Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules
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- Amos Kennedy
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1 Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules Summary of change: Effective for dates of service on and after 1/1/2014, Amerigroup is updating the Amerigroup Georgia CORE Services Behavioral Health Fee Schedule for outpatient behavioral health clinic services What is the impact of this change? Effective for dates of service on and after 1/1/2014, Amerigroup Community Care of Georgia is updating the Amerigroup Georgia CORE Services Behavioral Health Fee Schedule to the codes published in Table 1. Table 2 demonstrates the list of acceptable modifiers for the Amerigroup CORE Behavioral Health Schedule Fee. All codes and modifiers contained in Tables 1 and 2 must be used in accordance with standard billing guidelines. Providers must use HIPAA compliant billing codes when billing or submitting encounter data. This applies to both electronic and paper claims. Amerigroup reserves the right to use code editing software to determine which service is considered part of, incidental to, or inclusive of the primary procedure. Any code billed that is not specifically listed in Table 1 will be denied as non-covered and not eligible for reimbursement. Pre-Certification A Yes in the Pre-certification requirement column denotes that a given procedure code requires precertification. How do I request precertification? Request precertification by: Logging in to our provider self-service site at providers.amerigroup.com and selecting Precertification from the Tools menu Calling us at Faxing your request to Check the status of your request by logging back into provider self-service or calling Provider Services. What if I need assistance? If you have questions, please contact your local Provider Relations reative or call Provider Services at [ ].
2 Table 1: 2014 Amerigroup CORE Behavioral Health Schedule CPT Codes Description 2014 Precertification 90791U2* Psychiatric Diagnostic Evaluation (No Medical Services) 90791U3* Psychiatric Diagnostic Evaluation (No Medical Services) 90792U1* Psychiatric Diagnostic Evaluation with Medical Services 90792U2* Psychiatric Diagnostic Evaluation with Medical Services 90832U2 Psychotherapy, 30 Minutes 90832U3 Psychotherapy, 30 Minutes 90832U4 Psychotherapy, 30 Minutes 90833U1* Ind Psychotherapy w E&M (+30) 90833U2* Ind Psychotherapy w E&M (+30) 90834U2 Psychotherapy, 45 Minutes 90834U3 Psychotherapy, 45 Minutes 90834U4 Psychotherapy, 45 Minutes 90836U1* Ind Psychotherapy w E&M (+45) 90836U2* Ind Psychotherapy w E&M (+45) 90837U2 Psychotherapy, 60 Minutes 90837U3 Psychotherapy, 60 Minutes 90837U4 Psychotherapy, 60 Minutes 90839U1 Crisis Intervention, 60 Minutes 90839U2 Crisis Intervention, 60 Minutes 90839U3 Crisis Intervention, 60 Minutes 90840U1 Psychotherapy for crisis, each additional 30 minutes No 4 30 Minutes 90840U2 Psychotherapy for crisis, each additional 30 minutes 90840U3 Psychotherapy for crisis, each additional 30 minutes 90846U U U U U U4 Family Psychotherapy without the patient Family Psychotherapy without the patient Family Psychotherapy without the patient Conjoint Family Psychotherapy with the patient Conjoint Family Psychotherapy with the patient Conjoint Family Psychotherapy with the patient No 4 30 Minutes No 4 30 Minutes
3 90853U U U4 Group Psychotherapy other than of a multiple family group Group Psychotherapy other than of a multiple family group Group Psychotherapy other than of a multiple family group 96101U2 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 96102U2 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 96102U3 Psychological Testing Yes (Notification Required for 1 st 5 Hours) 5 1 Hour 5 1 Hour 5 1 Hour 96150U2 Ambulatory Initial Assessment 96150U3 Ambulatory Initial Assessment 96150U4 Ambulatory Initial Assessment 96151U2 Ambulatory Re-Assessment 96151U3 Ambulatory Re-Assessment 96151U4 Ambulatory Re-Assessment 96372U2 (PA/CNP/CNS) 96372U3 (RN) 96372U4 (LPN) Therapeutic, prophylactic or diagnostic injection Therapeutic, prophylactic or diagnostic injection Therapeutic, prophylactic or diagnostic injection 99201U1* E&M New Patient - 10 Minutes 99201U2* E&M New Patient - 10 Minutes 99202U1* E&M New Patient - 20 Minutes 99202U2* E&M New Patient - 20 Minutes 99203U1* E&M New Patient - 30 Minutes 99203U2* E&M New Patient - 30 Minutes 99204U1* E&M New Patient - 45 Minutes 99204U2* E&M New Patient - 45 Minutes 99205U1* E&M New Patient - 60 Minutes 99205U2* E&M New Patient - 60 Minutes 99211U1* E&M Established Patient - 5 Minutes 99211U2* E&M Established Patient - 5 Minutes 99212U1* E&M Established Patient - 10 Minutes 99212U2* E&M Established Patient - 10 Minutes 99213U1* E&M Established Patient - 15 Minutes
4 99213U2* E&M Established Patient - 15 Minutes 99214U1* E&M Established Patient - 25 Minutes 99214U2* E&M Established Patient - 25 Minutes 99215U1* E&M Established Patient - 40 Minutes 99215U2* E&M Established Patient - 40 Minutes H0004HQHRU2 Group Skills Training Yes Minutes H0004HQHRU3 Group Skills Training Yes Minutes H0004HQHRU4 Group Skills Training Yes Minutes H0004HQHRU5 Group Skills Training Yes Minutes H0004HQHSU2 Group Skills Training Yes Minutes H0004HQHSU3 Group Skills Training Yes Minutes H0004HQHSU4 Group Skills Training Yes Minutes H0004HQHSU5 Group Skills Training Yes Minutes H0004HQU2 Group Skills Training Yes Minutes H0004HQU3 Group Skills Training Yes Minutes H0004HQU4 Group Skills Training Yes Minutes H0004HQU5 Group Skills Training Yes Minutes H0004HRU2 Family Skills Training Yes Minutes H0004HRU3 Family Skills Training Yes Minutes H0004HRU4 Family Skills Training Yes Minutes H0004HRU5 Family Skills Training Yes Minutes H0004HSU2 Family Skills Training Yes Minutes H0004HSU3 Family Skills Training Yes Minutes H0004HSU4 Family Skills Training Yes Minutes H0004HSU5 Family Skills Training Yes Minutes H0012TF Alcohol and/or drug services; Sub-acute (Residential Addiction Program Outpatient) H0012TG Alcohol and/or drug services; Sub-acute (Residential Addiction Program Outpatient) H0013 Alcohol and/or drug services; Acute (Residential Addiction Program Outpatient) H0014U2 H0014U3 H0014U4 H0015U2 H0015U3 H0015U4
5 H0020U2 (PA/CNP/CNS) H0020U3 (RN) H0020U4 (LPN) Alcohol and/or drug services, methadone administration and/or service Alcohol and/or drug services, methadone administration and/or service Alcohol and/or drug services, methadone administration and/or service H0031U2 Mental Health Assessment by a non-physician No 8 15 Minutes H0031U3 Mental Health Assessment by a non-physician No 8 15 Minutes H0031U4 Mental Health Assessment by a non-physician No 8 15 Minutes H0032U2 H0032U3 H0032U4 Mental Health Service Plan Development by a non-physician Mental Health Service Plan Development by a non-physician Mental Health Service Plan Development by a non-physician No 8 15 Minutes No 8 15 Minutes No 8 15 Minutes H0036U3 Intensive Family Intervention Yes Minutes H0036U4 Intensive Family Intervention Yes Minutes H0036U5 Intensive Family Intervention Yes Minutes H0036U3U7 Intensive Family Intervention Yes Minutes H0036U4U7 Intensive Family Intervention Yes Minutes H0036U5U7 Intensive Family Intervention Yes Minutes H0039HQU3 Assertive Community Treatment Yes Minutes H0039HQU4 Assertive Community Treatment Yes Minutes H0039HQU5 Assertive Community Treatment Yes Minutes H0039HT Assertive Community Treatment Yes Minutes H0039TNU3 Community Support Team Yes Minutes H0039TNU4 Community Support Team Yes Minutes H0039TNU5 Community Support Team Yes Minutes H0039U1* Assertive Community Treatment Yes Minutes H0039U2* Assertive Community Treatment Yes Minutes H0039U3 Assertive Community Treatment Yes Minutes H0039U4 Assertive Community Treatment Yes Minutes H0039U5 Assertive Community Treatment Yes Minutes H0039TNU3U7 Community Support Team Yes Minutes H0039TNU4U7 Community Support Team Yes Minutes H0039TNU5U7 Community Support Team Yes Minutes H0039U1U7 Assertive Community Treatment Yes Minutes H0039U2U7 Assertive Community Treatment Yes Minutes H0039U3U7 Assertive Community Treatment Yes Minutes H0039U4U7 Assertive Community Treatment Yes Minutes H0039U5U7 Assertive Community Treatment Yes Minutes
6 H2010U2 Medication Administration (PA/CNP/CNS) H2010U3 Medication Administration (RN) H2010U4 Medication Administration (LPN) H2011U1 Crisis Intervention Services No Minutes H2011U2 Crisis Intervention Services No Minutes H2011U3 Crisis Intervention Services No Minutes H2011U4 Crisis Intervention Services No Minutes H2014HQHRU4 Family - Skills training and development Yes 8 15 Minutes H2014HQHRU5 Family - Skills training and development Yes 8 15 Minutes H2014HQHSU4 Family - Skills training and development Yes 8 15 Minutes H2014HQHSU5 Family - Skills training and development Yes 8 15 Minutes H2014HQU4 Family - Skills training and development Yes 8 15 Minutes H2014HQU5 Family - Skills training and development Yes 8 15 Minutes H2014HRU4 Family - Skills training and development Yes 8 15 Minutes H2014HRU5 Family - Skills training and development Yes 8 15 Minutes H2014HSU4 Family - Skills training and development Yes 8 15 Minutes H2014HSU5 Family - Skills training and development Yes 8 15 Minutes H2015HFU4 Community Support Services Yes Minutes H2015HFU5 Community Support Services Yes Minutes H2015U4 Community Support Services Yes Minutes H2015U5 Community Support Services Yes Minutes H2015UKU4 Community Support Services Yes Minutes H2015UKU5 Community Support Services Yes Minutes H2015HFU4U7 Community Support Services Yes Minutes H2015HFU5U7 Community Support Services Yes Minutes H2015U4U7 Community Support Services Yes Minutes H2015U5U7 Community Support Services Yes Minutes H2015UKU4U7 Community Support Services Yes Minutes H2015UKU5U7 Community Support Services Yes Minutes H2017HQU4 Psychosocial Rehabilitation Group Yes Minutes H2017HQU5 Psychosocial Rehabilitation Group Yes Minutes H2017U4 Psychosocial Rehabilitation Yes Minutes H2017U5 Psychosocial Rehabilitation Yes Minutes Q3014GT TeleHealth Site Fee No Minutes T1001U2 Nursing Assessment/ Evaluation No Minutes T1001U3 Nursing Assessment/ Evaluation No Minutes T1001U4 Nursing Assessment/ Evaluation No Minutes T1002U2 RN Services No Minutes T1002U3 RN Services No Minutes T1003U4 LPN/LVN Services No Minutes
7 * Indicates that a service is able to be rendered via interactive audio and video telecommunication systems. Refer to modifier GT in Table 2. Table 2: Schedule of Acceptable Modifiers for the Amerigroup CORE Behavioral Health Schedule Modifier U1 U2 U3 U4 U5 U7 HQ HR HS HT UK HA TN GT Description Level 1 Practitioner: Physician, Psychiatrist Level 2 Practitioner: Psychologist, Physician s Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist Level 3 Practitioner: Registered Nurse, Licensed Dietician, Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT) Level 4 Practitioner: Licensed Practical Nurse (LPN); Licensed Associate Professional Counselor (LAPC); Licensed Master s Social Worker (LMSW); Licensed Associate Marriage and Family Therapist (LAMFT); Certified/Registered Addictions Counselors, Certified Peer Specialists, Trained Paraprofessionals and Certified Psychosocial Rehabilitation Professionals (CPRP) with Bachelor s degrees or higher in the social sciences/helping professions Level 5 Practitioner: Trained Paraprofessionals, Certified/Registered Addiction Counselors (CAC-I, RADT), Certified Peer Specialists, Certified Psychosocial Rehabilitation Professionals, and Qualified Medication Aides with at least a high school diploma/equivalent Out of Clinic; If a service is provided out-of-clinic, then the U7 modifier must be appended to the CPT code in the sequence noted in Table 1. The U7 modifier may only be billed when the corresponding CPT code in Table 1 allows for it Group Setting Family/Couple with client Family/Couple with without client Multidisciplinary team Collateral Contact Child/Adolescent program Rural/outside providers customary service area Via interactive audio and video telecommunications systems. Informational modifier, no additional reimbursement allowed. Must be appended to the CPT code in the last position in a series of modifier combinations GAPEC Issued [Month Day, Year] by Amerigroup Georgia health plan
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