AUTHORIZATION RQUIREMENTS Notes (0= No Additional Comments) 101 All inclusive room and board On 0
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1 100 All inclusive room and board All inclusive room and board Room and Board- private psychiatric Room and Board- private room detoxification Room and Board- private rehabilitation Residential Treatment Room and Board -semi private psychiatric Room and Board- semi- private room detoxification Room and Board - semi private rehabilitation Room and Board bed psychiatric Room and Board- 3-4 bed detoxification Room and Board bed rehabilitation Room and board private psychiatric Room and board private- detoxification Room and Board- ward psychiatric Room and Board- detoxification ward Room and Board- ward rehabilitation leave of absence from residential Therapeutic home time Sub Acute Inpatient Emergency Room Off Emergency Room Off Clinic encounter all inclusive Off Psych clinic Off Urgent Care Clinic Other clinic- med supervised withdrawal Freestanding clinic Off 0 PRO_14034E Internal Approved MO8PROLTR14034E_0000
2 521 Rural Clinic Off Other freestanding clinic Off ECT- electroshock treatment 0 Intensive Outpatient - providers should be instructed to use 905 proper code with Intensive Outpatient - providers should be instructed to use 906 proper code with BH treatment services Substance abuse rehabilitation Off Psychiatric/Psychological Services- Individual therapy Off Psychiatric/Psychological Services- Family therapy Off Biofeedback Testing Off Other BH treatment services Off Drug Rehabilitation Off Alcohol Rehabilitation Off Behavioral Health Residential- psychiatric Detox - Docimillary (DASA) Interactive complexity add-on code Off Psychiatric diagnostic evaluation (no medical Services) Off Psychiatric diagnostic evaluation with medical services Off Psychotherapy, 30 mins At visit min psychotherapy add on code when performed with E/M Service- (list separately) Off Psychotherapy, 45 mins At visit minute psychotherapy add on code when performed with E/M Service (list separately) Off 0
3 90837 Psychotherapy, 60 mins At visit min psychotherapy when performed with E/M service (list separately Off Psychotherapy for crisis, first 60 min. At visit crisis code add on for each additional 30 min. Off Psychoanalysis Off Family Psychotherapy, without patient present At visit Family Psychotherapy, 45 min At visit Multiple-family group psychotherapy At visit Group psychotherapy At visit Pharmacologic management, add on code Off Narcosynthesis Off Electroconvulsive Therapy Ind psycho therapy incorporating bio feedback 30 min Off Ind psycho therapy incorporating bio feedback 45 min Off Hypnotherapy Psych eval of hospital records Off Psychological testing after 5 Hours Psychological testing after 5 Hours Assessment of Aphasia of speech/lang Developmental testing after 5 Hours Neurobehavioral status exam w clin assess after 5 Hours Neuropsych Testing Admin by Computer per occurrence after 5 Hours Nursing Assessment and Care-Initial Off Nursing Assessment and Care-Re-Assessment Off H&B individual intervention Off H&B group intervention Off 0
4 96154 Health & Behavior Intervention with patient present Off Services rendered after hours Off Payable only to Psychiatrists (MD/DO) Office Emergency Services Off Payable only to Psychiatrists (MD/DO) New Patient Office Visit Level 1 Off Payable only to Psychiatrists (MD/DO) New Patient Office Visit Level 2 Off Payable only to Psychiatrists (MD/DO) New Patient Office Visit Level 3 Off Payable only to Psychiatrists (MD/DO) New Patient Office Visit Level 4 Off Payable only to Psychiatrists (MD/DO) New Patient Office Visit Level 5 Off Payable only to Psychiatrists (MD/DO) Est Patient Office Visit Level 1 Off Payable only to Psychiatrists (MD/DO) Est Patient Office Visit Level 2 Off Payable only to Psychiatrists (MD/DO) Est Patient Office Visit Level 3 Off Payable only to Psychiatrists (MD/DO) Est Patient Office Visit Level 4 Off Payable only to Psychiatrists (MD/DO) Est Patient Office Visit Level 5 Off Payable only to Psychiatrists (MD/DO) Initial Hospital Care-comprehensive; low complexity Off Payable only to Psychiatrists (MD/DO) Initial Hospital Care-comprehensive; moderate complexity Off Payable only to Psychiatrists (MD/DO) Initial Hospital Care-comprehensive; high complexity Off Payable only to Psychiatrists (MD/DO) Subsequent observation Care Off Payable only to Psychiatrists (MD/DO) Subsequent observation Care Off Payable only to Psychiatrists (MD/DO) Subsequent observation Care Off Payable only to Psychiatrists (MD/DO) Subsequent Hospital Care-focused; low complexity Off Payable only to Psychiatrists (MD/DO) Subsequent Hospital Care-focused; moderate complexity Off Payable only to Psychiatrists (MD/DO) Subsequent Hospital Care-focused; high complexity Off Payable only to Psychiatrists (MD/DO) Observation-comprehensive; low complexity Off Observation-comprehensive; moderate complexity Off Observation-comprehensive; high complexity Off 0
5 99238 Discharge Day Management- 30 min or less Off Discharge Day Management-more than 30 min Off Problem focused; straightforward-15 min Off Expanded; straightforward-30 min Off Detailed; low complexity-40 min Off Comprehensive; moderate complexity-60 min Off Comprehensive; high complexity-80 min Off Initial Consultation-focused, straightforward Off Initial Consultation-expanded, straightforward Off Initial Consultation-detailed, low complexity Off Initial Consultation-comprehensive, moderate complexity Off Initial Consultation-comprehensive, high complexity Off ER Consultation-focused, straightforward Off ER Consultation-expanded; low complexity Off ER Consultation-expanded; moderate complexity Off ER Consultation-detailed; moderate complexity Off ER Consultation-comprehensive; high complexity Off Nursing facility consultation 25 min Off Nursing facility consultation 35 min Off Nursing facility consultation 45 min Off Evaluation Management nursing facility 10 min Off Evaluation Management nursing facility 15 min Off Evaluation Management nursing facility 25 min Off Evaluation Management nursing facility 35 min Off Home visit, new patient Off Home visit, new patient Off 0
6 99343 Home visit, new patient Off Home visit, new patient Off Home visit, new patient Off Home visit, est patient Off Home visit, est patient Off Home visit, est patient Off Home visit, est patient Off Prolonged evaluation and mgmt psycho therapy svs Off Prolonged evaluation and mgmt psycho therapy svs Off Medical team conference Off Medical team conference with family Off Medical team conference without family Off Preventive counseling, individual Off Preventive counseling, individual 30 min Off Preventive counseling, individual 45 min Off Preventive counseling, individual Off Smoking cessation Off Smoking cessation Off Alcohol substance abuse BH change intervention Off 0 Alcohol and substance abuse screening and brief intervention Off Preventive counseling, individual 60 min Off Preventive medicine group counseling- 60 min Off 0 907, H2012 Community behavioral program (day treatment) 0 d G0410, G0411, orpartial Hospitalization 0 915, S9480 BH intensive outpatient psychiatric 0 G0410 Partial Hospitalization 0
7 G0411 BH intensive outpatient substance abuse 0 ly payable on MO Healthnet fee schedule through C- H0001 Alcohol and/or drug assessment Off STAR program Behavioral Health Screen to determine eligibility for H0002 admission to treatment program Off 0 H0004 Behavioral health counseling and therapy; per 15 minutes Off 0 H0005 Alcohol and/or drug services; group counseling by a clinician Off 0 H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) Payable on MO Healthnet fee schedule to C-STAR and psychiatric rehab Behavioral health; short-term residential (non hospital residential treatment program), without room and board; H0018 per diem 0 Behavioral health; long term residential (non-medical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board; per H0019 diem Payable under the other medical/asc grouping. H0020 Alcohol and/or drug services; methadone administration and/or service (provisions of the drug by a licensed program) H0023 Behavioral health outreach service (planned approach to reach a targeted population) Off Payable on MOHealthnet fee schedule to C-STAR and Psyc Rehab.
8 Behavioral health prevention education service (delivered of services with target population to affect knowledge, attitude and/or behavior); 15 minutes RQUIREMENTS Notes (0= No Additional Comments) Payable on MOHealthnet fee schedule to C-STAR and H0025 Off Psyc Rehab. Payable on MOHealthnet fee schedule to C-STAR and H0031 Mental health assessment, by non-physician Off Psyc Rehab. Payable on MOHealthnet fee schedule to C-STAR and H0032 Mental health service plan development by non-physician Off Psyc Rehab. Mental health partial hospitalization, treatment, less than H hours 0 H0036 Community psychiatric supportive treatment, face to face Community psychiatric supportive treatment program; per H0037 diem H0038 Self-help/peer services; per 15 minutes Off H0040 Assertive Community Treatment; per diem H0047 Alcohol and drug services not otherwise specified H0049 Alcohol and/or drug Screening Off Alcohol and/or Drug Service, Brief Intervention; per 15 H0050 minutes Off Payable on mo healthnet fee schedule to psyc rehab only Payable on MO Healthnet fee schedule to psyc rehab, medical and other medical. Payable on MO Healthnet fee schedule to c-star, psyc rehab and other medical. Payable on mo healthnet fee schedule to psyc rehab only Payable on MO Healthnet fee schedule only to CSTAR and psyc rehab. Payable on MO Healthnet fee schedule to MD, clinical psychologist and LCSW Payable on MO Healthnet fee schedule to MD, clinical psychologist and LCSW
9 RQUIREMENTS H1000 Prenatal care, at-risk assessment Off Prenatal care, at-risk enhanced service; antepartum H1001 management Off H1004 Prenatal care, at-risk enhanced service; follow-up home visit Off Notes (0= No Additional Comments) Payable on MO Healthnet fee schedule to psychiatrist only. Payable on MO Healthnet fee schedule to psychiatrist only. Payable on MO Healthnet fee schedule to psychiatrist only. H2010 H2011 Comprehensive medication services; per 15 minutes =+'MASTER ALT TOOL ALL BH'!D272 Off Payable on mohealth net fee schedule to CSTAR and psyc rehab only. Payable on mohealth net fee schedule to CSTAR and psyc rehab only. H2012 Behavioral health day treatment; per hour 0 H2014 Skills training and development; per 15 minutes Payable on mohealth net fee schedule to psyc rehab only H2015 Comprehensive community support services; per 15 minutes Payable on mohealth net fee schedule to CSTAR and psyc rehab only.
10 H2017 Psychosocial rehabilitation services; per 15 minutes RQUIREMENTS Notes (0= No Additional Comments) payable on mo healthnet fee schedule to psyc rehab only. H2019 T1006 Therapeutic behavioral services; per 15 minutes Alcohol and/or substance abuse services, family/couple counseling Payable on mo healthnet fee schedule to psyc rehab identified HCPC Series Codes Payable on MO Healthnet fee schedule to CSTAR and psyc rehab only Payable on MO Healthnet fee schedule to CSTAR and psyc rehab only T1013 Sign language or oral interpretive services; per 15 minutes Off T1014 Telehealth telemedicine Off 0 T1015 Clinic encounter all inclusive Off Payable for IRHC setting
CMHC AUTHORIZATION REQUIREMENT. Non-CMHC Notes (0 = No SERVICE DESCRIPTION
Non- Notes (0 = No Non- Notes (0 = No 100 All inclusive room and board On 0 On 0 101 All inclusive room and board On 0 On 0 104 Anesthesia, ECT On 0 On 0 114 Room and Board- private psychiatric On 0 On
Page 1 of 11. Effective 9/15/2018 AUTHORIZATION REQUIREMENT LEVEL OF CARE. Notes (0 = No Additional Comments)
100 All inclusive room and board On 0 101 All inclusive room and board On 0 104 Anesthesia, ECT On 0 114 Room and Board- private psychiatric On 0 116 Room and Board- private room detoxification On 0 118
Behavioral Health Authorization Requirements*
100 All inclusive room and board MN 0 MN 0 101 All inclusive room and board MN Use MN Criteria for IP Medically-Supervised detox MN 0 104 Anesthesia, ECT MN 0 MN 0 114 Room and Board- private psychiatric
Revenue/Procedure Code Service Group Matrix
0 114 Room and Board- private psychiatric 0 118 Room and Board- private rehabilitation 0 124 Room and Board -semi private psychiatric 0 128 Room and Board - semi private rehabilitation 0 134 Room and Board
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RUN: 02/14/17 13:08:51 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: LEGEND ------------------------------------------------------------------------------------------------------------------------------------
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MEDICAL MANAGEMENT POLICY
PAGE: 1 of 6 This medical policy is not a guarantee of benefits or coverage, nor should it be deemed as medical advice. In the event of any conflict concerning benefit coverage, the employer/member summary
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Out of Annual Deductible Annual Deductible includes co-pays, coinsurance. The amounts are combined across all s. None Single Two-Person EE + Children Family $1,800 $3,600 $5,400 $5,400 Annual Out of Pocket
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