SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS Effective 7/1/2015 MENTAL HEALTH SERVICES
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1 SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS Effective 7/1/2015 MENTAL HEALTH S ACR Assessment Initial Assessment - Full $ ACR Assessment Annual Reassessment - Full $ ACR Assessment Initial Assessment - Short $ ACR Assessment Annual Reassessment - Short $ C & A Day Treatment Per Unit $36.53 C & A Day Treatment Assessment 1 Unit $36.53 Case Management Per Month $ Crisis Intervention Per 15 Minutes $ Education Group Per Session $10.00 Family Therapy 1 Hour $ Group Therapy Per Session $ Individual Therapy 30 Minutes $ Minutes $ Minutes $ Individual Patient & Family w/em 45 Minutes $ Individual Patient & Family w/em 60 Minutes $ Interactive Complexity Per Session $ Inpatient Hospitalization Per Day $ Intake Evaluation Per Evaluation $ Intensive Case Coordination Per Month $ Intensive Community Treatment Per Hour $ Laboratory Test Per Test
2 MENTAL HEALTH S (Continued) Level II Screening Per Screening Determined By State Medication Administration and Management Fee Per Prescription $4.25
3 MENTAL HEALTH S (Continued) Medication Review w/psychiatrist Per Session $ Level 1 Medication Review w/psychiatrist Per Session $ Level 2 Medication Review w/psychiatrist Per Session $ Level 3 Medication Review w/psychiatrist Per Session $ Level 4 Medication Review w/psychiatrist Per Session $ Level 5 Pharmacologic Management w/psych Per Session $ Medication, Therapeutic Injection Per Injection $ Psychiatric Evaluation Per Evaluation $ Psychiatric Evaluation w/medical Per Evaluation $ Psychosocial Rehab. Services Hours = 1 Unit $ Hours = 2 Units $ or More Hours = 3Units $ Psychiatric Consult (Deposition, court appearance, Etc.) Per Hour $ Residential (Atlantic Manor Group Home) Rent/Utilities Monthly $ Residential (Supervised Apartments) Rent/Utilities Monthly $ Support Services Hours = 1 Unit $ Hours = 2 Units $ Hours = 3 Units $ or More Hours = 4 Units $ Transportation Per mile 0-10 miles $.80 per mile Greater than 10 miles $.60 per mile VICAP Assessment 1 unit $
4 MENTAL HEALTH S (Continued) Materials or Supplies for ED Items Used Based on cost Medical Record Copies /DDS As Needed $15.00 Medical Record Copies /SSA Per Record $30.00 Medical Record Copies /other Number of Pages/ Determined by Processing Time City
5 SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BEHAVIORAL HEALTHCARE BOARD OF DIRECTORS INTELLECTUAL DISABILITY ACR Assessment Initial Assessment - Full $ ACR Assessment Annual Reassessment - Full $ ACR Assessment Initial Assessment - Short $ ACR Assessment Annual Reassessment - Short $ Case Management Per Month $ Day Support (Regular Intensity) Hours = 1 unit $ Hours = 2 units $ or More Hours = 3 Units $ Day Support (High Intensity) Hours = 1 unit $ Hours = 2 units $ or More Hours = 3 Units $ Day Support (non-ccsb) Supported Employment Group Supported Employment - Follow along Supported Employment Sheltered Medical Record Copies /DDS Per Record $15.00 Medical Record Copies /SSA Per Record $30.00 Medical Record Copies /other Number of Pages/ Determined by Processing Time City Occupational Therapy 15 Minutes $25.13 (Congregate) $37.50 (Individual) Physical Therapy 15 Minutes $25.13 (Congregate) $37.50 (Individual) Speech & Language Therapy 5 Minutes $25.13 (Congregate) $37.50 (Individual)
6 INTELLECTUAL DISABILITY (continued) Reimbursement Category 1 Providers Therapists, Nurse Category 2 Providers Educators, Home Visiting Teachers Initial Assessment for 15 minutes $37.50 (Category 1) Service Planning $27.50 (Category 2) Initial IFSP Development, 15 minutes $37.50 (Category 1) Annual IFSP Review $27.50 (Category 2) Team Treatment, Team Meeting, 15 minutes $37.50 (Category 1) On-going Assessments $27.50 (Category 2) Developmental Services 15 minutes $18.43 (Congregate) $27.50 (Individual) Center-based Group or Individual 15 minutes $ 7.43 (Group) Early Intervention Services $22.50 (Individual) Category I Center-based Group or Individual 15 minutes $ 5.44 (Group) Early Intervention Services $16.49 (Individual) Category 2 Transportation Per mile 0-10 miles $.80 per mile Greater than 10 miles $.60 per mile
7 SCHEDULE OF CHARGES APPROVED BY CHESAPEAKE INTEGRATED BOARD OF DIRECTORS SUBSTANCE ABUSE Case Management Per 15 minutes $16.50 SA Education Group Per Session $10.00 Family Therapy 1 Hour $ Group Therapy Per Session $ Individual Therapy 30 Minutes $ Minutes $ Minutes $ Individual Patient & Family w/em 45 Minutes $ Individual Patient & Family w/em 60 Minutes $ Intake Evaluation Per Evaluation $ Intensive Outpatient Program Per Day $ Laboratory Test Per Test Medical Detox Per Day $ Medical Record Copies /DDS Per Record $ Medical Record Copies /SSA Per Record $ Medical Record Copies /other Number of Pages/ Determined by City Processing Time Methadone Detox Per Day $ Psychiatric Consult (Deposition, court appearance, Etc.) Per Hour $ Transportation Per mile 0-10 miles $.80 per mile Greater than 10 miles $.60 per mile Urine Drug Screen Panel Per Screen $ Substance Abuse Screening Per Screen $ 75.00
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