Community Behavioral Health Services. Fee Schedule

Size: px

Start display at page:

Download "Community Behavioral Health Services. Fee Schedule"

Constance Eaton
5 years ago
Views:

1 Assessment s Psychiatric evaluation by physician Psychiatric evaluation by physician Psychiatric evaluation by nonphysician Brief behavioral health status exam Brief behavioral health status exam Community Behavioral Health s Fee Schedule H000 HP $0.00 per evaluation H000 HP GT $0.00 per evaluation H000 HO $50.00 per evaluation H00 HO $4.66 per H00 HO GT $4.66 per a maximum of two psychiatric evaluations per There is a maximum daily limit of two quarter-hour units. for brief behavioral health status examinations a maximum of 0 quarter-hour units annually (.5 hours), per Psychiatric review of records H000 $6.00 per review A brief behavioral is not same day that a psychiatric evaluation, bio-psychosocial, or indepth has been completed by a qualified treating practitioner. a maximum of two psychiatric reviews of records, per recipient, per state *July through June 30. This service may not be billed for review of lab work (see medication management). January, 05

2 Assessment s, continued In-depth, new patient, mental health In-depth, new patient, mental health In-depth, In-depth, In-depth, new patient, substance abuse In-depth, new patient, substance abuse In-depth, In-depth, Bio-psychosocial Evaluation, mental health Bio-psychosocial evaluation, mental health Bio-psychosocial evaluation, substance abuse Bio-psychosocial evaluation, substance H003 HO $5.00 per H003 HO GT $5.00 per H003 TS $00.00 per H003 TS GT $00.00 per H000 HO $5.00 per H000 HO GT $5.00 per H000 TS $00.00 per H000 TS GT $00.00 per H003 HN $48.00 per H003 HN GT $48.00 per H000 HN $48.00 per H000 HN GT $48.00 per abuse Psychological testing H09 $5.00 per *July through June 30. one in-depth, per An in-depth is not same day for the same recipient as a biopsychosocial evaluation. A bio-psychosocial evaluation is not reimbursable for the same recipient after an in-depth has been completed, unless there is a documented change in the recipient s status and additional information must be gathered to modify the recipient s treatment plan. one bio-psychosocial evaluation, per A bio-psychosocial evaluation is not same day for the same recipient as an indepth. a maximum of 40 quarter-hour units (0 hours) of psychological testing, per recipient, per state January, 05

3 Assessment s, continued Limited functional H003, mental health Limited functional, mental health Limited functional, substance abuse Limited functional, substance abuse $5.00 per H003 GT $5.00 per H000 $5.00 per H000 GT $5.00 per a maximum of three limited functional s, per Treatment Plan Development and Modification Treatment plan H003 development, new and Treatment plan T007 development, new and $97.00 per $97.00 per for the development of one treatment plan per provider, per state for a maximum total of two treatment plans per recipient per state Treatment plan review, Treatment plan review, *July through June 30. H003 TS $48.50 per T007 TS $48.50 per The reimbursement date for treatment plan development is the day it is authorized by the treating practitioner. a maximum of four treatment plan reviews, per recipient, per state The reimbursement date for a treatment plan review is the day it is authorized by the treating practitioner. January, 05

4 Medical and Psychiatric s Medication management T05 $60.00 per Medication management Brief individual psychotherapy, mental health Brief individual psychotherapy, mental health Brief individual psychotherapy, Brief individual psychotherapy, *July through June 30. T05 GT $60.00 per H00 HE $5.00 per H00 HE GT $5.00 per H00 HF $5.00 per H00 HF GT $5.00 per medication management as ly necessary. Medication management is not same day, for the same recipient, as brief group therapy or brief individual psychotherapy. There is a maximum daily limit of two quarter-hour units. a maximum of 6 quarter-hour units (4 hours) of brief individual psychotherapy, per Brief individual psychotherapy is not same day, for the same recipient, as brief group therapy or medication management. January, 05

5 Medical and Psychiatric s, continued Brief group therapy H00 HQ $8.65 per There is a maximum daily limit of two quarter-hour units. Behavioral health screening, Behavioral health screening, *July through June 30. T03 HE $43.6 per T03 HF $43.6 per a maximum of 8 quarter-hour units (4.5 hours) of group therapy, per Brief group therapy is not same day, for the same recipient as brief individual psychotherapy or behavioral healthrelated services: verbal interactions, medication management. two behavioral health screening services, per recipient, per state screening services are not reimbursable on the same day, for the same recipient, as behavioral healthrelated services: verbal interactions, medication management. January, 05

6 Medical and Psychiatric s, continued Behavioral health H0046 related services: verbal interaction, services: verbal interaction, services: verbal interaction, services: verbal interaction, services: procedures, services: procedures, services: alcohol and other drug screening specimen collection Medication-assisted treatment services *July through June 30. $5.00 per H0046 GT $5.00 per H0047 $5.00 per H0047 GT $5.00 per T05 HE $0.00 per T05 HF $0.00 per H0048 H000 $0.00 per $67.48, weekly rate 5 behavioral healthrelated services: procedures, per services: verbal interactions are not same day as behavioral health screening services. 5 behavioral healthrelated services: procedures, per 5 behavioral healthrelated services: alcohol and other drug screening specimen collections, per medication-assisted treatment services 5 times, per recipient, per state The service is billed one time per seven days. This service is not reimbursable using any other procedure code. January, 05

7 Behavioral Health Therapy s Individual and family therapy H09 HR $8.33 per Individual and family H09 HR GT $8.33 per therapy a maximum of 04 quarter-hour units (6 hours) of individual and family therapy services, per recipient, per state Group therapy H09 HQ $6.67 per Behavioral health day services, Behavioral health day services, substance abuse There is a maximum daily limit of four quarter-hour units ( hour). a maximum of 56 quarter-hour units (39 hours) of group therapy services, per H0 H0 HF $.50 per hour $.50 per hour a maximum of 90-hour units (47.5 hours;.9 half-days) per *July through June 30. Medicaid will not reimburse for behavioral health day services the same day as psychosocial rehabilitation services. January, 05

8 Reimbursement/ Community Support and Rehabilitative s Psychosocial H07 rehabilitation services $9.00 per a maximum of,90 units (480 hours; 0 days) of psychosocial rehabilitation services, per Clubhouse services H030 $5.00 per These units count against clubhouse service units. clubhouse services for a maximum of 90 quarter-hour units (480 hours; 0 days) annually, per recipient, per state These units count against psychosocial rehabilitation units of service. Therapeutic Behavioral On-Site s for Recipients Under the Age of Years Therapeutic behavioral on-site services, therapy H09 HO $6.00 per therapeutic behavioral on-site therapy services a maximum combined limit of a total of 36, 5-minute units per month( 9 hours) by a master s level or certified behavioral analyst. *July through June 30. January, 05

9 Reimbursement/ Therapeutic Behavioral On-Site s for Recipients Under the Age of Years, continued Therapeutic behavioral on-site services, behavior management H09 HN $0.00 per therapeutic behavioral on-site behavior management and therapeutic behavioral on-site therapy services for a maximum combined total of 36, 5-minute units per month by a master s level practitioner, certified behavioral analyst, or certified associate Therapeutic behavioral on-site services, therapeutic support H09 HM $4.00 per behavioral analyst. therapeutic behavioral on-site therapeutic support services for a maximum of 8 quarter-hour units per month (3 hours), per recipient. January, 05

PROCEDURE CODES & UNIT

PROCEDURE CODES & UNIT CPT Valid and its modifiers, which is billable to SAMH or Medicaid 90801 HW B No Yes Psychiatric Evaluation (Evaluation and management) when funded by the state mental health authority