service Description Psychiatric diagnostic interview 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 limit Mental Health Assessment 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 Limit of 2 hours per SFY-adults Pharmacological Management 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 24 hours per SFY - adults Behavioral Health Counseling- Individual 52 hours per SFY combined with group - adults Behavioral Health Counseling Group 52 hours per SFY combined with Individual adults Mental Health Assessment 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 4 hours per SFY - adults Psychiatric Support (CPST) - Individual Psychiatric Support (CPST) - Group COMMUNITY MENTAL HEALTH SERVICES Type 84 - Only Covered for MyCare Members (When not billed to Medicare) Billing Codes Modifier(s) Additional modifiers allowed as optional Allowed Locations CMHC HE or GT All except CMHC HE or GT All except CMHC HE, HQ, or GT All except CMHC H0004 HE or GT All except CMHC H0004 HQ All except CMHC H0031 HE or GT All except CMHC H0036* HE or GT All except CMHC H0036 HQ All except 104 hours w/out prior auth 104 hours w/out prior auth

7 Service Description Partial Hospitalization 1 unit = 1 day Limited to 1 unit per day for ages Under age 21 may bill 2 units per day. Medical Home, Comprehensive Care Coordination and Planning, Maintenance of Plan 1 unit = 1 calendar month Limited to 1 unit per calendar month Crisis Intervention 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 limits COMMUNITY MENTAL HEALTH SERVICES Type 84 - Only Covered for MyCare Members (When not billed to Medicare) Billing Codes Modifier(s) Additional modifiers allowed as optional Allowed Locations CMHC S0201 HE All except CMHC S0281 All except CMHC S9484 HE All except 3 hours without prior auth *CPST service may include either contact between the mental health professional and the client, or an individual essential to the mental health treatment of the client. Optional additional modifier UK could be billed in addition to required modifier. Service Description Ambulatory Detoxification 1 unit = 1 day Limit of 1 per day Assessment 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 limits COMMUNITY ALCOHOL AND OTHER DRUG TREATMENT SERVICES Type 95 - Only Covered for MyCare Members Billing Codes Modifier(s) Additional modifiers allowed as optional Allowed Locations H0014 HA or HF All exclude 21, 22, 23 and 51 H0001 HA or HF All

8 Case management 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 limits Service Description Crisis Intervention 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 limits Individual Counseling *Limit of 30 combined hours per week (Sun- Sat) - adult Group Counseling *Limit of 30 combined hours per week (Sun- Sat) - adult Medical/Somatic Intervention 1 unit = 1 hour, allowed to bill in six minute fractions (every 6 *Limit of 30 combined hours per week (Sun- Sat) - adult Intensive Outpatient 1 unit = 1 day Limit of 1 per day Laboratory Urinalysis 1 unit = 1 screening limits Methadone Administration 1 unit = 1 dose Limit of 1 unit per day H0006* HA or HF All Billing Codes Modifier(s) Additional modifiers allowed as optional Allowed Locations H0007 HA or HF All 3 hours without prior auth H0004 HA or HF All H0005 HA or HF All H0016 HA or HF All H0015 HA or HF All exclude 21, 22, 23 and 51 H0003 HA or HF All exclude 21, 22, 23 and 51 H0020 HA or HF All exclude 21, 22, 23 and 51

9 *Case management services may include contact with a client or with individuals other than the client. Optional additional modifier UK could be billed in addition to required modifier. Service Description Lorazepam 1 unit = 2 milligrams Diazepam (Valium) Naltrexone (Vivitrol) Generic Buprenorphine Haloperidol Decanoate 1 unit = 50 milligrams Olanzapine Pamoate Risperidone Haloperidol Lactate Fluphenazine Decanoate 1 unit = 25 milligrams Paliperidone Palmitate Prescription Drug, Injection n- Chemotherapeutic, Physician, PA,, Physician, PA, Injectables Billing Allowed Codes Locations J2060 All exclude 21, J3360 All exclude 21, J2315 All exclude 21, J8499 All exclude 21, J1631 All exclude 21, J2358 All exclude 21, J2794 All exclude 21, J1630 All exclude 21, J2680 All exclude 21, J2426 All exclude 21, J3490 All exclude 21,

10 Modifiers 99 Multiple modifiers GT Telecommunications H9 Court Ordered HA Child/Adolescent HB Adult, nongeriatric HC Adult, Geriatric HD Pregnant/Parent HE Mental Health HF Substance Abuse HG Opiod Addiction HH Integrated Mental Health/Substance Abuse HI Integrated Mental Health/Mental Retardation/Development al Disabilities HJ Employee Assistance HK Specialized Mental Health for High Risk Population HL Intern HM Less than Bachelor Degree Level HN Bachelors Degree Level HO Masters Degree Level HP Doctoral Level HQ Group setting HR Family/Couple with client present HT Multi-Disciplinary Team SC Medically Necessary TJ Group, child and/or adolescent TS Follow-up Service UK Services provided on behalf of the client to someone other than the Common Place of Service Codes 03 SCHOOL 49 INDEPENDENT CLINIC 04 HOMELESS SHELTER 50 FEDERALLY QUALIFIED HEALTH CENTER 09 PRISON-CORRECTIONAL FACILITY 51 INPATIENT PSYCHIATRIC FACILITY 11 PROVIDER'S OFFICE 52 PSYCHIATRIC FACILITY PARTIAL HOSPITALIZATION 12 HOME 53 COMMUNITY MENTAL HEALTH CENTER 20 URGENT CARE FACILITY 55 RESIDENTIAL SUBSTANCE ABUSE TREATMENT FAC 21 INPATIENT HOSPITAL 56 PSYCHIATRIC RESIDENTIAL TREATMENT CENTER 22 OUTPATIENT HOSPITAL 57 NON-RESIDENTIAL SUB. ABUSE TREATMENT FAC 23 EMERGENCY ROOM - HOSPITAL 72 RURAL HEALTH CLINIC 31 SKILLED NURSING FACILITY 99 OTHER PLACE OF SERVICE 32 NURSING FACILITY

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