Connecticut Behavioral Health Partnership Authorization Schedule Independent Practitioners (MD, APRN)
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1 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 - MD/APR Initial Hospital Care (30 Minutes) Initial Hospital Care (50 Minutes) Initial Hospital Care (70 Minutes) Subsequent Hospital Care (15 Min.) Subsequent Hospital Care (25 Min.) Subsequent Hospital Care (35 Min.) OBSERVATIO OR IPATIET HOSPITAL CARE, LOW SEVERIT PROBLEM OBSERVATIO OR IPATIET HOSPITAL CARE, MODERATE SEVERIT OBSERVATIO OR IPATIET HOSPITAL CARE, HIGH SEVERIT PROBLEM Hospital Discharge Day Management: 30 Minutes or Less Hospital Discharge Day Management: More than 30 Minutes Inpatient Consultations - MD/APR Inpatient Consultation (20 Min.) Inpatient Consultation (40 Min.) Inpatient Consultation (55 Min.) Inpatient Consultation (80 Min.) Inpatient Consultation (110 Min.) Confirmatory Consultation, Focused Confirmatory Consultation, Expanded Confirmatory Consultation, Detailed Confirmatory Consultation, Comprehensive, Moderate Complexity Confirmatory Consultation, Comprehensive, High Complexity Observation Care Services - MD/APR Observation Care Discharge Initial Observation Care, Detailed, Low Complexity Initial Observation Care, Comprehensive, Moderate Complexity Initial Observation Care, Comprehensive, High Complexity Inpatient Hospital or ursing Home Psychotherapy - MD/APR OUTPATIET SERVICES Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med Eval & Mgmt - Discontinued 12/31/ Interactive complexity add-on code Psychiatric Diagnostic Evaluation (no medical services) Psychiatric Diagnostic Evaluation with Medical Services (or E&M new patient codes) Psychotherapy, 30 minutes with patient and/or family member Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service Psychotherapy, 45 minutes with patient and/or family member Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M service Psychotherapy, 60 minutes with patient and/or family member Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M service Outpatient- Independent Practice - MD/APR COTP Interactive complexity add-on code Psychiatric Diagnostic Evaluation (no medical services) Psychiatric Diagnostic Evaluation with Medical Services (or E&M new patient codes) Initial Psychiatric Interview Examination - Discontinued 12/31/ Interactive Psych Diagnostic Interview/Exam - Discontinued 12/31/ Individual Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Medical Evaluation & Management - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med. Evaluation & Management - Discontinued 12/31/ Ind. Therapy Minutes - Discontinued 12/31/ Ind. Therapy Minutes with Med. Evaluation & Management - Discontinued 12/31/ Ind. Therapy, Interactive Minutes - Discontinued 12/31/ Ind. Therapy, Interactive Minutes with Med Eval & Mgmt. - Discontinued 12/31/ Ind Therapy, Interactive Minutes - Discontinued 12/31/ Ind. Therapy, Interactive Minutes with Med Eval & Mgmt - Discontinued 12/31/ Ind. Therapy, Interactive Minutes - Discontinued 12/31/ Ind. Therapy, Interactive Minutes with Med Eval & Mgmt - Discontinued 12/31/ Psychotherapy, 30 minutes with patient and/or family member Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service Psychotherapy, 45 minutes with patient and/or family member Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M service Psychotherapy, 60 minutes with patient and/or family member Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M service Family Medical Psychotherapy (without patient present) minutes Page 1 of 8Family Medical Psychotherapy (with patient) minutes Multi-family group, psychotherapy Group Medical Psychotherapy, minutes Interactive Group Psychotherapy, minutes - Discontinued 12/31/12 R (90/12 months) R (45/12 months )
2 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? Pharmacological Management, including prescription, use, and review of medication with no more than minimal medical psychotherapy - Discontinued 12/31/ arcosynthesis for psychiatric diagnostic and therapeutic purposes Individual psychophysiological therapy incorporating biofeedback; approximately minutes Individual psychophysiological therapy incorporating biofeedback; approximately minutes Hypnotherapy 99201, 99202, Evaluation and management procedures, new or established patient 99203, 99204, 99205, 99211, 99212, 99213, 99214, , 99242, Evaluation and management procedures, office or other outpatient consultation 99243, 99244, M0064 Brief office visit to monitor drug prescriptions Injections - Independent Practice - MD/APR MEDICAL PSCHIATRIC THERAP J1630,J1631, J2680, J0515, J0735, J0780, J1200, J1320, J1990, J2060, J2794, J2358, J2426, J3230, J3310, J3410, J3411, J3486 Therapeutic of Diagnostic injection; subcutaneous or intramuscular ECT - physician component - MD/APR Physician component of ECT A (TBD) A (TBD) PSCHOLOGICAL TESTIG Psych Testing- Independent Practitioner - MD / APR CTST , Psychological Testing, 1 Hour Initial Psychiatric Interview Examination Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient R/A DEVELOPMETAL TESTIG Developmental Testing- Independent Practice Developmental Testing; limited with interpretation and report Developmental Testing; extended with interpretation and report IDIRECT SERVICES Consultation - Independent Practitioner - MD/APR CMCT Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient A>2 A Page 2 of 8
3 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? Case management- Independent Practice - MD/APR CCMS1 < 19 < 19 <19 T1016 Case management, per 15 minutes, coordination of health care services R >12 R (20/6 months) R (20/6 months) Page 3 of 8
4 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? SMOKIG CESSATIO (MD, APR only) Smoking Cessation - Independent Practice - MD / APR *** Coverage available for all HUSK A, C and D members, but restricted to only pregnant HUSK B and Charter Oak members. EPSDT *** *** *** *** Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes EPSDT- BH - Independent Practice - MD/APR CEPS1 Determined case by case Special services - These are all single case agreements. A A Auth Required/Re-Auth? A= Authorization or reauthorization R=Registration or re-registration (units registered/duration in months or days) =either authorization nor registration R/A = Providers will register services and depending on units requested, registration will either auto-approve or pend for further review. =ot Applicable TBD=To Be Determined 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. R >12 means no PA required for first twelve units of service. PA via registration required for subsequent units of service. Page 4 of 8
5 Auth/Reg Eff Date 9/1/2006 CO 08/01/08 HUSK C&D 4/1/2011 Page 5 of 8
6 Auth/Reg Eff Date TBD TBD 9/1/2006 CO 8/1/08 HUSK C & D 4/1/2011 TBD Page 6 of 8
7 Auth/Reg Eff Date 7/1/2007 HUSK C & D 4/1/2011 Page 7 of 8
8 Auth/Reg Eff Date 1/1/2006 HUSK C & D 4/1/2011 Page 8 of 8
Connecticut Behavioral Health Partnership Authorization Schedule General and Psychiatric Hospital SVC CODE MOD- IFIER
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 &
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
Florida Behavioral Health - Authorization Grid Series
DESCRIPTION REQUIREMENT RESPONSIBILITY AUTH PARAMETERS 90785 Interactive complexity add-on code MD,NP Psychiatric diagnostic evaluation (no medical 90791 Services) 90792 Psychiatric diagnostic evaluation
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
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
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
Nebraska Behavioral Health Authorization List If the procedure code is not listed here, it is not a covered benefit
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Ohio. SAMPLE NCCI Edits*** Navigate to the Overall Coding Sheet
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New York Medicaid BEHAVIORAL HEALTH PRIOR AUTHORIZATION GRID AUTHORIZATION IS NOT A GUARANTEE OF PAYMENT
NEW YORK MEDICAID HIGHER LEVEL OF CARE - BH PRIOR AUTH GRID New York Medicaid BEHAVIORAL HEALTH PRIOR AUTHORIZATION GRID AUTHORIZATION IS NOT A GUARANTEE OF PAYMENT REV CODE LEVEL OF CARE AUTHORIZATION
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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HUSKY Health Benefits and Prior Authorization Requirements Grid* Behavioral Health Partnership Effective: January 1, 2012
Behavioral Health Health and Behavior Assessments (CPT 96150-96155) When Performed by Psychologists Mental Health Inpatient 100% covered under medical benefit for members with diagnoses outside the range
RUN: 02/14/17 13:08:51 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: LEGEND ------------------------------------------------------------------------------------------------------------------------------------
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DESCRIPTION CODE Age or Setting Modifier PHYSICIAN PSYCHOLOGIST LEVEL SPECIALIST Psychiatric Diagnostic Evaluation no medical svcs* 90791 IP w/ or w/o GT $104.18 $93.76 $70.32 $70.32 Psychiatric Diagnostic
emeasure Titles and Descriptions
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