Sandhills Center Care/Utilization Management Service Certification Request Reviews. Legend
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1 = Comprehensive Clinical Assessment Sandhills Center Care/Utilization Management Legend = Service Authorization Request = Individual Support PA=Prior Approval = Person-Centered LOC = Level of Care Form NCSNAP = North Carolina Support Needs Assessment Profile SIS = Supports Intensity Scale Certificate of Need = CON =Treatment/Service IEP=Individualized Education BIP=Behavior Intervention PLEASE NOTE: All Concurrent Urgent requests are to be submitted at least 24 hours prior to the expiration of the previous authorization. All Concurrent Non-Urgent/Routine requests are to be submitted at least 14 days prior to the expiration of the previous authorization. Retrospective requests are only to be conducted for retrospective eligibility dates. Direct Bill Services (not initially requiring a submission) Sandhills Center Review Information H0001 H0005 H0004 H0004:HQ H0004:HR H0004:HS :GT Unit = 1 event H0031 Service Names Alcohol and/or Drug Assessment (P) Alcohol and/or Drug Group Counseling (P) Behavioral Health Counseling (P) (Individual / Group / Family) Clinical Evaluation / Intake / Interactive Evaluation Family Therapy (With or Without Member) Group Therapy (Multiple Family or Non-Multiple Family) Individual Therapy (30 minutes/45 minutes/60 minutes) Mental Health Assessment (P) Prospective (Urgent) Prospective (Non-Urgent / Routine) (prior to (prior to (prior to (prior to (prior to (prior to (prior to (prior to Concurrent (Urgent) Concurrent (Non-Urgent / Routine) 1
2 E/M codes Medication Check Psychological / Developmental / Neuropsychological Testing (prior to exhausted for adults) (prior to Services requiring a submission Sandhills Center Utilization Management (UM) Certification Review Types H2036 YP 620 H0014 H Unit = 1 event/day YA352 YA353 T Unit = Invoice H2012:HA H2015:HT H2015 H2015UI Service Names ADATC/Medically Supervised/Detox/Crisis Stabilization Adult Developmental Vocational Program (ADVP) Ambulatory Detox Assertive Community Treatment Team (ACTT) Assertive Engagement Assistive Technology Equipment and Supplies Day Treatment Community Support Team (CST) Community Networking Prospective (Urgent) Prospective (Non-Urgent / Routine) Concurrent (Urgent) Concurrent (Non-Urgent / Routine) or (service auth must go through the end of the month 14 th is the cut-off) (IEP BIP 504 plan) or (service auth must go through the end of the month 14 th is the cut-off) 2
3 YP650 H2011 T2025-U3 T2034 YP660 T2021-Individual T2021HQ-Group T2027 YM unit= 1 day H2014 H2014:HQ H2014:HM H2014:U1 YP610 T1023 T1023:GT YP690 YP692 YP485 YP740 YP750 T2025U or T2025U1 T2025U2 YP760 YP770 Community Rehabilitation Program (Sheltered Workshop) I/DD Crisis Services Day/Evening Activity I/DD Day Supports Day Supports (IPRS) Developmental Therapies Developmental Day Child Diagnostic Assessment (pass through event of 1 event per year) Drop-In Center / NCSNAP NCSNAP or or / or or Facility-Based Crisis Program Family Living - Low Intensity Family Living - Moderate Intensity Financial Support Services Group Living Low Intensity (MH) Group Living Moderate Intensity (MH) 3
4 YP780 YP Unit= 1 day YP770 YP 770 1unit =1 day YP760 YM686 S Unit = invoice YM700 T Unit = invoice T2013 T2013HQ T Unit=15 minutes YP821(3 WAY) YP820 (Non- Medicaid) YP821(3 WAY) YP820 (Non- Medicaid) H2022 YA 389 H2011 Group Living High Intensity Group Living-High Intensity (IPRS, SA) Group Living Adults Group Moderate (I/DD IPRS only) Group Living-Adults Group Moderate (SA/IPRS only) Group Living Adults Group Low (IPRS I/DD only) Guardianship Home Modifications Independent Living Individual Goods and Services In-Home Skill Building In-Home Intensive Supports Inpatient Hospital Psychiatric or or LOC Inpatient Hospital Detox Intensive In-Home (IIH) Long-Term Vocational Support Services Mobile Crisis (pass through of 8 hours- PA required prior to 9 th hour of service delivered) or or 4
5 H2033 S5110 S Unit = invoice H0010 H Unit = 1 event/1 day H Unit = 1 event/1 day Multi-Systemic Therapy (MST) Natural Supports Education Non-Hospital Medical Detox Opioid Treatment Partial Hospitalization (ned admit) YA308 YA309(Group) Peer Support NA YP020 YP021 YM050 S5125 S9484 (adults) RC911 YA230 H2017 H2016 T2014 T2020 H2016H1 H0046 Personal Assistance Personal Care Services Personal Care Services Professional Treatment Services in Facility Based Crisis Program (7 day pass through, PA required prior to day 8) Psychiatric Residential Treatment Facility (PRTF) Psychosocial Rehabilitation (PSR) Residential Supports I-V Residential Treatment - Level I/Family Type or or CON 5
6 H2020 Y2362 Y2363 Y2348 H0019:A H0019:B Y2349-Level III GH (5+ beds) Y2360-Level IV GH (4 beds or less) Y2361-Level IV GH (5+ beds) H0019:C H0019:D H0019:CTL H0019:DTL S5150 Individual S5150HQ Group T1005TD (RN) T1005TE (LPN) S5150US (Facility) YP010-Hourly YP730-Daily YP010-Hourly YP730-Daily YP790 Residential Treatment - Level II / Family (TFC) Residential Treatment - Level II / Group Home Residential Treatment Level III (4 beds or less) Residential Treatment Level III-IV Placement must be transition from PRTF/inpatient setting; MST or IIH within last 6 months and severe/functional impairment consists CFT reviewed alternatives Residential Treatment Level IV Respite Respite-Crisis Respite-ned (I/DD only) Social Detox - Psych Eval for requests exceeding a 120 days - Psych Eval for requests exceeding a 120 days 6
7 T2025 T2025HO H2035 H2034 YP760 YP710 H Unit = 1 event H0013 H0012:HB YP710 YP710 YP720 YM725 YM811-I YM812-II YM813-III YM814-IV YM815-V YM816-VI YP630 Individual YA 390 Individual YP640 Group Specialized Consultative Services Substance Abuse Comprehensive Outpatient Treatment (SACOT) (pass through 60 days of service avail. 1x/cal. year) Substance Abuse Halfway House Substance Abuse Intensive Outpatient (SAIOP) (pass through for 30 days of service available 1x/ calendar year) Substance Abuse Medically Monitored Community Residential Substance Abuse Non-Medically Monitored Community Residential Supervised Living Low Intensity (IPRS MH) Supervised Living Low Intensity (IPRS I/DD) Supervised Living Moderate Intensity Supervised Living High Intensity Supervised Living - MR/MI I-VI Residents (I/DD only) Supported Employment (IPRS)(MH/SA) Supported Employment (IPRS)(I/DD) or or or or or or or or or or or or 7
8 H2025-Individual H2025HQ-Group I Unit=15 minutes YA254 YA256 YA258 YA255 YA257 YA259 T Unit = invoice Supported Employment Therapeutic Leave Level I-IV Vehicle Modifications/Adaptations THE FOLLOWING ARE B-3 SERVICES THAT ALSO REQUIRE THE IDENTIFIED DOCUMENTATION T2041 U4 1 Unit = 1 month H0018 U4 1 Unit = 24 hours T1019 U4 H2023U4-Individual H2023HQU4-Group I Unit = 15 minutes H2026U4-Individual H2026HQU4-Group I Unit = 15 minutes H0038U4 H0038HQU4 H0045U4-Individual H0045U4-Group H0045U4-Individual H0045U4-Group Community Guide Crisis Respite Individual Support Initial Supported Employment Maintenance Supported Employment Peer Support Respite I/DD Respite MH/SA or or or or 8
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