Covered Professional Services & orization Guidelines Please note that the listing below does not fully comprise all Cenpatico Mississippi covered services. Please refer to your Provider Agreement with Cenpatico to identify additional services you are contracted and eligible to provide. Facility Behavioral Health Services Service Description ECT Hospital 901/90870 Observation Hospital 760, 761, 762/G0378, G0379 Service Description Professional Behavioral Health Services Psychiatric diagnostic (no medical services) Psychiatrist(MD/DO),, Master s Level Professional (LCSW, LPC, LMFT), (PhD/ PsyD) 90791 04, 11, 12, 20, 21, 22, 23, 51, 52, 53, 55, 71, 72, 99 Interactive psychiatric diagnostic with medical services Psychiatrist (MD/DO), Nurse Practitioner (ARNP, NP), Mental Health (MHNP), Clinical Nurse Specialist (CNS) 90792 04, 11, 12, 20, 21, 22, 23, 51, 52, 53, 55, 71, 72, 99
Individual Psychiatrist 90832, 59 04, 11, 20, psychotherapy 90834, 21, 22, 51, (MD/DO), Nurse 90837 53, 99 Practitioner (ARNP, NP), Mental Health (MHNP), Clinical Nurse Specialist (CNS), Individual 90833, 04, 11, 20, psychotherapy with 90836, 21, 22, 51, medication 90838 53, 99 management Interactive complexity add-on code, 90785 04, 11, 20, 21, 22, 51, 53, 99
Psychoanalysis, 90845 21, 22, 51, 53, 72 Family psychotherapy without patient, 90846 59 04, 11, 20, 21, 22, 23, 51, 52, 53, 55, 71, 72, 99 Family psychotherapy with patient, 90847 59 04, 11, 20, 21, 22, 23, 51, 52, 53, 55, 71, 72, 99
Group Psychotherapy 90849, 59 04, 11, 20, 90853 21, 22, 23, 51, 52, 53, 55, 71, 72, 99,, Electroconvulsive therapy 90870, 90871 21, 51, 22 Medication Management M0064 12, 31, 32, 53, 99 Psychological testing (PhD/PsyD) 96101 03, 11, 12, 21, 22, 51, 99 Developmental testing 96110, 03, 11, 12, 96111 22, 99 (PhD/PsyD)
Neuropsychological testing (PhD) 96118 03, 11, 12, 21, 22, 51, 99 Office Visits 99201-99205, 99211-99215, 99241-99245, 99251-99255 HI 11, 22 Initial Hospital Care 99221-99223 HI 21, 51 Subsequent Hospital Care 99231-99236 HI 21, 51 Hospital Discharge Management 99238, 99239 HI 21, 51
Initial Observation Care 99217-99220 HI 22, 23 Home visits 99341 99350 HI 12 Community Mental Health Center (CMHC) Services Service Description Billable Provider Psychiatric diagnostic interview CMHC 90791 HW 53 Individual psychotherapy CMHC 90832, 90834, 90837 HW, 59 53 Individual psychotherapy with medication management CMHC 90833, 90836, 90838 HW 53
Billable Provider Family psychotherapy without patient CMHC 90846 HW, 59 53 Family psychotherapy with patient CMHC 90847 HW, 59 53 Group Psychotherapy CMHC 90853 HW, 59 53 Psychological testing CMHC 96101 HW 53 Neuropsychological testing CMHC 96110, 96111, 96118 HW 53 Assessment CMHC H0031 HW 53 Treatment Plan Review CMHC H0032 HW, HT 53 Mental health partial hospitalization, treatment, less than 24 hours CMHC H0035 HW 53 Community Support Services CMHC H0036 HW 53 Peer Support CMHC H0038 HW 53 Assertive Community Treatment (ACT) Restorative partial hospitalization, per half day CMHC H0039 HW 53 CMHC H2012 HW 53 Day Support CMHC H2017 HW 53 Wraparound Facilitation CMHC H2021 HW 53
Billable Provider Psychosocial Rehab CMHC H2030 HW, HB, HC 53 Intensive Outpatient Psychiatric CMHC S9480 HW 53 Crisis Services CMHC H2011 HW 53 Nursing Assessment CMHC T1002 HW 53 Case Management CMHC T1017 HW, HB, HA 53 Injectable Medication CMHC T1502 HW 53 Crisis Residential CMHC T2048 HW 53 Early Periodic Screening, Diagnostic, and Testing (EPSDT) Services Service Description Adolescent Counseling Clinic 99401 EP
Injectable Medications and Covered Drugs Service Description Trade Name Injectable Medication T1502 HW 53 Injectable Medication 90471, 90472 03, 11, 12, Ziprasidone Mesylate Geodon J3486 03, 11, 12, Olanzapine Pamoate Zyprexa J2358 03, 11, 12, (Relprevv Paliperidone Palmitati Risperidone Invega Sustenna Risperdal Consta (long acting) J2426 03, 11, 12, J2794 03, 11, 12, Aripiprazole Abilify J0400 03, 11, 12, Aripiprazole Abilify J3490 03, 11, 12, Maintena Chlorpromazine HCL Thorazine J3230 03, 11, 12, Fluphenazine Decanoate Prolixin J2680 03, 11, 12, Prochlorperazine Edisylate Compazine J0780 03, 11, 12, Haloperidol Lactate Haldol J1630 03, 11, 12, Haloperidol Decanoate Haldol D J1631 03, 11, 12, Lorazepam Ativan J2060 03, 11, 12, Diazepam Valium J3360 03, 11, 12,