Connecticut Behavioral Health Partnership Authorization Schedule General and Psychiatric Hospital SVC CODE MOD- IFIER
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1 CPT//REV INPATIENT HOSPITAL Psychiatric Hospital or General Hospital Psychiatric Unit CIPFY Y Y Y Y 0114, 0124, 0134, 0144, 0154, 0204, 0190, 0224 In hospitalization Bypass: R Non-Bypass: A R HUSKY A & B. Intermediate Duration Acute Psychiatric In CIDAY Y Y if age 18 or older N Y if age 18 or older 0124 Intermediate Duration Stay A A General Hospital Medical Unit CIPMY Y Y Y Y 0110, 0111, 0112, 0113, 0115, 0117, 0118, 0119, 0120, 0121, 0122, 0123, 0125, 0127, 0128, 0129, 0130, 0131, 0132, 0133, 0135, 0137, 0138, 0139, 0140, 0141, 0142, 0143, 0145, 0147, 0148, 0149, 0150, 0151, 0152, 0153, 0155, 0157, 0158, 0206, 0213, 0214, 0219 In Medical Floor Admission/Boarding A A HUSKY A & B CHILD AND ADOLESCENT RAPID EMERGENCY SERVICE (CARES) C.A.R.E.S. Out (Evaluation) - C.A.R.E.S. Out (Evaluation) - CCREY Y Y if age 5-17 Y if age 5-17 Y if age C.A.R.E.S. - Treatment Room - Evaluation R (1/1 day) N/A HUSKY A & CCREY Y Y if age 5-17 Y if age 5-17 Y if age C.A.R.E.S. - Treatment Room - Evaluation R (1/1 day) N/A HUSKY A & C.A.R.E.S. In CCRSY Y Y if age 5-17 Y if age 5-17 Y if age C.A.R.E.S. - All Inclusive Room & Board R (3/3 days) A HUSKY A & OBSERVATION 48 Hour Observation COBSY Y Y Y Y 0762 Observation Room N N 7/1/2016 G0378 Hospital Observation Services, per hour: G0379 Direct admission of for hospital observation care ED Visit Level Critical Care first hour G G0384 Hospital ED provided in type B Emergency Department Level 1-5) Page 1 of 5
2 CPT//REV G0463 Hospital Out Clinic Visit INPATIENT DETOXIFICATION In Detox - Hospital CIPDY Y Y Y Y 0116, 0126, 0136, 0146, 0156 Detoxification in an in hospital A A HUSKY A & B Page 2 of 5
3 CPT//REV INTERMEDIATE CARE PROGRAMS Partial Hospitalization - Hospital CPHPY Y Y Y Y 0900, 0913 Partial Hospitalization A A Partial Hospitalization - Hospital CPHPC Y Y Y Y H0035, 90791, 90792, Partial Hospitalization A A Intensive Out - Hospital - CIOPY Y Y Y Y 0900, 0905, 0906 Intensive Out - MH/SA Child 0-18 R (15/42 days) Child 0-18 Intensive Out - Hospital - CIOPC Y Y Y Y H0015, S9480, 90791, 90792, Intensive Out - MH/SA Child 0-18 R (15/42 days) Child 0-18 Extended Day Treatment - Hospital CEDTY Y Y Y Y 0900, 0907 Extended Day Treatment R (44/60 days) R (44/60 days) 6/1/2006 Extended Day Treatment - Hospital CEDTC Y Y Y Y H2012, 90791, 90792, Extended Day Treatment R (44/60 days) R (44/60 days) 6/1/2006 OUTPATIENT Out-Hospital or Psychiatric Hospital COTPY Y Y Y Y 0900 Psychiatric Service General (Evaluation) R (90/12 months) R (45/12 months) CT BHP 0914 Individual Therapy 0915 Group therapy 0916 Family Therapy 0919 Other Behavioral Health Service (Med Management) Smoking and tobacco use cessation group counseling greater than 45 minutes and must include one of the following diagnosis codes; Tobacco Use Disorder or N N 10/1/2014 update 0953 Tobacco withdrawal 6/1/2015 Out-Hospital Emergency Department Services Y Y Y Y 90791, General Evaluation - Psychiatric Services N N 7/1/2016 Page 3 of 5
4 Department Services CPT//REV 99281, 99282, 99283, 99284, Emergency department visit for the evaluation and management of a N N 7/1/2016 Out-Hospital or Psychiatric Hospital COTPC Y Y Y Y Interactive complexity add-on code Psychiatric Diagnostic Evaluation (no medical services) Psychiatric Diagnostic Evaluation with Medical Services (or E&M new codes) Psychotherapy, 30 minutes with and/or family member Psychotherapy, 30 minutes with and/or family member when performed with an Psychotherapy, 45 minutes with and/or family member Psychotherapy, 45 minutes with and/or family member when performed with an Psychotherapy, 60 minutes with and/or family member Psychotherapy, 60 minutes with and/or family member when performed with an Family Medical Psychotherapy (without present) minutes Family Medical Psychotherapy (with ) minutes Multi-family group, psychotherapy Group Medical Psychotherapy, minutes Office or other out visit for the evaluation and management of a new Office or other out visit for the evaluation and management of a new Office or other out visit for the evaluation and management of a new Office or other out visit for the evaluation and management of a new Office or other out visit for the evaluation and management of a new R (90/12 months) R (45/12 months) 9/1/ Office or other out visit for the evaluation and management of an established Office or other out visit for the evaluation and management of an established Office or other out visit for the evaluation and management of an established Office or other out visit for the evaluation and management of an established Office or other out visit for the evaluation and management of an established Smoking and tobacco use cessation group counseling greater than 45 minutes and must include one of the following diagnosis codes; Tobacco Use Disorder or Tobacco withdrawal N N 10/1/2014 update 6/1/2015 MEDICAL PSYCHIATRIC THERAPY ECT - Out Hospital / Facility component CMPTY Y Y Y Y 0901 Electroconvulsive Therapy - facility component A A ECT - Emergencey Department CMPTC Y Y Y Y Electroconvulsive Therapy - ED & facility component N N/A 7/1/2016 ECT - Out Hospital / Facility component Effective 7/1/16 CMPTC Y Y Y Y Electroconvulsive Therapy - ED & facility component 7/1/2016 PSYCHOLOGICAL TESTING Page 4 of 5
5 CPT//REV Psych Testing - Hospital CTSTY Y Y Y Y 0900 Psychiatric Services General (Evaluation) N/A 9/1/ Psychological Testing, 1 Hour (8 units/hrs CO 8/1/08 Maximum 0513 Neuropsychological Testing, 1 Hour 9/1/2014 Psych Testing - Hospital CTSTY Y Y Y Y 90791, Psychiatric Services General (Evaluation) N/A 9/1/ , Psychological Testing, 1 Hour (8 units/hrs CO 8/1/08 Maximum 96116, Neuropsychological Testing, 1 Hour 9/1/2014 EPSDT EPSDT-BH- Hospital CEPSY Y Y Y Y Determined case by case Auth Required/Re-Auth? A= Authorization or reauthorization R=Registration or re-registration (units registered/duration in months or days) N=Neither authorization nor registration N/A=Not Applicable TBD=To Be Determined = Providers will register services and depending on units requested, registration will either auto-approve or pend for further review. A >2 means no PA required for first two services. PA required for subsequent services A >4 means no PA required for first four units of service. PA required for subsequent units of service. Special services - These are all single case agreements. A A 1/1/2006 Page 5 of 5
Connecticut Behavioral Health Partnership Authorization Schedule Independent Practitioners (MD, APRN)
SERVICES HP Service Class HP Payable Service Husky A Husky B Charter Oak Husky C & Husky D CPT/SVC/REV SVC MODIFIER DESCRIPTIO Auth Req'd? Re-Auth? IPATIET PROFESSIOAL SERVICES Inpatient E & M Services
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
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
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
AUTHORIZATION RQUIREMENTS Notes (0= No Additional Comments) 101 All inclusive room and board On 0
100 All inclusive room and board 0 101 All inclusive room and board 0 114 Room and Board- private psychiatric 0 116 Room and Board- private room detoxification 0 118 Room and Board- private rehabilitation
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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
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Ohio. SAMPLE NCCI Edits*** Navigate to the Overall Coding Sheet
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