NM Behavioral Health Design Service List By HIPAA Code and Definition. Modifiers Service Definition Unit Comments

Transcription

1 CPT H9, TR, HA Psychiatric diagnostic interview examination Psychiatric diagnostic interview examination includes a history, mental status, and a disposition, and may include communication with family or other sources, ordering and medical interpretation of laboratory or other medical diagnostic studies. In certain circumstances other informants will be seen in lieu of the individual. Product/ Hourly Licensed Psychologist, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, Licensed Independent Social Worker (LISW), Licensed Professional Clinical Mental Health Counselor (LPCC), Licensed Marriage & Family Therapist (LMFT). DOH will use this code for commitment-related evaluations only. CYFD will use this code only for a diagnostic exam. Use HA modifier. For HSD/Medicaid Psychosocial Rehabilitation Program (PSR), use H0031 for assessment. For school-based services, use modifier TR. For court-ordered exam, use modifier H9. For HSD/Medicaid, Practitioner Type will determine rate. Note: HSD/Medicaid pays based on practitioner and on an hourly rate; DOH and CYFD pay per product. Page 1 of 38 Revised 6/24/05

2 90802 H9, TR Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication. Licensed Psychologist, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT. Product/ Hourly For court-ordered, use modifier H9. For DOH school-based, use modifier TR TR, U8, HA Individual psychotherapy, office (90804 for min, for 45-50min, for min) Face-to-face interactive interventions are focused and time-limited. Interventions are designed to improve functioning and increase independence. Interventions are relevant to the needs of the recipient and relate directly to the individualized goals and objectives specified in the recipient s treatment plan. This service includes individual (child or adult), family, and group counseling. Individual psychotherapy, office with medical evaluation and management services (E/M), for min, for min, for min) Psychotherapy is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the individual and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development Insight Oriented, Behavior Modifying and/or Supportive Psychotherapy refers to the development of insight or affective understanding, the CPT defined time For HSD/Medicaid, Practitioner Type will determine rate. Note: HSD/Medicaid pays based on practitioner and on an hourly rate. Authorized practitioners for even numbered services: Licensed Psychologist, Psychologist Associate licensed at the master s level, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, Licensed Professional Art Therapist (LPAT), Licensed Alcohol & Drug Abuse Counselor (LADAC), Registered or Licensed Mental Health Counselor (RMHC/LMHC), Licensed Professional Mental Health Counselor (LPC), or Licensed Masters Social Worker (LMSW). Authorized practitioners for odd numbered services: Page 2 of 38 Revised 6/24/05

3 use of behavior modification techniques, the use of supportive interactions, the use of cognitive discussion of reality, or any combination of the above to provide therapeutic change. Individual psychotherapy is divided into two broad categories: 1) Insight Oriented, Behavior Modifying and/or Supportive Psychotherapy, and 2) Interactive Psychotherapy. Individual psychotherapy, interactive, office, (90810 for min, for min, for min) Individual psychotherapy, interactive, office with medical evaluation and management services (E/M), (90811 for min, for min, 908 for min) Licensed or board-eligible Psychiatrist. For HSD/Medicaid school-based services, use modifier TR. For HSD/Medicaid PSR Therapeutic Intervention service, use modifier U8. For CYFD, use HA modifier. Practitioner Type will determine rate. Interactive Psychotherapy ( ) is typically furnished to children. It involves the use of physical aids and non-verbal communication to overcome barriers to therapeutic interaction between the clinician and an individual who has not yet developed, or has lost, either the expressive language communication skills to explain his/her symptoms and response to treatment, or the receptive communication skills to understand the clinician if he/she were to use ordinary adult language for communications Individual psychotherapy, inpatient, (90816 for min, for min, for min) Individual psychotherapy, inpatient, with medical evaluation and management services (E/M), (90817 for min, for min, for min) Individual psychotherapy, interactive, inpatient, (90823 for min, for min, for min) Individual psychotherapy, interactive, inpatient, with medical evaluation and management services (E/M) (90824 for min, for min, for min) CPT defined time Authorized practitioners for 90816, 90818, 90821, 90823, & 90828: Licensed Psychologist, Licensed or board-eligible Psychiatrist. Authorized practitioners for 90817, & 90822, 90824, & 90829: Licensed or board-eligible Psychiatrist. For HSD/Medicaid, Practitioner Type will determine rate. Page 3 of 38 Revised 6/24/05

4 90846 w/out patient w/ patient TR, HA Family psychotherapy (without the patient present) Psychotherapy directed toward an individual and family to address emotional, behavioral or cognitive problems, which may be causative/exacerbating of the primary mental disorder or have been triggered by the stress related to coping with mental and physical illness, alcohol and drug abuse, and psychosocial dysfunction. Personal trauma, family conflicts, family dysfunction, self-concept responses to medication, and other life adjustments reflect a few of the many issues that may be addressed Family psychotherapy (conjoint psychotherapy) (with patient present) minutes Licensed Psychologist, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, LPAT, LADAC, RMHC, LMHC, LPC, LMSW. For school-based services, use modifier TR. For CYFD, use modifier HA TR Multiple family group psychotherapy Therapy sessions for multiple families when similar dynamics are occurring due to a commonality of problems. Each family is treated as a unit and all services are billed under one admitted individual. minutes Practitioner Type will determine rate. Licensed Psychologist, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, LPAT, LADAC, RMHC, LMHC, LPC, LMSW. For DOH school-based services, use modifier TR. Practitioner Type will determine rate. Page 4 of 38 Revised 6/24/05

5 90853 TR, U8, HA, UN, UP, UQ, Group psychotherapy (other than a multiple-family group) Psychotherapy administered in a group setting with a trained group leader in charge of individuals. Personal and group dynamics are discussed and explored in a therapeutic setting when similar dynamics are occurring due to a commonality of problems. minutes Licensed Psychologist, Psychologist Associate licensed at the masters level, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, LPAT, LADAC, RMHC, LMHC, LPC, LMSW. For school-based services, use modifier TR. For HSD/Medicaid PSR, use U8. For CYFD, use modifier HA. Group size should be at least two or more, but no more than 9. For group of two, use modifier UN, for group of three, use modifier UP, for group of 4 or more, use modifier UQ. Note: More than one modifier may be used. Practitioner Type will determine rate. Page 5 of 38 Revised 6/24/05

6 90857 TR, U8, UN, UP, UQ Interactive group psychotherapy Interactive psychotherapy, using play equipment, physical devices, language interpretation or other mechanisms of communication, in a group setting with a trained group leader in charge of individuals. Personal and group dynamics are discussed and explored in a therapeutic setting when similar dynamics are occurring due to a commonality of problems. minutes Licensed Psychologist, Psychologist Associate licensed at the masters level, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, LPAT, LADAC, RMHC, LMHC, LPC, LMSW. For school-based services, use modifier TR. For HSD/Medicaid PSR, use U8. Group size should be at least two or more, but no more than 9. For group of two, use modifier UN, for group of three, use modifier UP, for group of 4 or more, use modifier UQ. Note: More than one modifier may be used. Practitioner Type will determine rate TR, U8 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy. Comprehensive medication services provided by a licensed professional with prescriptive authority to assess and evaluate the individual s presenting conditions and symptoms, medical status, medication needs and/or substance abuse status. Comprehensive medication services include medication assessment, medication administration, medication monitoring, and medication education. There is a focus on educating and teaching individuals and members of their support system as to the effects of medication and its impact on alcohol/drug minutes Licensed Psychologist with prescriptive authority, Licensed or board-eligible Psychiatrist, Physician Assistant, Nurse Practitioner or Clinical Psychiatric Nurse Specialist. For school-based services, use modifier TR. Page 6 of 38 Revised 6/24/05

7 abuse/dependence and/or mental illness. Medication services are goal-directed interventions to administer and monitor pharmacological treatment. Oral, injectable, intravenous, or topical medications and treatments are administered and their positive and negative effects monitored. This includes antabuse and other medications, excluding methadone and buprenorphine medications, used to treat substance abuse or addiction. Counseling related to medication management and case coordination with other practitioners involved with the individual may be included. For administration only, use T02. For administration of methadone use H0020, and for the administration of buprenorphine use J Narcosynthesis for psychiatric diagnostic and therapeutic purposes (e.g. Sodium amobarbital [Amytal] interview) Preparation of report of patient s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers U8, TR Unlisted psychiatric service or procedure (Specialized Consultation) Specialized consultation is access to expertise, in order to assist the treatment team in the development of a comprehensive assessment and master treatment plan, and its on going monitoring and assessment. This service provides an opportunity to gather all relevant caregivers with specialized expertise so that they can coordinate the care provided, and assure that the customer s care is individualized and comprehensive. The specialized expertise includes the provision of tests, the interpretation of reports or other required skills and abilities to enhance the decisions related to the care and treatment of the individual. Session Product minutes For HSD/Medicaid PSR, use modifier U8. Practitioner Type will determine rate. Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, Licensed Psychologist, LPCC, LMFT, LISW. For CYFD & HSD/Medicaid use only. Licensed Psychologist, Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, LISW, LPCC, LMFT, LADAC. DOH & CYFD will use for Specialized Consultation. HSD/Medicaid will use for PSR only. Use modifier U8. For DOH school based services, use modifier TR. Practitioner Type will determine rate. Page 7 of 38 Revised 6/24/05

8 96100 H9, HA Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour 1 Hour Licensed Psychologist, Licensed or Board-eligible Psychiatrist Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour Developmental testing; limited (e.g., Developmental Screening Test II, Early Language Milestone Screen) with interpretation and report Developmental testing; extended (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments, e.g. Bayley Scales of Infant Development) with interpretation and report, per hour 961 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, memory, visual spatial abilities, language functions, planning) with interpretation and report, per hour CYFD will use this code with both HA and H9 modifiers for Forensic evaluations. For Comprehensive Psychological Evaluations, Emergency Mental Health and Intellectual & Cognitive Evals, use only modifier HA. Note: For CYFD, bill a maximum of one unit. One unit = product. 1 Hour For HSD/Medicaid use only. Licensed Psychologist, Licensed or board-eligible Psychiatrist. min. HSD/Medicaid use only. Licensed Psychologist, Licensed or board-eligible Psychiatrist 1 Hour For HSD/Medicaid use only. Licensed Psychologist, Licensed or board-eligible Psychiatrist 1 Hour For HSD/Medicaid use only. Licensed Psychologist, Licensed or board-eligible Psychiatrist Page 8 of 38 Revised 6/24/05

9 96117 Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour Office or other outpatient visit for the evaluation and management of a new patient, which requires three key components: Problem focused history, problem focused exam, straightforward medical decision making, typically 10 minutes face-to-face: Self limited or minor problems Expanded problem focused history, expanded problem focused exam, straightforward medical decision making, typically 20 minutes face-to-face: low to moderate severity problems Detailed history, detailed exam, low complexity medical decision making, typically 30 minutes face-to-face: moderate severity problems Comprehensive history, comprehensive exam, moderate complexity medical decision making, typically 45 minutes face-to-face: moderate to high severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, typically 60 minutes face-to-face: moderate to high severity problems. The activities and components completed, more than the time, define which code to use. 1 Hour For HSD/Medicaid use only. Licensed Psychologist, Licensed or Board-eligible Psychiatrist CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. Page 9 of 38 Revised 6/24/05

10 Office or other outpatient visit for the evaluation and management of an established patient, which requires three key components: May not require the presence of a physician, presenting problems minimal, typically 5 minutes spent performing services: presenting problems minimal Problem focused history, problem focused exam, straightforward medical decision making, typically 10 minutes face-to-face: self-limited or minor problems Expanded problem-focused history, expanded problem focused exam, low complexity medical decision making, typically minutes face-to-face: low to moderate problems Detailed history, detailed exam, moderate complexity medical decision making, typically 25 minutes face-to-face: moderate to high severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, typically 40 minutes face-to-face: moderate to high severity problems. The activities and components completed, more than the time, define which code to use. Observation care discharge day management (This codes is to be utilized by the physician to report all services provided to a patient on discharge from observation status.) Initial observation care, per day, for the evaluation and management of a patient which requires these three key components: A detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the problem(s) requiring admission to observation status are of low severity A detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. CPT Defined Time CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist Page 10 of 38 Revised 6/24/05

11 Usually, the problem(s) requiring admission to observation status are of moderate severity A detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient s and/or family s needs. Usually, the problem(s) requiring admission to observation status are of high severity. Initial hospital care new or established patient Used to report the first hospital inpatient encounter with the patient by the admitting physician Initial hospital care, per day, for the evaluation and management of a patient, which requires three key components: Detailed or comprehensive history, detailed or comprehensive exam, straightforward or low complexity medical decision making, typically 30 minutes at the bedside and on the patient s hospital floor or unit: low severity problems Comprehensive history, comprehensive exam, moderate complexity medical decision making, typically 50 minutes at the bedside and on the patient s hospital floor or unit: moderate severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, typically 70 minutes at the bedside and on the patient s hospital floor or unit: high severity problems. CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. Page 11 of 38 Revised 6/24/05

12 Subsequent hospital care all levels of subsequent hospital care including reviewing the medical record and reviewing the results of diagnostic studies and changes in the patient s status. CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: Problem focused interval history, problem focused exam, straightforward or low complexity medical decision making, typically minutes at the bedside and on patient s hospital floor or unit: Usually, patient is stable, recovering or improving Expanded problem focused interval history, expanded problem-focused exam, moderate complexity medical decision making, typically 25 minutes at the bedside and on the patient s hospital floor or unit. Usually, patient is responding inadequately to therapy or has developed a minor complication Detailed interval history, detailed exam, high complexity medical decision making, typically 35 minutes at the bedside and on the patient s hospital floor or unit: Usually, patient is unstable or has developed a significant complication or a significant new problem , Observation or inpatient hospital care for the evaluation and management of a patient including admission and discharge on the same date which requires these three key components: Detailed or comprehensive history, detailed or comprehensive exam, straightforward or low complexity medical decision making, low severity problems Comprehensive history, comprehensive exam, moderate complexity medical decision making, moderate severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, high severity problems. Hospital discharge services - used to report total duration of time spent by a physician for final hospital discharge of a patient Hospital discharge day management; 30 minutes or less Hospital discharge day management; more than 30 minutes CPT Defined Time CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist. Page 12 of 38 Revised 6/24/05

13 HA Office or other outpatient consultations new or established patient, which requires three key components Problem focused history, problem focused exam, straightforward medical decision making, typically minutes face-to-face with patient and/or family: selflimited or minor problems Expanded problem focused history, expanded problem focused exam, straightforward medical decision making, typically 30 minutes face-to-face with patient and/or family: low severity problems Detailed history, detailed exam, low complexity medical decision making, typically 40 minutes face-to-face with patient and/or family: moderate severity problems Comprehensive history, comprehensive exam, moderate complexity medical decision making, typically 60 minutes face-to-face with patient and/or family: moderate to high severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, typically 80 minutes face-to-face with patient and/or family: moderate to high severity problems. CPT Defined Time Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, Licensed Psychologist, LPCC, LMFT, LISW. For CYFD, use code 99241only. And include HA modifier. This code is used only when seeking consultations outside of the agency. Page 13 of 38 Revised 6/24/05

14 Initial inpatient consultations new or established patient, which requires these three key components Problem focused history, problem focused exam, straightforward medical decision making, typically 20 minutes at the bedside and on the patient s hospital floor or unit: self-limited or minor problems Expanded problem focused history, expanded problem focused exam, straightforward medical decision making, typically 40 minutes at the bedside and on the patient s hospital floor or unit: low severity problems Detailed history, detailed exam, low complexity medical decision making, typically 55 minutes at the bedside and on the patient s hospital floor or unit: moderate severity problems Comprehensive history, comprehensive exam, moderate complexity medical decision making, typically 80 minutes at the bedside and on the patient s hospital floor or unit: moderate to high severity problems Comprehensive history, comprehensive exam, high complexity medical decision making, typically 110 minutes at the bedside and on the patient s hospital floor or unit: moderate to high severity problems. CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist, Licensed Psychologist Follow-up inpatient consultations established patient, which requires at least two of three key components Problem focused interval history, problem focused exam, straightforward or low complexity medical decision making, typically 10 minutes at the bedside and on patient s hospital floor or unit: Usually, patient is stable, recovering or improving Expanded problem focused interval history, expanded problem-focused exam, moderate complexity medical decision making, typically 20 minutes at the bedside and on the patient s hospital floor or unit. Usually, patient is responding inadequately to therapy or has developed a minor complication Detailed interval history, detailed exam, high complexity medical decision making, typically 30 minutes at the bedside and on the patient s hospital floor or unit: Usually, patient is unstable or has developed a significant complication or a significant new problem. CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist, Licensed Psychologist Page 14 of 38 Revised 6/24/05

15 Prolonged physician service with direct (face-to-face) patient contact Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g. Prolonged care and treatment of an acute asthmatic patient in an a=outpatient setting); first hour (list separately in addition to code for office or other outpatient Evaluation and Management service). Note that is an add-on code and must be used in conjunction with , , and each additional 30 minutes (list separately in addition to code for prolonged physician service). Note that is an add-on code and must be used in conjunction with Prolonged physician service in the inpatient setting, requiring direct (faceto-face) patient contact beyond the usual service, first hour, (list separately in addition to code for inpatient Evaluation and Management service). Note that is an add-on code and must be used in conjunction with , , and each additional 30 minutes (list separately in addition to code for prolonged physician service). Note that is an add-on code and must be used in conjunction with CPT Defined Time For HSD/Medicaid use only. Licensed or board-eligible Psychiatrist HCPCS A0090 Non-emergency transportation, per mile vehicle provided by individual (family member, self, neighbor) with vested interest Non-emergency transportation is provided when necessary to secure a necessary, covered behavioral health service in or out of the individual s home community. Transportation is provided by self, a family member, or neighbor, and is reimbursed only if an individual does not have access to transportation services which are available free of charge. A0100 Non-emergency transportation; taxi Non-emergency transportation is provided when necessary to secure a necessary, covered behavioral health service in or out of the individual s home community. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Page of 38 Revised 6/24/05

16 Services are provided by a taxicab, taxi van or van certified by the NM Public Regulation Commission within those geographic regions of the state specifically authorized by the NM Public Regulation Commission. Transportation is reimbursed only if this is the least costly transportation available for required service. A0110 Non-emergency transportation and bus, intra-or interstate carrier Non-emergency transportation is provided when necessary to secure a necessary, covered behavioral health service in or out of the individual s home community. Services are provided by certain bus services certified by the NM Public Regulation Commission within those geographic regions of the state specifically authorized by the NM Public Regulation Commission. Transportation is reimbursed only if this is the least costly transportation available for the service required. A0140 Non-emergency transportation per mile, Air, intra- or interstate carrier, private or commercial Non-emergency transportation is provided when necessary to secure a necessary, covered behavioral health service. Air transportation is reimbursed only if this is the least costly transportation available for the service required. A0160 HA Non-emergency transportation: per mile case worker or social worker Non-Emergency Transportation is provided by a Caseworker or Social Worker and compensates for vehicle use while providing necessary, covered transportation to designated target populations. Eligible staff include, but are not limited to, Caseworker or Social worker, Community Support Worker, Clinician, and other appropriate agency staff. A0180 Non-emergency transportation, Lodging, recipient Lodging is reimbursed if an individual is required to travel to receive a covered behavioral health service more than four hours one-way from the individual s home community, and an overnight stay is required due to medical necessity or cost considerations. Per Mile Organizations will be responsible for Medicaid client transportation. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. For CYFD and DOH use only. For CYFD use modifier HA. This service will be reimbursed at a flat rate. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Page 16 of 38 Revised 6/24/05

17 A0190 Non-emergency transportation, Meals, recipient Meals are reimbursed if an individual is required to travel for eight hours or more to receive a covered behavioral health service. A0200 Non-emergency transportation, Lodging, Escort Lodging for an escort is reimbursed if (a) an individual is required to travel to receive a necessary, covered behavioral health service more than four hours oneway from the individual s home community, and an overnight stay is required due to medical necessity or cost considerations; and (b) the medical necessity for the presence of an escort is certified in writing by the individual s behavioral health provider; or if the individual who is receiving covered behavioral health services is under 18 years of age. The escort for a child under 18 years of age should be the parent or legal guardian. A0210 Non-emergency transportation, Meals, Escort H0002 HE, HF, HH, TR, HA, H9 Meals for an escort are reimbursed if (a) an individual is required to travel for eight hours or more to receive a covered behavioral health service; and (b) the medical necessity for the presence of an escort is certified in writing by the individual s behavioral health provider; or if the individual who is receiving covered behavioral health services is under 18 years of age. The escort for a child under 18 years of age should be the parent or legal guardian. Behavioral Health Screening Behavioral Health Screening is provided to determine eligibility for admission to behavioral health treatment services, and may include the following: Integrated mental health and substance use disorders screening, mental health screening, alcohol screening and drug abuse screening. The behavioral health screen is a preliminary procedure limited in nature and intended to merely indicate whether there is a probability that a mental health problem and/or drug/alcohol abuse or dependence problem is present. This screen Product Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Currently not paid by DOH or CYFD. Note: The HSD/Salud! Managed Care Organizations will be responsible for Medicaid client transportation. Bachelor s degree in human services related field and a combination of relevant education, training and experience totaling four years; or LADAC; or Masters Degree in human services related field. Page 17 of 38 Revised 6/24/05

18 may be accomplished using any one of a collection of nationally accepted standardized screening tools that are appropriately designed for the individuals being screened. NOTE: Completed screening must be signed and dated by staff completing the screening and as appropriate, a masters level supervisor. For supervision requirements, see specific service requirement staffing guideline. H0003 H9, TR Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs Alcohol and/or drug screening is provided for the laboratory analysis of specimens for the presence of alcohol and/or drugs (illicit or licit). Product For DOH school based, use modifier TR. For CYFD, use modifier HA. Also use modifier H9 if court-ordered. For mental health screening, use modifier HE. For substance abuse screening, use modifier HF When both a mental health and substance abuse screen are conducted, use modifier HH. For NMCD or DOH use only. Note: Analysis conducted by a certified clinical laboratory. For DOH school based, use modifier TR. For court-ordered services, use modifier H9. Page 18 of 38 Revised 6/24/05

19 H0010 H9, TG Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) Residential inpatient detoxification Residential detoxification (sometimes referred to as social setting detoxification ) services include 24-hour supervision, observation, and support for individuals who are intoxicated or experiencing withdrawal. Residential detoxification is delivered by appropriately trained staff, is characterized by its emphasis on peer and social support, and provides care to individuals whose intoxication/withdrawal signs and symptoms are sufficiently severe to require 24-hour structure and support. All programs at this level rely on established clinical protocols to identify individuals who are in need of medical services beyond the capacity of the facility and to transfer such individuals to more appropriate levels of care. This service is delivered under a defined set of physician-approved policies and procedures or clinical protocols. Sub-intensive Medically Monitored Detoxification This service, equivalent to the American Society of Addiction Medicine (ASAM) Level III.7D, medical monitored inpatient detoxification, is an organized service, delivered by medical and nursing professionals, that provides 24-hour medically supervised evaluation and withdrawal management in a permanent facility with inpatient beds. This service provides care for individuals whose intoxication and/or withdrawal signs and symptoms are sufficiently severe to require 24-hour structure and support. All programs at this level rely on established clinical protocols to identify individuals who are in need of medical services beyond the capacity of the facility and to transfer such individuals to more appropriate levels of care. This service is delivered under a defined set of physician-approved policies and procedures or clinical protocols. 24 hours Authorized Staff: Staff must receive relevant training, to include but not limited to safety, basic first aid, CPR, and emergency protocols. Staff must be trained in the defined set of physician-approved policies and procedures or clinical protocols for residential detox. Staff must successfully pass a criminal background check. The program must be under the supervision of a licensed behavioral health professional or licensed medical professional. For court-ordered service, use modifier H9. For medically monitored detoxification service, use modifier TG. NOTE: For medically monitored detox, the above requirements must be met. In addition, a nurse must be on staff for all shifts and a physician must be accessible 24/7. Page 19 of 38 Revised 6/24/05

20 H00 SE, H9, HH Alcohol and/or drug services; intensive outpatient treatment (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education. An Intensive Outpatient Treatment Program provides a time-limited, multi-faceted approach to treatment service for individuals who require structure and support to achieve and sustain recovery. Intensive outpatient treatment programs generally provide a minimum of 9 treatment hours per week delivered during the day, evenings and/or weekends. A multi-disciplinary team must provide this service. The treatment program consists of, but is not limited to, individual, group and family counseling; relapse prevention and education; withdrawal management; and drug refusal skills. The amount of weekly services per individual is directly related to the goals and objectives specified in the individual s treatment plan; however, a minimum of 3 hours per day, 3 days a week is required. Per diem = min. 3 hours per day Authorized Staff: Intensive Outpatient Treatment can only be provided by a Licensed BH Professional (excluding licensed substance abuse interns). For supervision requirements, see specific service requirement staffing guideline. For HSD TANF, use modifier SE. For court-ordered services, use modifier H9. For co-occurring services, use modifier HH. Use BHSD s billing instructions. H0018 HD, HE, HF, HH, HI, H9 Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem A short-term residential treatment program offering 24-hour intensive residential treatment, habilitative, and rehabilitative services for up to 30 days in a highly structured, community-oriented environment. This type of program is appropriate for individuals who need concentrated therapeutic services prior to community residence. The focus of services is to stabilize the individual and provide a safe and supportive living environment during detox and/or recovery from addictions. Per diem Authorized Staff: Staff must receive relevant training, to include but not limited to safety, basic first aid, CPR, emergency protocols. Staff must be trained in the defined set of physician-approved policies and procedures or clinical protocols for residential services. Staff must successfully pass a criminal background check. The program must be under the supervision of a licensed behavioral health professional or licensed medical professional. Refer to modifier list for appropriate use of modifiers. Page 20 of 38 Revised 6/24/05

21 H0019 HA, HB, HC, HD, HE, HF, HH, HI Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem A long-term residential program offering 24-hour supervised voluntary residential treatment, habilitative, and rehabilitative services in a structured, communityoriented environment. Also called transitional living, the services are designed for individuals who have the potential and motivation to ameliorate some skills deficits through a moderately structured rehabilitative housing program. Services stress normalization and maximum community involvement and integration; and include daily living and socialization skills training; case management (community supports); recreational activities; educational and support activities; and access to therapeutic interventions, when necessary. The focus of services is on placement of the individual in a safe and stable living environment upon discharge. H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) Methadone administration and and/or service programs provide Opioid Replacement Treatment (ORT) or Opioid Maintenance Treatment (OMT) services including, but not limited to, the administration of methadone (opioid replacement medication) to an individual for detoxification from opioids and/or maintenance treatment. The administration/supervision must be delivered in conjunction with the overall treatment milieu, which must include counseling/therapy, case review, and medication monitoring. This service definition includes the provision of the methadone. Per diem 1 Day s Dosage Authorized Staff: Staff must receive relevant training, to include but not limited to safety, basic first aid, CPR, and emergency protocols. Staff must successfully pass a criminal background check. The program must be under the supervision of a licensed behavioral health professional or licensed medical professional. Refer to modifier list for appropriate use of modifiers. Programs must be staffed (at minimum) by: A medical director (must be a M.D. or a D.O. licensed to practice in the State of New Mexico) A clinical director; A licensed BH practitioner; A registered nurse; A licensed practical nurse; and A full-time or part-time pharmacist. For detailed information, see specific service requirement staffing guidelines. Note: Methadone clinics are licensed by the municipality, if required, and by DEA. Page 21 of 38 Revised 6/24/05

22 H0031 HF, HT, HH, U8, TR, HA Mental Health Assessment by non-physician (Behavioral Health Assessment and Initial Treatment Plan) Assessment is an integrated series of procedures conducted with an individual to provide the basis for the development of an effective, comprehensive and individualized treatment plan. It is an intensive clinical and psychosocial evaluation of an individual s mental health and/or co-occurring (mental health/substance abuse) conditions which results in an issuance of an integrated written document. This service may be conducted by an individual or by a multidisciplinary team and includes face-to-face interview contacts with the individual; and may include the individual s family and/or significant others, collateral contacts and other agencies to determine the individual s problems and strengths, to identify the disability(ies), and to identify natural supports. Product Bachelor s degree in human servicesrelated field and a combination of relevant education, training, and experience totaling four years; or LADAC; or Masters Degree in human servicesrelated field. NOTE: Completed assessment must be signed and dated by staff completing the assessment and, as appropriate, a masters level supervisor. An initial treatment plan, including discharge criteria and/or treatment recommendations is included as part of the assessment. For supervision requirements, see specific service requirement staffing guideline. DOH will use for all individuals. For DOH school-based, use modifier TR. CYFD will use for mental health assessment to determine eligibility for services. Use modifier HA. HSD/Medicaid will use this code for PSR only. Use modifier U8. For multi-disciplinary team, use modifier HT. For substance abuse assessment, use modifier HF. For substance abuse/mental health assessment, use modifier HH. Page 22 of 38 Revised 6/24/05

23 H0039 Assertive community treatment, face-to-face, per minutes Assertive Community Treatment (ACT) consists of therapeutic interventions that address the functional problems associated with the most complex and/or pervasive conditions of the identified population. These interventions are strengthbased and focused on promoting symptom stability, increasing the recipient s ability to cope and relate to others and enhancing the highest level of functioning in the community. Interventions may address adaptive skill areas such as: housing; school and training opportunities; daily activities; health and safety; medication support; harm reduction; money management and entitlements; and service planning and coordination. The ACT program provides two levels of care. ACT Intensive serves program participants who require frequent and mobile contacts. The clinical staff-toprogram participant ratio for ACT Intensive is 1: 8.3. The ACT Step-Down level serves program participants who no longer require ACT Intensive but who do need the continuity and support of the ACT team. H0048 H9 Alcohol and/or other drug testing; collection and handling only, specimens other than blood This testing provides only for the collection, supervision of the collection, and handling of urine and/or saliva specimens, other than blood, for analysis for the presence of alcohol and/or other drugs (illicit or licit). Per minutes Product Assertive Community Treatment Teams must be staffed by: One psychiatrist; Two registered nurses; An additional mental health professional; An additional substance abuse professional; and One peer counselor. For detailed information, see specific service requirement staffing guidelines. Provider staff must meet CLIA certification standards. Specialized Instructions: For court-ordered service, use modifier H9. Page 23 of 38 Revised 6/24/05

24 H2011 U1, U2, U3, U8, TR, HA Crisis intervention services, per Minutes Community-based crisis intervention services are immediate, crisis-oriented services designed to ameliorate or minimize an acute crisis episode and/or to prevent inpatient psychiatric hospitalization or medical detoxification. Services are provided to adults, adolescents, and their families or support systems who have suffered a breakdown of their normal strategies or resources and who exhibit acute problems or disturbed thoughts, behaviors, or moods. These services are characterized by the need for highly coordinated services across a range of service systems. Crisis intervention services should be available on a 24 hour, 7-day a week basis. Services can be provided by a mobile team or by a crisis program in a facility or clinic. Crisis intervention services include: crisis prevention, primary assessment, secondary evaluation, acute crisis services and support services. minutes Telephone Crisis Service Individual crisis workers who are covering the crisis telephone must have a Bachelor s degree and one year of work experience with individuals with mental illness and/or substance related disorders. Face-to-Face Crisis Services Individual crisis workers who are providing face-to-face crisis services must be a Master s level licensed mental health professional and have one-year work experience with individuals with mental illness and/or substance related disorders. Mobile Crisis Services When mobile crisis is provided, the response will include a two-member team meeting the above face-to-face staffing requirements. For detailed information, see specific service requirement staffing guidelines. For Telephone Crisis, use modifier U1. For Face-to-Face Crisis Services, use modifier U2. For Mobile Crisis Services, use modifier U3. Page 24 of 38 For HSD/Medicaid PSR, Revised use modifier 6/24/05 U8. For DOH school-based services, use modifier TR. For CYFD, use HA modifier.

25 H2012 HK Behavioral health day treatment, per hour Behavioral health day treatment is a non-residential treatment program designed for children and adolescents under the age of 21 who have emotional, behavioral, and neurobiological or substance abuse problems and may be at high risk of outof-home placement. Behavioral health day treatment services are specialized services/training provided after school, weekends, or when school is not in session. Services include counseling (individual, group, family), parent consumer education, skill and socialization training that focus on the amelioration of functional and behavioral deficits. Intensive coordination/linkage with schools and or other child serving agencies is included. The goals of the service are clearly documented, utilizing a clinical model for service delivery and support. H2014 Skills training and development, per minutes (Behavior Management Skills Development) Behavior management services are provided to children and adolescents (individuals under age 21) who need behavioral management intervention to avoid inpatient hospitalization, residential treatment, and separation from their families or who require continued intensive treatment following hospitalization or as a transition to avoid return to a more restrictive environment. Behavior management services include the development of a behavior management plan, implementation of the behavior management plan, assisting caregivers to implement the plan and ongoing monitoring of the behavior management plan. This service may include the use of basic techniques, such as reinforcement, redirection, voluntary time-outs and verbal de-escalation. BMS services are provided as part of a comprehensive approach to treatment and are not provided as stand-alone services. 1 hour, minim. of 3 hours per day minutes Refer to the CYFD Certification Requirements for Child and Youth Behavioral Health Services, for specific Day Treatment Services staffing requirements. For CYFD Therapeutic Preschool, use modifier HK. Refer to the New Mexico Interagency Behavioral Health Service Requirements and Utilization Guideline for this service. Page 25 of 38 Revised 6/24/05

26 H20 H2017 HA, HB, HC HA, HQ Comprehensive community support services, per minutes The purpose of Community Support Services is to surround individuals/families with the services and resources necessary to promote recovery, rehabilitation and resiliency. Community support activities address goals specifically in the following areas: independent living; learning; working; socializing and recreation. Community Support Services consist of a variety of interventions, primarily face-toface and in community locations that address barriers that impede the development of skills necessary for independent functioning in the community. Community Support Services also include assistance with identifying and coordinating services and supports identified in an individual s service plan; supporting an individual and family in crisis situations; and providing individual interventions to develop or enhance an individual s ability to make informed and independent choices. Psychosocial rehabilitation services, per minutes Psychosocial rehabilitation, either Individual or Integrated/Classroom, is an array of services designed to help an individual to capitalize on personal strengths, to develop coping strategies and skills to deal with deficits, and to develop a supportive environment in which to function as independently as possible. Psychosocial rehabilitation services are provided in a variety of settings. minutes Minutes Will not be used until 01/01/06 Comprehensive Community Support Team must be staffed by: A Community Support Worker A Community Support Program Supervisor A Clinical Supervisor For detailed information, see specific service requirement staffing guidelines. For child/adolescents, use modifier HA. For adults, use modifier HB. For geriatrics, use modifier HC. Psychosocial Rehabilitation Team members must be staffed by: A Clinical Supervisor An on-site Team Leader A Rehabilitation Coordinator(s) A Classroom/Rehabilitation Instructor (Classroom setting only) A Rehabilitation Specialist (Homebased or Community setting) For detailed information, see specific service requirement staffing guidelines. Specialized Instructions: For services provided in a group or classroom setting, use modifier HQ. For CYFD children and adolescents, use modifier HA. More than one modifier may be used. Page 26 of 38 Revised 6/24/05

27 H2022 HA Community-Based Wrap-Around Services, Per Diem Community-based wrap-around services are a uniquely individualized array of intensive home and/or community-based services utilizing a wrap-around process for the delivery of services. The process is guided by a plan that is individual/family centered, based on identified needs in the full range of life domains, outcome focused and based on the unique strengths, values, norms and preferences of the individual and family. The individual and family are integral parts of the wraparound team and must have ownership of the plan. The wraparound team consists of the individual, family, members of the community and agency behavioral health staff. H2023 Supported employment, per minutes Supported Employment provides on the job supports in an integrated work setting with ongoing support services for individuals in need of intensive supported employment services in order to perform work. Activities are typically performed by a job developer, job coach and/or job specialist (case manager) to achieve a successful employment outcome. Per Diem Minutes The Wrap-Around Team members shall consist of: The individual Family members Agency facilitator Agency staff Community members (as selected by the individual and family) For detailed information, see specific service requirement staffing guidelines. Special Services: For CYFD, use this code when requesting a wraparound service. This service must be prior authorized. Use with modifier HA. Bachelors Degree in Business Administration, Social Services or five years experience working with clients who have behavioral health issues of which two years must be working directly with clients, and Two years experience in the community with a local business. For supervision requirements, see specific service requirement staffing guideline. Page 27 of 38 Revised 6/24/05

28 H2025 Ongoing support to maintain employment, per minutes Ongoing or long-term supports to maintain employment are utilized following successful employment placement and development of natural on-the-job supports for a client. Transition to this service is intended to provide those supports necessary to ensure: continued employment; advancement in employment as evidenced by salary increases and job promotion; improvement in independent living; maximization of benefits; and referral to other health and behavioral health services as required. H2032 HA Activity therapy, per minutes Activity therapy is a program of alternative recreation and social and/or therapeutic strategies in a structured setting to enable individuals to develop and improve their psychological competencies; services engage individuals in learning social skills to enhance their level of functioning toward self-sufficiency, e.g. equine-assisted therapy, experiential wilderness. minutes minutes Bachelors Degree in Business Administration, Social Services or five years experience working with individuals who have behavioral health issues of which two years must be working directly with individuals, and Two years experience in the community with a local business. For supervision requirements, see specific service requirement staffing guideline. Staff providing clinical services (therapies) must be licensed and provide services in accordance with the applicable licensing regulations. For CYFD use modifier HA. Note: Activity therapies must meet national certification requirements specific to the activity conducted (e.g. experiential wilderness). Page 28 of 38 Revised 6/24/05

29 H2033 Multisystemic therapy for juveniles, per minutes Multisystemic therapy (MST) provides an intensive family preservation model of treatment for youth and their families who are at risk of out-of-home placement. The MST model is based on empirical data and evidence-based interventions that target specific behaviors with individualized behavioral interventions. Services include: an initial assessment to identify the focus of the MST intervention; and individual therapeutic interventions with the youth and family. Specialized therapeutic and rehabilitative interventions are available to address special areas such as substance abuse, sexual abuse, sex offending, and domestic violence. Services are available in-home, at school and in other community settings. The duration of MST intervention is typically three to five months. J0592 Injection, buprenorphine hydrochloride, 0.1 mg Injection of buprenorphine hydrochloride as provided by a licensed medical professional for the purpose of treatment of opioid dependence. minutes 1 injection Multi-systemic Therapy Teams (at a minimum) must be staffed by: Clinical Supervisor (Independently licensed Mental Health Professional); and Two (2) trained Licensed Masters Level Mental Health staff that provide 24-hour coverage, 7 days per week. For detailed information, see specific service requirement staffing guidelines. A physician who has been certified by SAMHSA/CSAT to provide buprenorphine treatment must deliver or provide oversight of the service. Physician must be licensed in New Mexico. Licensed medical professional staff authorized to inject include Physician, Nurse Practitioner, Physician s Assistant, Registered Nurse, Licensed Practical Nurse. Page 29 of 38 Revised 6/24/05

30 M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders. S5145 U1 Foster care, therapeutic, child; per diem (Treatment Foster Care) Treatment foster care services provided to children or adolescents (up to age 21) who are placed with licensed and professionally trained families who provide 24- hour skilled, therapeutic care. Treatment Foster Care I services incorporate behavioral, psychological, and psychosocial approaches to clinical treatment services. Services must include clinical interventions by the specialized therapeutic foster care parent(s) and a clinical staff person. Services included in individualized treatment plans are designed to assist the child/adolescent to develop skills necessary for successful reintegration into the natural family or transition into the community. The family living experience is the core treatment service. Treatment Foster Care II (TFC II) allows for a step-down from TFC I when the child improves and no longer requires the level of intensity provided in TFC I. Note: A Service Requirement Guideline has not been developed for TFC I & II. Refer to HSD/MAD Program Policy Manual, sections and minutes Per diem HSD/Medicaid Use Only For DOH, use Licensed or board-eligible Psychiatrist, Clinical Psychiatric Nurse Specialist, Licensed Psychologist with prescriptive authority. Treatment Foster Care teams must be staffed by: A Clinical Supervisor A Treatment Coordinator Therapist(s) Treatment Foster Parent(s) For detailed information refer to the CYFD Certification Requirements for Child and Youth Behavioral Health Services, for specific Treatment Foster Care I and II staffing requirements. For TFC II, use modifier U1. Page 30 of 38 Revised 6/24/05

31 S9446 Patient education, not otherwise classified, non-physician provider, group, per session S9480 HH, H9 A patient education group is a topic-specific, supportive, educationally structured face-to-face activity delivered to individuals, their families or significant others. Intensive outpatient psychiatric services, per diem Intensive Outpatient Psychiatric Services (IOP) provide a time-limited, multi-faceted approach to treatment for individuals who require structure and support to achieve and sustain recovery. Intensive outpatient treatment programs generally provide a minimum of 9 treatment hours per week delivered during the day, evenings and/or weekends. A multi-disciplinary team must provide this service. Programming consists of, but is not limited to, individual, group and family counseling; medication education; symptom management; and education regarding diagnosis. The amount of weekly services per individual is directly related to the goals and objectives specified in the individual s treatment plan; however, a minimum of 3 hours per day, 3 days a week is required. S9482 HA Family Stabilization Services, per minutes (Intensive Home-based Services) Family Stabilization is a time-limited intensive therapeutic and supportive intervention delivered in the home or in another location that is a natural setting for family interaction. This service is intended for children and adolescents under the age of 21 and their families to prevent the utilization of an out-of-home placement. These services are designed to strengthen and preserve families by providing needs driven, comprehensive, integrated approaches to services. Services are multi-faceted in nature and include: situation management, environmental assessment, interventions to improve individual and family interactions, skill training, self and family management, and coordination and linkage with other services and supports. 1 Session Per diem Minutes Educational services may be provided by BH professionals or paraprofessionals as well as medical personnel as determined by the specific topic area. Intensive Outpatient Treatment can only be provided by a Licensed BH Professional (excluding licensed substance abuse interns). For supervision requirements, see specific service requirement staffing guideline. For court-ordered services, used modifier H9. For co-occurring substance abuse and mental health services, use modifier HH Family Stabilization teams are staffed by: A Clinical Director A licensed BH professional One or more paraprofessional staff The individual and family members For supervision requirements, see specific service requirement staffing guideline. For CYFD use modifier HA. Page 31 of 38 Revised 6/24/05

32 T1005 HA, HB, HC Respite care services, up to minutes Respite care services are a program of care, in a supervised setting, for individuals with or at risk of serious emotional, behavioral, or neurobiological disorders (SED/NBD) or severe mental illness and/or serious addictive disorders. The purpose of respite is to sustain the family or other primary caregiver by providing those individuals with time-limited temporary relief from the ongoing responsibility of care. Respite may be provided on either a planned or an emergency basis and may be provided in a variety of settings. Minutes Authorized practitioners must: Have three (3) years working with target population Pass all criminal records and background checks Possess a valid driver s license and vehicle registration and insurance Complete a behavioral health respite care pre-service core training curriculum (e.g. Respiro model) approved by funding source prior to giving care Have current certification in CPR and First Aid Have documented negative TB test. For supervision requirements, see specific service requirement staffing guideline. For CYFD child/adolescents, use modifier HA. For adults, use modifier HB. For geriatrics, use modifier HC. Page 32 of 38 Revised 6/24/05

33 T1007 HE, HH, HT, U8, TR, HA Alcohol and/or substance abuse services, treatment plan modification (Behavioral Health Treatment Plan Update) Modification (or update) of the treatment plan is conducted in order to collect, assemble, and coordinate relevant planning and treatment information, and identify treatment team members to assure that treatment is both comprehensive and individualized. The treatment/service plan is based on assessment and evaluation information and contains specific treatment and recovery goals and services directed towards addressing the individual s needs and symptoms. Note: Initial treatment plan is included under H0031. Product Bachelor s degree in human services related field and a combination of relevant education, training and experience totaling four years; or LADAC; or Masters Degree in human services related field. NOTE: Completed treatment plan update must be signed and dated by staff completing the treatment plan update and as appropriate, a masters level independent supervisor. For supervision requirements, see specific service requirement staffing guideline. For HSD/Medicaid, use only for PSR. Use modifier U8. For DOH school-based, use modifier TR. For CYFD use modifier HA. For a mental health program, use modifier HE. For co-occurring substance abuse and mental health, use modifier HH. For a multi-disciplinary team, use modifier HT. Page 33 of 38 Revised 6/24/05

34 T1016 HA, HB, HC, TF, TS, TR, Case management, each minutes DOH Definition Case management is provided when medically necessary to serve targeted individuals with severe mental illness who require intensive intervention. Case management is a set of functions that are intended to ensure that individuals receive the services they need in a timely, appropriate, effective, efficient and coordinate fashion. It is individual centered, family member-focused when appropriate, culturally competent and strength-based. The general purposes of case management are to coordinate and monitor services and to assess individuals progress toward specific goals. Services typically include assessment; plan of care/service plan development and review; advocacy, referral and linkage to services; housing activities; the individual s income maintenance activities; facilitation of natural helping resources; and coordination of physical health, behavioral health and social services. CYFD Definition Case management is a set of functions that are intended to ensure that individuals receive the services they need in a timely, appropriate, effective, efficient and coordinate fashion. It is individual centered, family member-focused when appropriate, culturally competent and strength-based. The general purposes of case management are to coordinate and monitor services and to assess individuals progress toward specific goals. Services typically include assessment; plan of care/service plan development and review; advocacy, referral and linkage to services; facilitation of natural helping resources; and coordination of physical health, behavioral health and social services. Case management services are provided to children/youth involved or at risk of involvement with CYFD juvenile justice or protective services systems. Note: A Service Requirement Guideline has not been developed for Case Management. This service will be in existence only until Minutes Authorized practitioners (DOH): Bachelor s degree in social work, counseling, psychology or a related field, from an accredited institution and one year of experience in the mental health field; or Associate s degree and a minimum of 3 years experience working with individuals with chronic mental illness; or HS diploma or GED and a minimum of 4 years experience working with individuals with chronic mental illness. Licensed as a registered nurse with one year of experience in the mental health field. Authorized practitioners (CYFD): HS diploma or GED and a minimum of 2 years experience working with the target population. For CYFD, use modifier HA. For DOH, use modifiers HB or HC. For DOH case management for housing support activities: Use modifier TS for procurement and placement (eviction prevention); Use modifier TF for retention and support. For DOH school-based, use modifier TR. Page 34 of 38 Revised 6/24/05

35 T1017 HK, HE Targeted case management, each minutes Targeted case management is provided when medically necessary to serve targeted individuals who require intensive intervention. Case management is a set of functions that are intended to ensure that individuals receive the services they need in a timely, appropriate, effective, efficient and coordinated fashion. It is individual centered, family member-focused when appropriate, culturally competent and strength-based. The general purposes of case management are to coordinate and monitor services and to assess individuals progress toward specific goals. Services typically include assessment, plan of care/service plan development and review, advocacy, referral and linkage to services, facilitation of natural helping resources and coordination of physical health, behavioral health and social services. Targeted case management populations include the chronically mentally ill (CMI) and the severely emotionally disturbed (SED). For detailed information, please refer to HSD/MAD Program Policy Manuel, section 744 EPSDT Case Management (SED) and Section 773 Case Management for the Chronically Mentally Ill (CMI). Minutes Authorized practitioners for CMI Case Management: Bachelor s degree in social work, counseling, psychology or a related field, from an accredited institution and one year of experience in the mental health field; or Licensed registered nurse with one year of experience in the mental health field; or In the event that there are no suitable candidates with the above qualifications, an associate s degree and a minimum of three years experience working with individual with chronic mental illness; or a HS degree or GED and a minimum of four years experience working individuals with chronic mental illness. Authorized practitioners for SED Case Management: Bachelor s degree in social work, counseling, psychology or a related field, from an accredited institution; or Bachelor s degree in another field with two years of direct experience in serving the SED population; or Licensed registered or licensed practical nurse with one year of experience in the mental health field; or In the event that there are no suitable Page 35 of 38 Revised 6/24/05

36 candidates with the above qualifications, an associate s degree and a minimum of three years of experience in social services; or a HS degree or GED and a minimum of four years experience in social services. Use this code for Medicaid targeted case management. For SED population, use modifier HK. For CMI population, use modifier HE. T1027 HA Family training and counseling for child development, per minutes. Family Training and Counseling for Child Development is a comprehensive behavioral program for children birth through 3 and their families. The program provides early intervention, family training and counseling for child development provided for the bio-psychosocial and emotional well-being of infants, toddlers and children in relationship with their caregivers, environment and culture, and with respect for each child s uniqueness. 1 Unit = minutes Bachelors Degree in Social Services, Nursing or related field with two years experience in infant mental health or working with children with developmental disabilities, who are experienced with parent/child relationships. For supervision requirements, see specific service requirement staffing guideline. For CYFD use modifier HA. Page 36 of 38 Revised 6/24/05

37 T02 HE, HF, TR Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit This service is only for the administration of medication to an individual as ordered by the medical practitioner, excluding methadone and buprenorphine. For pharmacologic management use For administration of methadone use H0020, and for the administration of buprenorphine use J0592. For brief office visit for sole purpose of monitoring or changing drug prescriptions, use M Unit only Physician, Nurse Practitioner, Physician Assistant, Registered Nurse, Licensed Practical Nurse For mental health medication, use modifier HE For substance abuse medication, use modifier HF For DOH school based, use modifier TR Page 37 of 38 Revised 6/24/05

38 0114 Room and board private psychiatric 0124 Room and board semi-private (two bed) - psychiatric 0134 Room and board semi-private (three and four bed) psychiatric 0144 Room and board private deluxe psychiatric 04 Room and board ward psychiatric 0169 Room and board - waiting placement psychiatric 0204 Intensive care (ICU) psychiatric 0762 Observation Room 0900 Behavioral health treatment services general classification 0901 Behavioral health treatment services electroshock treatment 0902 Behavioral health treatment services milieu therapy 0903 Behavioral health treatment services play therapy 0911 Behavioral health treatment services rehabilitation 0912 Behavioral health treatment services -partial hospitalization-less intensive 0913 Behavioral health treatment services-partial hospitalization-more intensive 0914 Behavioral health treatment services - individual therapy 09 Behavioral health treatment services - group therapy 0916 Behavioral health treatment services - family therapy 0918 Behavioral health treatment services testing 0944 Other therapeutic services drug rehabilitation 0945 Other therapeutic services alcohol rehabilitation 0190 Long Term Care Residential (Non-accredited RTC) 1001 Behavioral health accommodation residential treatment psychiatric (Accredited RTC) 1002 Behavioral health accommodation residential treatment chemical dependency (Accredited RTC) 1005 Behavioral health accommodation group home Page 38 of 38 Revised 6/24/05