FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS (FUH)

Transcription

1 FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS (FUH) APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA ACCPETED CODES HEDIS (Administrative) NCQA Accreditation To ensure members ages six (6) years and older who were hospitalized for treatment of a mental health disorder received appropriate follow-up care with a mental health practitioner in one of the following settings: an outpatient visit, intensive outpatient encounter, or a partial hospitalization program. Two time intervals are assessed: within 7 days of discharge and within 30 days of discharge. Members age six years and older as of the date of discharge *Members in hospice are excluded. Members who were hospitalized for treatment of a mental health disorder need appropriate follow-up care; an outpatient visit, an intensive outpatient encounter, or a partial hospitalization. Please see code table. For both timeframes, any of the following meet criteria for a follow-up visit: A visit with a mental health practitioner. A visit in a behavioral healthcare setting. A visit in a non-behavioral healthcare setting with a mental health practitioner. A visit in a non-behavioral healthcare setting with a diagnosis of mental illness. Transitional care management services, where the date of service on the claim is 29 days after the eligible population event/diagnosis date of discharge. The following meets criteria for only the 30-Day Follow-Up indicator: Transitional care management services where the date of

2 service on the claim is 29 days after the event/diagnosis date of discharge. DOCUMENTATION REQUIREMENTS What documentation should be submitted? REFERENCES Note: Transitional care management is a 30-day period that begins on the date of discharge and continues for the next 29 days. The date of service on the claim is 29 days after discharge and not the date of the face-to-face visit. The medical record should document the DOS for follow-up visit and all aspects of the visit, including but not limited to: physical exam findings, thorough and diagnosis-appropriate mental health assessment, medication list, medication side effects, compliance with prescribed treatment, questions/concerns member and/or caregiver may have, etc. For more information, please refer to Passport Health Plan s Panic Disorders and Depression Clinical Practice Guidelines. Additionally, Beacon has the AACAP Adolescent Depression and Schizophrenia clinical practice guidelines and various Provider Toolkits available to providers. The criteria above are based on standards established under NCQA s HEDIS 2018 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Behavioral health case management is available for Passport members. Our behavioral health case managers work with our medical case managers to coordinate care and communication between providers. To make a referral, call the Behavioral Health Hotline at

3 FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS Meet Screening Criteria Mental Illness ICD10CM F20.0 [F20.0] Paranoid schizophrenia ICD10CM F20.1 [F20.1] Disorganized schizophrenia ICD10CM F20.2 [F20.2] Catatonic schizophrenia ICD10CM F20.3 [F20.3] Undifferentiated schizophrenia ICD10CM F20.5 [F20.5] Residual schizophrenia ICD10CM F20.81 [F20.81] Schizophreniform disorder ICD10CM F20.89 [F20.89] Other schizophrenia ICD10CM F20.9 [F20.9] Schizophrenia, unspecified ICD10CM F21 [F21] Schizotypal disorder ICD10CM F22 [F22] Delusional disorders ICD10CM F23 [F23] Brief psychotic disorder ICD10CM F24 [F24] Shared psychotic disorder ICD10CM F25.0 [F25.0] Schizoaffective disorder, bipolar type ICD10CM F25.1 [F25.1] Schizoaffective disorder, depressive type ICD10CM F25.8 [F25.8] Other schizoaffective disorders ICD10CM F25.9 [F25.9] Schizoaffective disorder, unspecified ICD10CM F28 [F28] Other psychotic disorder not due to a substance or known physiological condition ICD10CM F29 [F29] Unspecified psychosis not due to a substance or known physiological condition ICD10CM F30.10 [F30.10] Manic episode without psychotic symptoms, unspecified ICD10CM F30.11 [F30.11] Manic episode without psychotic symptoms, mild ICD10CM F30.12 [F30.12] Manic episode without psychotic symptoms, moderate ICD10CM F30.13 [F30.13] Manic episode, severe, without psychotic symptoms ICD10CM F30.2 [F30.2] Manic episode, severe with psychotic symptoms ICD10CM F30.3 [F30.3] Manic episode in partial remission ICD10CM F30.4 [F30.4] Manic episode in full remission ICD10CM F30.8 [F30.8] Other manic episodes ICD10CM F30.9 [F30.9] Manic episode, unspecified ICD10CM F31.0 [F31.0] Bipolar disorder, current episode hypomanic ICD10CM F31.10 [F31.10] Bipolar disorder, current episode manic without psychotic features, unspecified ICD10CM F31.11 [F31.11] Bipolar disorder, current episode manic without psychotic features, mild ICD10CM F31.12 [F31.12] Bipolar disorder, current episode manic without psychotic features, moderate

4 ICD10CM F31.13 [F31.13] Bipolar disorder, current episode manic without psychotic features, severe ICD10CM F31.2 [F31.2] Bipolar disorder, current episode manic severe with psychotic features ICD10CM F31.30 [F31.30] Bipolar disorder, current episode depressed, mild or moderate severity, unspecified ICD10CM F31.31 [F31.31] Bipolar disorder, current episode depressed, mild ICD10CM F31.32 [F31.32] Bipolar disorder, current episode depressed, moderate ICD10CM F31.4 [F31.4] Bipolar disorder, current episode depressed, severe, without psychotic features ICD10CM F31.5 [F31.5] Bipolar disorder, current episode depressed, severe, with psychotic features ICD10CM F31.60 [F31.60] Bipolar disorder, current episode mixed, unspecified ICD10CM F31.61 [F31.61] Bipolar disorder, current episode mixed, mild ICD10CM F31.62 [F31.62] Bipolar disorder, current episode mixed, moderate ICD10CM F31.63 [F31.63] Bipolar disorder, current episode mixed, severe, without psychotic features ICD10CM F31.64 [F31.64] Bipolar disorder, current episode mixed, severe, with psychotic features ICD10CM F31.70 [F31.70] Bipolar disorder, currently in remission, most recent episode unspecified ICD10CM F31.71 [F31.71] Bipolar disorder, in partial remission, most recent episode hypomanic ICD10CM F31.72 [F31.72] Bipolar disorder, in full remission, most recent episode hypomanic ICD10CM F31.73 [F31.73] Bipolar disorder, in partial remission, most recent episode manic ICD10CM F31.74 [F31.74] Bipolar disorder, in full remission, most recent episode manic ICD10CM F31.75 [F31.75] Bipolar disorder, in partial remission, most recent episode depressed ICD10CM F31.76 [F31.76] Bipolar disorder, in full remission, most recent episode depressed ICD10CM F31.77 [F31.77] Bipolar disorder, in partial remission, most recent episode mixed ICD10CM F31.78 [F31.78] Bipolar disorder, in full remission, most recent episode mixed ICD10CM F31.81 [F31.81] Bipolar II disorder ICD10CM F31.89 [F31.89] Other bipolar disorder ICD10CM F31.9 [F31.9] Bipolar disorder, unspecified ICD10CM F32.0 [F32.0] Major depressive disorder, single episode, mild ICD10CM F32.1 [F32.1] Major depressive disorder, single episode, moderate ICD10CM F32.2 [F32.2] Major depressive disorder, single episode, severe without psychotic features ICD10CM F32.3 [F32.3] Major depressive disorder, single episode, severe with psychotic features ICD10CM F32.4 [F32.4] Major depressive disorder, single episode, in partial remission ICD10CM F32.5 [F32.5] Major depressive disorder, single episode, in full remission ICD10CM F32.8 [F32.8] Other depressive episodes ICD10CM F32.81 [F32.81] Premenstrual dysphoric disorder ICD10CM F32.89 [F32.89] Other specified depressive episodes ICD10CM F32.9 [F32.9] Major depressive disorder, single episode, unspecified ICD10CM F33.0 [F33.0] Major depressive disorder, recurrent, mild ICD10CM F33.1 [F33.1] Major depressive disorder, recurrent, moderate ICD10CM F33.2 [F33.2] Major depressive disorder, recurrent severe without psychotic features ICD10CM F33.3 [F33.3] Major depressive disorder, recurrent, severe with psychotic symptoms

5 ICD10CM F33.40 [F33.40] Major depressive disorder, recurrent, in remission, unspecified ICD10CM F33.41 [F33.41] Major depressive disorder, recurrent, in partial remission ICD10CM F33.42 [F33.42] Major depressive disorder, recurrent, in full remission ICD10CM F33.8 [F33.8] Other recurrent depressive disorders ICD10CM F33.9 [F33.9] Major depressive disorder, recurrent, unspecified ICD10CM F34.0 [F34.0] Cyclothymic disorder ICD10CM F34.1 [F34.1] Dysthymic disorder ICD10CM F34.8 [F34.8] Other persistent mood [affective] disorders ICD10CM F34.81 [F34.81] Disruptive mood dysregulation disorder ICD10CM F34.89 [F34.89] Other specified persistent mood disorders ICD10CM F34.9 [F34.9] Persistent mood [affective] disorder, unspecified ICD10CM F39 [F39] Unspecified mood [affective] disorder ICD10CM F42 [F42] Obsessive-compulsive disorder ICD10CM F42.2 [F42.2] Mixed obsessional thoughts and acts ICD10CM F42.3 [F42.3] Hoarding disorder ICD10CM F42.4 [F42.4] Excoriation (skin-picking) disorder ICD10CM F42.8 [F42.8] Other obsessive-compulsive disorder ICD10CM F42.9 [F42.9] Obsessive-compulsive disorder, unspecified ICD10CM F43.0 [F43.0] Acute stress reaction ICD10CM F43.10 [F43.10] Post-traumatic stress disorder, unspecified ICD10CM F43.11 [F43.11] Post-traumatic stress disorder, acute ICD10CM F43.12 [F43.12] Post-traumatic stress disorder, chronic ICD10CM F43.20 [F43.20] Adjustment disorder, unspecified ICD10CM F43.21 [F43.21] Adjustment disorder with depressed mood ICD10CM F43.22 [F43.22] Adjustment disorder with anxiety ICD10CM F43.23 [F43.23] Adjustment disorder with mixed anxiety and depressed mood ICD10CM F43.24 [F43.24] Adjustment disorder with disturbance of conduct ICD10CM F43.25 [F43.25] Adjustment disorder with mixed disturbance of emotions and conduct ICD10CM F43.29 [F43.29] Adjustment disorder with other symptoms ICD10CM F43.8 [F43.8] Other reactions to severe stress ICD10CM F43.9 [F43.9] Reaction to severe stress, unspecified ICD10CM F44.89 [F44.89] Other dissociative and conversion disorders ICD10CM F53 [F53] Puerperal psychosis ICD10CM F60.0 [F60.0] Paranoid personality disorder ICD10CM F60.1 [F60.1] Schizoid personality disorder ICD10CM F60.2 [F60.2] Antisocial personality disorder ICD10CM F60.3 [F60.3] Borderline personality disorder ICD10CM F60.4 [F60.4] Histrionic personality disorder ICD10CM F60.5 [F60.5] Obsessive-compulsive personality disorder ICD10CM F60.6 [F60.6] Avoidant personality disorder ICD10CM F60.7 [F60.7] Dependent personality disorder

6 ICD10CM F60.81 [F60.81] Narcissistic personality disorder ICD10CM F60.89 [F60.89] Other specific personality disorders ICD10CM F60.9 [F60.9] Personality disorder, unspecified ICD10CM F63.0 [F63.0] Pathological gambling ICD10CM F63.1 [F63.1] Pyromania ICD10CM F63.2 [F63.2] Kleptomania ICD10CM F63.3 [F63.3] Trichotillomania ICD10CM F63.81 [F63.81] Intermittent explosive disorder ICD10CM F63.89 [F63.89] Other impulse disorders ICD10CM F63.9 [F63.9] Impulse disorder, unspecified ICD10CM F68.10 [F68.10] Factitious disorder, unspecified ICD10CM F68.11 [F68.11] Factitious disorder with predominantly psychological signs and symptoms ICD10CM F68.12 [F68.12] Factitious disorder with predominantly physical signs and symptoms ICD10CM F68.13 [F68.13] Factitious disorder with combined psychological and physical signs and symptoms ICD10CM F68.8 [F68.8] Other specified disorders of adult personality and behavior ICD10CM F84.0 [F84.0] Autistic disorder ICD10CM F84.2 [F84.2] Rett's syndrome ICD10CM F84.3 [F84.3] Other childhood disintegrative disorder ICD10CM F84.5 [F84.5] Asperger's syndrome ICD10CM F84.8 [F84.8] Other pervasive developmental disorders ICD10CM F84.9 [F84.9] Pervasive developmental disorder, unspecified ICD10CM F90.0 [F90.0] Attention-deficit hyperactivity disorder, predominantly inattentive type ICD10CM F90.1 [F90.1] Attention-deficit hyperactivity disorder, predominantly hyperactive type ICD10CM F90.2 [F90.2] Attention-deficit hyperactivity disorder, combined type ICD10CM F90.8 [F90.8] Attention-deficit hyperactivity disorder, other type ICD10CM F90.9 [F90.9] Attention-deficit hyperactivity disorder, unspecified type ICD10CM F91.0 [F91.0] Conduct disorder confined to family context ICD10CM F91.1 [F91.1] Conduct disorder, childhood-onset type ICD10CM F91.2 [F91.2] Conduct disorder, adolescent-onset type ICD10CM F91.3 [F91.3] Oppositional defiant disorder ICD10CM F91.8 [F91.8] Other conduct disorders ICD10CM F91.9 [F91.9] Conduct disorder, unspecified ICD10CM F93.0 [F93.0] Separation anxiety disorder of childhood ICD10CM F93.8 [F93.8] Other childhood emotional disorders ICD10CM F93.9 [F93.9] Childhood emotional disorder, unspecified ICD10CM F94.0 [F94.0] Selective mutism ICD10CM F94.1 [F94.1] Reactive attachment disorder of childhood ICD10CM F94.2 [F94.2] Disinhibited attachment disorder of childhood ICD10CM F94.8 [F94.8] Other childhood disorders of social functioning

7 ICD10CM F94.9 [F94.9] Childhood disorder of social functioning, unspecified Mental Health Diagnosis ICD10CM F03.90 [F03.90] Unspecified dementia without behavioral disturbance ICD10CM F03.91 [F03.91] Unspecified dementia with behavioral disturbance ICD10CM F20.0 [F20.0] Paranoid schizophrenia ICD10CM F20.1 [F20.1] Disorganized schizophrenia ICD10CM F20.2 [F20.2] Catatonic schizophrenia ICD10CM F20.3 [F20.3] Undifferentiated schizophrenia ICD10CM F20.5 [F20.5] Residual schizophrenia ICD10CM F20.81 [F20.81] Schizophreniform disorder ICD10CM F20.89 [F20.89] Other schizophrenia ICD10CM F20.9 [F20.9] Schizophrenia, unspecified ICD10CM F21 [F21] Schizotypal disorder ICD10CM F22 [F22] Delusional disorders ICD10CM F23 [F23] Brief psychotic disorder ICD10CM F24 [F24] Shared psychotic disorder ICD10CM F25.0 [F25.0] Schizoaffective disorder, bipolar type ICD10CM F25.1 [F25.1] Schizoaffective disorder, depressive type ICD10CM F25.8 [F25.8] Other schizoaffective disorders ICD10CM F25.9 [F25.9] Schizoaffective disorder, unspecified ICD10CM F28 [F28] Other psychotic disorder not due to a substance or known physiological condition ICD10CM F29 [F29] Unspecified psychosis not due to a substance or known physiological condition ICD10CM F30.10 [F30.10] Manic episode without psychotic symptoms, unspecified ICD10CM F30.11 [F30.11] Manic episode without psychotic symptoms, mild ICD10CM F30.12 [F30.12] Manic episode without psychotic symptoms, moderate ICD10CM F30.13 [F30.13] Manic episode, severe, without psychotic symptoms ICD10CM F30.2 [F30.2] Manic episode, severe with psychotic symptoms ICD10CM F30.3 [F30.3] Manic episode in partial remission ICD10CM F30.4 [F30.4] Manic episode in full remission ICD10CM F30.8 [F30.8] Other manic episodes ICD10CM F30.9 [F30.9] Manic episode, unspecified ICD10CM F31.0 [F31.0] Bipolar disorder, current episode hypomanic ICD10CM F31.10 [F31.10] Bipolar disorder, current episode manic without psychotic features, unspecified ICD10CM F31.11 [F31.11] Bipolar disorder, current episode manic without psychotic features, mild ICD10CM F31.12 [F31.12] Bipolar disorder, current episode manic without psychotic features, moderate ICD10CM F31.13 [F31.13] Bipolar disorder, current episode manic without psychotic features, severe ICD10CM F31.2 [F31.2] Bipolar disorder, current episode manic severe with psychotic features ICD10CM F31.30 [F31.30] Bipolar disorder, current episode depressed, mild or moderate severity, unspecified

8 ICD10CM F31.31 [F31.31] Bipolar disorder, current episode depressed, mild ICD10CM F31.32 [F31.32] Bipolar disorder, current episode depressed, moderate ICD10CM F31.4 [F31.4] Bipolar disorder, current episode depressed, severe, without psychotic features ICD10CM F31.5 [F31.5] Bipolar disorder, current episode depressed, severe, with psychotic features ICD10CM F31.60 [F31.60] Bipolar disorder, current episode mixed, unspecified ICD10CM F31.61 [F31.61] Bipolar disorder, current episode mixed, mild ICD10CM F31.62 [F31.62] Bipolar disorder, current episode mixed, moderate ICD10CM F31.63 [F31.63] Bipolar disorder, current episode mixed, severe, without psychotic features ICD10CM F31.64 [F31.64] Bipolar disorder, current episode mixed, severe, with psychotic features ICD10CM F31.70 [F31.70] Bipolar disorder, currently in remission, most recent episode unspecified ICD10CM F31.71 [F31.71] Bipolar disorder, in partial remission, most recent episode hypomanic ICD10CM F31.72 [F31.72] Bipolar disorder, in full remission, most recent episode hypomanic ICD10CM F31.73 [F31.73] Bipolar disorder, in partial remission, most recent episode manic ICD10CM F31.74 [F31.74] Bipolar disorder, in full remission, most recent episode manic ICD10CM F31.75 [F31.75] Bipolar disorder, in partial remission, most recent episode depressed ICD10CM F31.76 [F31.76] Bipolar disorder, in full remission, most recent episode depressed ICD10CM F31.77 [F31.77] Bipolar disorder, in partial remission, most recent episode mixed ICD10CM F31.78 [F31.78] Bipolar disorder, in full remission, most recent episode mixed ICD10CM F31.81 [F31.81] Bipolar II disorder ICD10CM F31.89 [F31.89] Other bipolar disorder ICD10CM F31.9 [F31.9] Bipolar disorder, unspecified ICD10CM F32.0 [F32.0] Major depressive disorder, single episode, mild ICD10CM F32.1 [F32.1] Major depressive disorder, single episode, moderate ICD10CM F32.2 [F32.2] Major depressive disorder, single episode, severe without psychotic features ICD10CM F32.3 [F32.3] Major depressive disorder, single episode, severe with psychotic features ICD10CM F32.4 [F32.4] Major depressive disorder, single episode, in partial remission ICD10CM F32.5 [F32.5] Major depressive disorder, single episode, in full remission ICD10CM F32.8 [F32.8] Other depressive episodes ICD10CM F32.81 [F32.81] Premenstrual dysphoric disorder ICD10CM F32.89 [F32.89] Other specified depressive episodes ICD10CM F32.9 [F32.9] Major depressive disorder, single episode, unspecified ICD10CM F33.0 [F33.0] Major depressive disorder, recurrent, mild ICD10CM F33.1 [F33.1] Major depressive disorder, recurrent, moderate ICD10CM F33.2 [F33.2] Major depressive disorder, recurrent severe without psychotic features ICD10CM F33.3 [F33.3] Major depressive disorder, recurrent, severe with psychotic symptoms ICD10CM F33.40 [F33.40] Major depressive disorder, recurrent, in remission, unspecified ICD10CM F33.41 [F33.41] Major depressive disorder, recurrent, in partial remission ICD10CM F33.42 [F33.42] Major depressive disorder, recurrent, in full remission ICD10CM F33.8 [F33.8] Other recurrent depressive disorders ICD10CM F33.9 [F33.9] Major depressive disorder, recurrent, unspecified

9 ICD10CM F34.0 [F34.0] Cyclothymic disorder ICD10CM F34.1 [F34.1] Dysthymic disorder ICD10CM F34.8 [F34.8] Other persistent mood [affective] disorders ICD10CM F34.81 [F34.81] Disruptive mood dysregulation disorder ICD10CM F34.89 [F34.89] Other specified persistent mood disorders ICD10CM F34.9 [F34.9] Persistent mood [affective] disorder, unspecified ICD10CM F39 [F39] Unspecified mood [affective] disorder ICD10CM F40.00 [F40.00] Agoraphobia, unspecified ICD10CM F40.01 [F40.01] Agoraphobia with panic disorder ICD10CM F40.02 [F40.02] Agoraphobia without panic disorder ICD10CM F40.10 [F40.10] Social phobia, unspecified ICD10CM F40.11 [F40.11] Social phobia, generalized ICD10CM F [F40.210] Arachnophobia ICD10CM F [F40.218] Other animal type phobia ICD10CM F [F40.220] Fear of thunderstorms ICD10CM F [F40.228] Other natural environment type phobia ICD10CM F [F40.230] Fear of blood ICD10CM F [F40.231] Fear of injections and transfusions ICD10CM F [F40.232] Fear of other medical care ICD10CM F [F40.233] Fear of injury ICD10CM F [F40.240] Claustrophobia ICD10CM F [F40.241] Acrophobia ICD10CM F [F40.242] Fear of bridges ICD10CM F [F40.243] Fear of flying ICD10CM F [F40.248] Other situational type phobia ICD10CM F [F40.290] Androphobia ICD10CM F [F40.291] Gynephobia ICD10CM F [F40.298] Other specified phobia ICD10CM F40.8 [F40.8] Other phobic anxiety disorders ICD10CM F40.9 [F40.9] Phobic anxiety disorder, unspecified ICD10CM F41.0 [F41.0] Panic disorder [episodic paroxysmal anxiety] ICD10CM F41.1 [F41.1] Generalized anxiety disorder ICD10CM F41.3 [F41.3] Other mixed anxiety disorders ICD10CM F41.8 [F41.8] Other specified anxiety disorders ICD10CM F41.9 [F41.9] Anxiety disorder, unspecified ICD10CM F42 [F42] Obsessive-compulsive disorder ICD10CM F42.2 [F42.2] Mixed obsessional thoughts and acts ICD10CM F42.3 [F42.3] Hoarding disorder ICD10CM F42.4 [F42.4] Excoriation (skin-picking) disorder ICD10CM F42.8 [F42.8] Other obsessive-compulsive disorder ICD10CM F42.9 [F42.9] Obsessive-compulsive disorder, unspecified ICD10CM F43.0 [F43.0] Acute stress reaction ICD10CM F43.10 [F43.10] Post-traumatic stress disorder, unspecified ICD10CM F43.11 [F43.11] Post-traumatic stress disorder, acute ICD10CM F43.12 [F43.12] Post-traumatic stress disorder, chronic

10 ICD10CM F43.20 [F43.20] Adjustment disorder, unspecified ICD10CM F43.21 [F43.21] Adjustment disorder with depressed mood ICD10CM F43.22 [F43.22] Adjustment disorder with anxiety ICD10CM F43.23 [F43.23] Adjustment disorder with mixed anxiety and depressed mood ICD10CM F43.24 [F43.24] Adjustment disorder with disturbance of conduct ICD10CM F43.25 [F43.25] Adjustment disorder with mixed disturbance of emotions and conduct ICD10CM F43.29 [F43.29] Adjustment disorder with other symptoms ICD10CM F43.8 [F43.8] Other reactions to severe stress ICD10CM F43.9 [F43.9] Reaction to severe stress, unspecified ICD10CM F44.0 [F44.0] Dissociative amnesia ICD10CM F44.1 [F44.1] Dissociative fugue ICD10CM F44.2 [F44.2] Dissociative stupor ICD10CM F44.4 [F44.4] Conversion disorder with motor symptom or deficit ICD10CM F44.5 [F44.5] Conversion disorder with seizures or convulsions ICD10CM F44.6 [F44.6] Conversion disorder with sensory symptom or deficit ICD10CM F44.7 [F44.7] Conversion disorder with mixed symptom presentation ICD10CM F44.81 [F44.81] Dissociative identity disorder ICD10CM F44.89 [F44.89] Other dissociative and conversion disorders ICD10CM F44.9 [F44.9] Dissociative and conversion disorder, unspecified ICD10CM F45.0 [F45.0] Somatization disorder ICD10CM F45.1 [F45.1] Undifferentiated somatoform disorder ICD10CM F45.20 [F45.20] Hypochondriacal disorder, unspecified ICD10CM F45.21 [F45.21] Hypochondriasis ICD10CM F45.22 [F45.22] Body dysmorphic disorder ICD10CM F45.29 [F45.29] Other hypochondriacal disorders ICD10CM F45.41 [F45.41] Pain disorder exclusively related to psychological factors ICD10CM F45.42 [F45.42] Pain disorder with related psychological factors ICD10CM F45.8 [F45.8] Other somatoform disorders ICD10CM F45.9 [F45.9] Somatoform disorder, unspecified ICD10CM F48.1 [F48.1] Depersonalization-derealization syndrome ICD10CM F48.2 [F48.2] Pseudobulbar affect ICD10CM F48.8 [F48.8] Other specified nonpsychotic mental disorders ICD10CM F48.9 [F48.9] Nonpsychotic mental disorder, unspecified ICD10CM F50.00 [F50.00] Anorexia nervosa, unspecified ICD10CM F50.01 [F50.01] Anorexia nervosa, restricting type ICD10CM F50.02 [F50.02] Anorexia nervosa, binge eating/purging type ICD10CM F50.2 [F50.2] Bulimia nervosa ICD10CM F50.8 [F50.8] Other eating disorders ICD10CM F50.81 [F50.81] Binge eating disorder ICD10CM F50.89 [F50.89] Other specified eating disorder ICD10CM F50.9 [F50.9] Eating disorder, unspecified ICD10CM F51.01 [F51.01] Primary insomnia ICD10CM F51.02 [F51.02] Adjustment insomnia ICD10CM F51.03 [F51.03] Paradoxical insomnia ICD10CM F51.04 [F51.04] Psychophysiologic insomnia

11 ICD10CM F51.05 [F51.05] Insomnia due to other mental disorder ICD10CM F51.09 [F51.09] Other insomnia not due to a substance or known physiological condition ICD10CM F51.11 [F51.11] Primary hypersomnia ICD10CM F51.12 [F51.12] Insufficient sleep syndrome ICD10CM F51.13 [F51.13] Hypersomnia due to other mental disorder ICD10CM F51.19 [F51.19] Other hypersomnia not due to a substance or known physiological condition ICD10CM F51.3 [F51.3] Sleepwalking [somnambulism] ICD10CM F51.4 [F51.4] Sleep terrors [night terrors] ICD10CM F51.5 [F51.5] Nightmare disorder ICD10CM F51.8 [F51.8] Other sleep disorders not due to a substance or known physiological condition ICD10CM F51.9 [F51.9] Sleep disorder not due to a substance or known physiological condition, unspecified ICD10CM F52.0 [F52.0] Hypoactive sexual desire disorder ICD10CM F52.1 [F52.1] Sexual aversion disorder ICD10CM F52.21 [F52.21] Male erectile disorder ICD10CM F52.22 [F52.22] Female sexual arousal disorder ICD10CM F52.31 [F52.31] Female orgasmic disorder ICD10CM F52.32 [F52.32] Male orgasmic disorder ICD10CM F52.4 [F52.4] Premature ejaculation ICD10CM F52.5 [F52.5] Vaginismus not due to a substance or known physiological condition ICD10CM F52.6 [F52.6] Dyspareunia not due to a substance or known physiological condition ICD10CM F52.8 [F52.8] Other sexual dysfunction not due to a substance or known physiological condition ICD10CM F52.9 [F52.9] Unspecified sexual dysfunction not due to a substance or known physiological condition ICD10CM F53 [F53] Puerperal psychosis ICD10CM F59 [F59] Unspecified behavioral syndromes associated with physiological disturbances and physical factors ICD10CM F60.0 [F60.0] Paranoid personality disorder ICD10CM F60.1 [F60.1] Schizoid personality disorder ICD10CM F60.2 [F60.2] Antisocial personality disorder ICD10CM F60.3 [F60.3] Borderline personality disorder ICD10CM F60.4 [F60.4] Histrionic personality disorder ICD10CM F60.5 [F60.5] Obsessive-compulsive personality disorder ICD10CM F60.6 [F60.6] Avoidant personality disorder ICD10CM F60.7 [F60.7] Dependent personality disorder ICD10CM F60.81 [F60.81] Narcissistic personality disorder ICD10CM F60.89 [F60.89] Other specific personality disorders ICD10CM F60.9 [F60.9] Personality disorder, unspecified ICD10CM F63.0 [F63.0] Pathological gambling ICD10CM F63.1 [F63.1] Pyromania ICD10CM F63.2 [F63.2] Kleptomania ICD10CM F63.3 [F63.3] Trichotillomania

12 ICD10CM F63.81 [F63.81] Intermittent explosive disorder ICD10CM F63.89 [F63.89] Other impulse disorders ICD10CM F63.9 [F63.9] Impulse disorder, unspecified ICD10CM F64.0 [F64.0] Transsexualism ICD10CM F64.1 [F64.1] Dual role transvestism ICD10CM F64.2 [F64.2] Gender identity disorder of childhood ICD10CM F64.8 [F64.8] Other gender identity disorders ICD10CM F64.9 [F64.9] Gender identity disorder, unspecified ICD10CM F65.0 [F65.0] Fetishism ICD10CM F65.1 [F65.1] Transvestic fetishism ICD10CM F65.2 [F65.2] Exhibitionism ICD10CM F65.3 [F65.3] Voyeurism ICD10CM F65.4 [F65.4] Pedophilia ICD10CM F65.50 [F65.50] Sadomasochism, unspecified ICD10CM F65.51 [F65.51] Sexual masochism ICD10CM F65.52 [F65.52] Sexual sadism ICD10CM F65.81 [F65.81] Frotteurism ICD10CM F65.89 [F65.89] Other paraphilias ICD10CM F65.9 [F65.9] Paraphilia, unspecified ICD10CM F66 [F66] Other sexual disorders ICD10CM F68.10 [F68.10] Factitious disorder, unspecified ICD10CM F68.11 [F68.11] Factitious disorder with predominantly psychological signs and symptoms ICD10CM F68.12 [F68.12] Factitious disorder with predominantly physical signs and symptoms ICD10CM F68.13 [F68.13] Factitious disorder with combined psychological and physical signs and symptoms ICD10CM F68.8 [F68.8] Other specified disorders of adult personality and behavior ICD10CM F69 [F69] Unspecified disorder of adult personality and behavior ICD10CM F80.0 [F80.0] Phonological disorder ICD10CM F80.1 [F80.1] Expressive language disorder ICD10CM F80.2 [F80.2] Mixed receptive-expressive language disorder ICD10CM F80.4 [F80.4] Speech and language development delay due to hearing loss ICD10CM F80.81 [F80.81] Childhood onset fluency disorder ICD10CM F80.82 [F80.82] Social pragmatic communication disorder ICD10CM F80.89 [F80.89] Other developmental disorders of speech and language ICD10CM F80.9 [F80.9] Developmental disorder of speech and language, unspecified ICD10CM F81.0 [F81.0] Specific reading disorder ICD10CM F81.2 [F81.2] Mathematics disorder ICD10CM F81.81 [F81.81] Disorder of written expression ICD10CM F81.89 [F81.89] Other developmental disorders of scholastic skills ICD10CM F81.9 [F81.9] Developmental disorder of scholastic skills, unspecified ICD10CM F82 [F82] Specific developmental disorder of motor function ICD10CM F84.0 [F84.0] Autistic disorder ICD10CM F84.2 [F84.2] Rett's syndrome ICD10CM F84.3 [F84.3] Other childhood disintegrative disorder

13 ICD10CM F84.5 [F84.5] Asperger's syndrome ICD10CM F84.8 [F84.8] Other pervasive developmental disorders ICD10CM F84.9 [F84.9] Pervasive developmental disorder, unspecified ICD10CM F88 [F88] Other disorders of psychological development ICD10CM F89 [F89] Unspecified disorder of psychological development ICD10CM F90.0 [F90.0] Attention-deficit hyperactivity disorder, predominantly inattentive type ICD10CM F90.1 [F90.1] Attention-deficit hyperactivity disorder, predominantly hyperactive type ICD10CM F90.2 [F90.2] Attention-deficit hyperactivity disorder, combined type ICD10CM F90.8 [F90.8] Attention-deficit hyperactivity disorder, other type ICD10CM F90.9 [F90.9] Attention-deficit hyperactivity disorder, unspecified type ICD10CM F91.0 [F91.0] Conduct disorder confined to family context ICD10CM F91.1 [F91.1] Conduct disorder, childhood-onset type ICD10CM F91.2 [F91.2] Conduct disorder, adolescent-onset type ICD10CM F91.3 [F91.3] Oppositional defiant disorder ICD10CM F91.8 [F91.8] Other conduct disorders ICD10CM F91.9 [F91.9] Conduct disorder, unspecified ICD10CM F93.0 [F93.0] Separation anxiety disorder of childhood ICD10CM F93.8 [F93.8] Other childhood emotional disorders ICD10CM F93.9 [F93.9] Childhood emotional disorder, unspecified ICD10CM F94.0 [F94.0] Selective mutism ICD10CM F94.1 [F94.1] Reactive attachment disorder of childhood ICD10CM F94.2 [F94.2] Disinhibited attachment disorder of childhood ICD10CM F94.8 [F94.8] Other childhood disorders of social functioning ICD10CM F94.9 [F94.9] Childhood disorder of social functioning, unspecified ICD10CM F95.0 [F95.0] Transient tic disorder ICD10CM F95.1 [F95.1] Chronic motor or vocal tic disorder ICD10CM F95.2 [F95.2] Tourette's disorder ICD10CM F95.8 [F95.8] Other tic disorders ICD10CM F95.9 [F95.9] Tic disorder, unspecified ICD10CM F98.0 [F98.0] Enuresis not due to a substance or known physiological condition ICD10CM F98.1 [F98.1] Encopresis not due to a substance or known physiological condition ICD10CM F98.21 [F98.21] Rumination disorder of infancy ICD10CM F98.29 [F98.29] Other feeding disorders of infancy and early childhood ICD10CM F98.3 [F98.3] Pica of infancy and childhood ICD10CM F98.4 [F98.4] Stereotyped movement disorders ICD10CM F98.5 [F98.5] Adult onset fluency disorder ICD10CM F98.8 [F98.8] Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence ICD10CM F98.9 [F98.9] Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence ICD10CM F99 [F99] Mental disorder, not otherwise specified FUH Stand Alone Visit CPT CPT 98961

14 CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT 99411

15 CPT CPT HCPCS G0155 Services of clinical social worker in home health or hospice settings, each 15 minutes (G0155) HCPCS G0176 Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) (G0176) HCPCS G0177 Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) (G0177) HCPCS G0409 Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf) (G0409) HCPCS G0410 Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes (G0410) HCPCS G0411 Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes (G0411) HCPCS G0463 Hospital outpatient clinic visit for assessment and management of a patient (G0463) HCPCS H0002 Behavioral health screening to determine eligibility for admission to treatment program (H0002) HCPCS H0004 Behavioral health counseling and therapy, per 15 minutes (H0004) HCPCS H0031 Mental health assessment, by non-physician (H0031) HCPCS H0034 Medication training and support, per 15 minutes (H0034) HCPCS H0035 Mental health partial hospitalization, treatment, less than 24 hours (H0035) HCPCS H0036 Community psychiatric supportive treatment, face-to-face, per 15 minutes (H0036) HCPCS H0037 Community psychiatric supportive treatment program, per diem (H0037) HCPCS H0039 Assertive community treatment, face-to-face, per 15 minutes (H0039) HCPCS H0040 Assertive community treatment program, per diem (H0040) HCPCS H2000 Comprehensive multidisciplinary evaluation (H2000) HCPCS H2001 Rehabilitation program, per 1/2 day (H2001) HCPCS H2010 Comprehensive medication services, per 15 minutes (H2010) HCPCS H2011 Crisis intervention service, per 15 minutes (H2011) HCPCS H2012 Behavioral health day treatment, per hour (H2012) HCPCS H2013 Psychiatric health facility service, per diem (H2013) HCPCS H2014 Skills training and development, per 15 minutes (H2014) HCPCS H2015 Comprehensive community support services, per 15 minutes (H2015) HCPCS H2016 Comprehensive community support services, per diem (H2016) HCPCS H2017 Psychosocial rehabilitation services, per 15 minutes (H2017) HCPCS H2018 Psychosocial rehabilitation services, per diem (H2018) HCPCS H2019 Therapeutic behavioral services, per 15 minutes (H2019) HCPCS H2020 Therapeutic behavioral services, per diem (H2020) HCPCS M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders (M0064)

16 HCPCS S0201 Partial hospitalization services, less than 24 hours, per diem (S0201) HCPCS S9480 Intensive outpatient psychiatric services, per diem (S9480) HCPCS S9484 Crisis intervention mental health services, per hour (S9484) HCPCS S9485 Crisis intervention mental health services, per diem (S9485) HCPCS T1015 Clinic visit/encounter, all-inclusive (T1015) FUH Visits Group 1 CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT FUH POS Group 1 POS 02 Telehealth POS 03 School POS 05 Indian Health Service Free-standing Facility POS 07 Tribal 638 Free-standing Facility POS 09 Prison/Correctional Facility POS 11 Office POS 12 Home POS 13 Assisted Living Facility POS 14 Group Home POS 15 Mobile Unit POS 16 Temporary Lodging POS 17 Walk-in Retail Health Clinic

17 POS 18 Place of Employment-Worksite POS 19 Off Campus-Outpatient Hospital POS 20 Urgent Care Facility POS 22 On Campus-Outpatient Hospital POS 24 Ambulatory Surgical Center POS 33 Custodial Care Facility POS 49 Independent Clinic POS 50 Federally Qualified Health Center POS 52 Psychiatric Facility-Partial Hospitalization POS 53 Community Mental Health Center POS 71 Public Health Clinic POS 72 Rural Health Clinic FUH Visits Group 2 CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT FUH POS Group 2 POS 02 Telehealth POS 52 Psychiatric Facility-Partial Hospitalization POS 53 Community Mental Health Center FUH RevCodes Group 1 UBREV 0513 UBREV 0900 UBREV 0901 UBREV 0902 UBREV 0903 UBREV 0904 UBREV 0905 UBREV 0907

18 UBREV 0911 UBREV 0912 UBREV 0913 UBREV 0914 UBREV 0915 UBREV 0916 UBREV 0917 UBREV 0919 FUH RevCodes Group 2 UBREV 0510 UBREV 0515 UBREV 0516 UBREV 0517 UBREV 0519 UBREV 0520 UBREV 0521 UBREV 0522 UBREV 0523 UBREV 0526 UBREV 0527 UBREV 0528 UBREV 0529 UBREV 0982 UBREV 0983 Transitional Care Management Services CPT CPT Telehealth Modifier CPT 95 CPT GT