Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-010 - Rehabilitative Services for Persons with Mental Illness

Current through Register Vol. 49, No. 6, June, 2024
Section II Rehabilitative Services for
			 Persons with Mental Illness
252.110
			 Outpatient Procedure Codes 10-1-16
*(...) This symbol, along with text in parentheses, indicates
				the Arkansas Medicaid description of the service. When using a procedure code
				with this symbol, the service must meet the indicated Arkansas Medicaid
				description.
National Code
Required IVIodifier
Definition
92521
HA, UA
***(Diagnosis:
Evaluation of Speech Fluency
						  {e.g.,
stuttering, cluttering))
1 unit = 30 minutes
MAXIMUM UNITS PER DAY: 4
MAXIMUM UNITS PER STATE FISCAL YEAR:
4
						  units
92522
HA, UA
**[GREATER THAN]K(Diagnosis: Evaluation of Speech
						  Sound Production (e.g., articulation, phonological process, apraxia,
						  dysarthria))
1 unit = 30 minutes
MAXIMUM UNITS PER DAY: 4
MAXIMUM UNITS PER STATE FISCAL YEAR:
4
						  units
92523
HA, UA
***(Diagnosis: Evaluation of Speech Production
						  (e.g., articulation, phonological process, apraxia, dysarthria) with evaluation
						  of language comprehension and expression (e.g., receptive and expressive
						  language))
1 unit = 30 minutes
MAXIMUM UNITS PER DAY: 4
MAXIMUM UNITS PER STATE FISCAL YEAR:
4
						  units
92524
HA, UA
***(Diagnosis: Behavioral and qualitative
						  analysis of voice and resonance)
1 unit = 30 minutes
MAXIMUM UNITS PER DAY: 4
MAXIMUM UNITS PER STATE FISCAL YEAR:
4
						  units
90791
HA, U1
SERVICE: Mental Health Evaluation/Diagnosis
						  (Formerly known only as Diagnosis)
DEFINITION:
The cultural, developmental,
						  age and disability-relevant clinical evaluation and determination of a
						  beneficiary's mental status, functioning in various life domains; and an axis
						  five DSM diagnostic formulation for the purpose of developing a plan of care.
						  This service is required prior to provision of all other mental health services
						  with the exception of crisis interventions. Services are to be congruent with
						  the age, strengths necessary, accommodations for disability and cultural
						  framework of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 16
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's
Home (12); Nursing Facility (32); Skilled Nursing
						  Facility (31); School (03); Homeless Shelter (04); Assisted Living Facility
						  (13); Group Home (14);ICF/IID(54)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of the face-to-face encounter
						  with the beneficiary and the interpretation time for diagnostic
						  formulation
* Place of service
* Identifying information
* Referral reason
* Presenting problem(s), history of presenting
						  problem(s),
including duration, intensity and response(s) to prior
						  treatment
* Culturally- and age-appropriate psychosocial history
						  and assessment
* Mental status/clinical observations and
						  impressions
* Current functioning and strengths in specified life
						  domains
* DSM diagnostic impressions to include all five
						  axes
* Treatment recommendations
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
This service may be
						  billed for face-to-face contact as well as for time spent obtaining necessary
						  information for diagnostic purposes; however, this time may NOT be used for
						  development or submission of required paperwork processes (i.e.. Prior
						  Authorization requests, master treatment plans, etc.).
90791 U7
Mental Health Evaluation/Diagnosis:
Use
						  the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90791
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine PCS 99
96101 HA, UA
SERVICE: Psychological Evaluation
						  (Formerly Diagnosis -
Psychological Test/Evaluation and Diagnosis -
						  Psychological Testing Battery)
DEFINITION:
A Psychological Evaluation
						  employs standardized psychological tests conducted and documented for
						  evaluation, diagnostic or therapeutic purposes. The evaluation must be
						  medically necessary, culturally relevant, with reasonable accommodations for
						  any disability, provide infonnation relevant to the beneficiary's continuation
						  in treatment and assist in treatment planning. All psychometric instruments
						  must be administered, scored and interpreted by the qualified
						  professional.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  16
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 32
ALLOWABLE PLACES OF SERVICE:
Office
						  (11)
AGE GROUP{S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual encounter with
						  beneficiary
* Start and stop times of scoring, interpretation and
						  report preparation
* Place of service
* Identifying information
* Rationale for referral
* Presenting problem(s)
* Culturally- and age-appropriate psychosocial history
						  and assessment
* Mental status/clinical observations and
						  impressions
* Psychological tests used, results and
						  interpretations, as indicated
* Axis Five DSM diagnostic impressions
* Treatment recommendations and findings related to
						  rationale for service and guided by the master treatment plan and test
						  results
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
Medical necessity for
						  this service is met when the service is necessary to establish a differential
						  diagnosis of behavioral or psychiatric conditions, when the history and
						  symptomatology are not readily attributable to a particular psychiatric
						  diagnosis and the questions to be answered by the evaluation could not be
						  resolved by a psychiatric/diagnostic interview, observation in therapy or an
						  assessment for level of care at a mental health facility,
Or
Medical necessity is met when the beneficiary has
						  demonstrated a complexity of issues related to cognitive functioning or the
						  impact of a disability on a condition or behavior and the service is necessary
						  to develop treatment recommendations after the beneficiary has received various
						  treatment services and modalities, has not progressed in treatment and
						  continues to be symptomatic.
Medicaid WILL NOT reimburse evaluations or testing that
						  is considered primarily educational. Such services are those used to identify
						  specific learning disabilities and developmental disabilities in beneficiaries
						  who have no presenting behavioral or psychiatric symptoms which meet the need
						  for mental health treatment evaluation. This type of evaluation and testing is
						  provided by local school systems under applicable state
and federal laws and rules. Psychological Evaluation
						  services that are ordered strictly as a result of court-ordered services are
						  not covered unless medical necessity criteria are met. Psychological Evaluation
						  services for employment, disability qualification or legal/court-related
						  purposes are not reimbursable by Medicaid as they are not considered treatment
						  of illness. A Psychological Evaluation report must be completed within fourteen
						  (14) calendar days of the examination, documented, clearly identified as such
						  and signed/dated by the staff completing the evaluation. This service
						  constitutes both face-to-face time administering tests to the beneficiary and
						  time interpreting these test results and preparing the report.
90792
HA, U1
SERVICE: Psychiatric Diagnostic Assessment -
						  Initial
DEFINITION:
A direct face-to-face service
						  contact occurring between the physician or the Adult Psychiatric Mental Health
						  Advanced Nurse Practitioner/Family Psychiatric Mental Health Advanced Nurse
						  Practitioner (PMHNP-BC) and the beneficiary for the purpose of evaluation. The
						  initial Psychiatric Diagnostic Assessment includes a history, mental status and
						  a disposition, and may include communication with family or other sources,
						  ordering and medical interpretation of laboratory or other medical diagnostic
						  studies. (See Section
						  224.000 for requirements.)
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
This service must be billed as 1 per episode.
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS:
* Date of service
* Start and stop times
* Place of service
* Diagnosis (all 5 Axes)
* Diagnostic impression
* Psychiatric assessment
* Functional assessment
* Discharge criteria
* Physician's or Adult Psychiatric Mental Health
						  Advanced Nurse Practitioner's/Family Psychiatric Mental Health Advanced Nurse
						  Practitioner's signature indicating medical necessity/credentials/date of
						  signature
NOTES and COMMENTS:
The initial
						  Psychiatric Diagnostic Assessment can only be provided to a new patient.
Only one (1) Psychiatric Diagnostic Assessment (whether
						  Initial or Continuing Care) is allowed per State Fiscal Year.
90792
U7
SERVICE: Psychiatric Diagnostic Assessment -
						  Initial
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90792
						  with modifier "U7" to claim for sen/ices provided via teiemedicine only.
NOTE:
Teiemedicine POS 99
90792
HA, U2
SERVICE: Psychiatric Diagnostic Assessment -
						  Continuing Care
DEFINITION:
A direct face-to-face service
						  contact occurring between the physician or the Adult Psychiatric Mental Health
						  Advanced Nurse Practitioner/Family Psychiatric Mental Health Advanced Nurse
						  Practitioner (PMHNP-BC) and the beneficiary during an episode of care for the
						  purpose of evaluation. The continuing care Psychiatric Diagnostic Assessment
						  includes a Psychiatric assessment, mental status examination, functional
						  assessment, medications and a
disposition, and may include communication with family
						  or other sources, ordering and medical interpretation of laboratory or other
						  medical diagnostic studies. (See Section
						  224.000 for requirements.)
DAILY MAXIMUIVI OF UNITS THAT MAY BE BILLED:
This service must be billed as 1 per episode.
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS:
* Date of service
* Start and stop times
* Place of service
* Diagnosis (all 5 Axes)
* Psychiatric assessment
* Functional assessment
* Mental status examination
* Medications
* Discharge criteria
* Physician's or Adult Psychiatric Mental Health
						  Advanced Nurse Practitioner's/Family Psychiatric Mental Health Advanced Nurse
						  Practitioner's signature indicating medical necessity/credentials/date of
						  signature
NOTES and COMMENTS:
The continuing care
						  Psychiatric Diagnostic Assessment is for established patients only. It must be
						  performed, at a minimum, at least every 12 months for established
						  patients.
Only one (1) Psychiatric Diagnostic Assessment (whether
						  Initial or Continuing Care) is allowed per State Fiscal Year.
90792
U7, U1
SERVICE: Psychiatric Diagnostic Assessment -
						  Continuing Care:
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90792
						  with modifier "U7, U1" to claim for services provided via telemedicine
						  only.
NOTE:
Telemedicine PCS 99
90885
HA, U2
SERVICE: IVIaster Treatment Plan
DEFINITION:
A developed plan in
						  cooperation with the beneficiary (parent or guardian if the beneficiary is
						  under 18), to deliver specific mental health services to the beneficiary to
						  restore, improve or stabilize the beneficiary's mental health condition. The
						  plan must be based on individualized service needs identified in the completed
						  Mental Health Diagnostic Evaluation. The plan must include goals for the
						  medically necessary treatment of identified problems, symptoms and mental
						  health conditions. The plan must identify individuals or treatment teams
						  responsible for treatment, specific treatment modalities prescribed for the
						  beneficiary, time limitations for sen/ices and documentation of medical
						  necessity by the supervising physician.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 8
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Nursing Facility (32); Skilled Nursing Facility (31);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14);ICF/IID(54)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service (date plan is developed)
* Start and stop times for development of plan
* Place of service
* Diagnosis
* Beneficiary's strengths and needs
* Treatment goal(s) developed in cooperation with and
						  as stated by beneficiary that are related specifically to the beneficiary's
						  strengths and needs
* Measurable objectives
* Treatment modalities - The specific services that
						  will be used to meet the measurable objectives
* Projected schedule for service delivery, including
						  amount, scope and duration
* Credentials of staff who will be providing the
						  services
* Discharge criteria
* Signature/credentials of staff drafting the document
						  and primary
staff who will be delivering or supervising the
						  delivery of the specific services/ date of signature(s)
* Beneficiary's signature (or signature of parent,
						  guardian, or custodian of beneficiaries under the age of 18)/date of
						  signature
* Physician's signature indicating medical
						  necessity/date of signature
NOTES and COMMENTS:
The service formerly
						  coded as T1023 and titled "Assessment and Treatment Plan/Plan of Care" is now
						  incorporated into this service. This service may be billed one (1) time upon
						  entering care and once yearly thereafter. The master treatment plan must be
						  reviewed every ninety (90) calendar days or more frequently if there is
						  documentation of significant acuity changes in clinical status requiring an
						  update/change in the beneficiary's master treatment plan. It is the
						  responsibility of the primary mental health professional to ensure that all
						  paraprofessionals working with the client have a clear understanding and work
						  toward the goals and objectives stated on the treatment plan.
90885
HA
SERVICE: Periodic Review of Master Treatment
						  Plan
DEFINITION:
The periodic review and
						  revision of the master treatment plan, in cooperation with the beneficiary, to
						  determine the beneficiary's progress or lack of progress toward the master
						  treatment plan goals and objectives; the efficacy of the services provided and
						  continued medical necessity of services. This includes a review and revision of
						  the measurable goals and measurable objectives directed at the medically
						  necessary treatment of identified symptoms/mental health condition, individuals
						  or treatment teams responsible for treatment, specific treatment modalities and
						  necessary accommodations that will be provided to the beneficiary, time
						  limitations for services and the medical necessity of continued services.
						  Services are to be congruent with the age, strengths, necessary accommodations
						  for any disability and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  2
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 10
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Nursing Facility (32); Skilled Nursing Facility (31);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14);ICF/IID(54)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
Completed by the primary MHP (If not, then must have a
						  rationale for another MHP completing the documentation and only with input from
						  the primary MHP.)
* Date of service
* Start and stop times for review and revision of
						  plan
* Place of service
* Diagnosis and pertinent interval iiistory
* Beneficiary's updated strengtlis and needs
* Progress/regression with regard to treatment goal(s)
						  as documented in the master treatment plan
* Progress/regression of the measurable objectives as
						  documented in the master treatment plan
* Individualized rationale to support the medical
						  necessity of continued services
* Updated schedule for service delivery, including
						  amount, scope and duration
* Credentials of staff who will be providing the
						  services
* Modifications to discharge criteria
* Signature/credentials of staff drafting the document
						  and primary staff who will be delivering or supervising the delivery of the
						  specific services/date of signature(s)
* Beneficiary's signature (or signature of parent,
						  guardian or custodian of beneficiaries under the age of 18)/date of
						  signature(s)
* Physician's signature indicating continued medical
						  necessity/date of signature
NOTES and COMMENTS:
This service must be
						  provided every ninety (90) days or more frequently if there is documentation of
						  significant change in acuity or change in clinical status requiring an
						  update/change in the beneficiary's master treatment plan. If progress is not
						  documented, then modifications should be made in the master treatment plan or
						  rationale why continuing to provide the same type and amount of services is
						  expected to achieve progress/outcome. It is the responsibility of the primary
						  mental health professional to ensure that all paraprofessionals working with
						  the client have a clear understanding and work toward the goals and objectives
						  stated on the treatment plan.
90885
HA, U1
Periodic Review of Master Treatment
						  Plan
Apply the above description.
ADDITIONAL INFORMATION:
Use code 90885
						  with modifier "U1" to claim for this service when provided by a
						  non-physician.
90887
HA, U2
SERVICE: Interpretation of
						  Diagnosis
DEFINITION:
A face-to-face therapeutic
						  intervention provided to a beneficiary in which the
						  results/implications/diagnoses from a mental health diagnosis evaluation or a
						  psychological evaluation are explained by the professional who administered the
						  evaluation. Services are to be congruent with the age, strengths, necessary
						  accommodations and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 16
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Nursing Facility (32); Skilled Nursing Facility (31);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14); ICF/IID (54); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Start and stop times of face-to-face encounter with
						  beneficiary and/or parents or guardian
* Date of service
* Place of service
* Participants present and relationship to
						  beneficiary
* Diagnosis
* Rationale for and intervention used that must
						  coincide with the master treatment plan or proposed master treatment plan or
						  recommendations
* Participant response and feedback
* Any changes or revision to the master treatment plan,
						  diagnosis or medication(s)
* Staff signature/credentials/date of
						  signature(s)
NOTES AND COMMENTS:
For beneficiaries
						  under the age of 18, the time may be spent face-to-face with the beneficiary,
						  the beneficiary and the parent(s) or guardian(s) or alone with the parent(s) or
						  guardian(s). For beneficiaries over the age of 18, the time may be spent
						  face-to-face with the beneficiary and the spouse, legal guardian or significant
						  other.
90887
U3, U7
Interpretation of Diagnosis
Use above definition and requirements
ADDITIONAL INFORMATION:
Use code 90887
						  with modifier "U3, U7" to claim for services provided via telemedicine
						  only.
NOTE:
Telemedicine PCS 99
H0004
HA
SERVICE: Individual Psychotherapy
DEFINITION:
Face-to-face treatment
						  provided by a licensed mental health professional on an individual basis.
						  Services consist of structured sessions that work toward achieving mutually
						  defined goals as documented in the master treatment plan. Services are to be
						  congruent with the age, strengths, needed accommodations necessary for any
						  disability and cultural framework of the beneficiary and his/her family. The
						  treatment service must reduce or alleviate identified symptoms, maintain or
						  improve level of functioning or prevent deterioration.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 48
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Nursing Facility (32); Skilled Nursing Facility
						  (31); ICF/IID (54); Telemedicine (99)
AGE GROUP(S):
U21, but not for
						  beneficiaries under the age of 3 except in documented exceptional cases
REQUIRED DOCUMENTATION
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of face-to-face encounter with
						  beneficiary
* Place of service
* Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale and description of the intervention used
						  that must coincide with the master treatment plan
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Any revisions indicated for the master treatment
						  plan, diagnosis or medication(s)
* Plan for next individual therapy session, including
						  any homework assignments and/or advanced psychiatric directive
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Services provided must
						  be congruent with the objectives and interventions articulated on the most
						  recent treatment plan. Services must be consistent with established behavioral
						  healthcare standards. Individual Psychotherapy is not permitted with
						  beneficiaries who do not have the cognitive ability to benefit from the
						  service.
H0004
Individual Psychotherapy
Use above definition and requirements.
ADDITONAL INFORMATION:
Use code H0004 with
						  no modifier to claim for services provided to beneficiaries ages 21 and
						  over.
H0004
U7
Individual Psychotherapy
Use above definition and requirements.
ADDITIONAL INFORMATION:
Use code H0004
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine POS 99
90846
HA, U3
SERVICE: Marital/Family Psychotherapy -
						  Beneficiary is not present
DEFINITION:
Face-to-face treatment
						  provided to more than one member of a family simultaneously in the same session
						  or treatment with an individual family member (i.e., spouse or single parent)
						  that is
specifically related to achieving goals identified on
						  the beneficiary's master treatment plan. The identified beneficiary is not
						  present for this service. Services are to be congruent with the age, strengths,
						  needed accommodations for any disability and cultural framework of the
						  beneficiary and his/her family. These services identify and address
						  marital/family dynamics and improve/strengthen marital/family interactions and
						  functioning in relationship to the beneficiary, the beneficiary's condition and
						  the condition's impact on the marital/family relationship.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
6
REQUIRES PRIOR AUTHORIZATION
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual encounter with
						  spouse/family
* Place of service
* Participants present
* Nature of relationship with beneficiary
* Rationale for excluding the identified
						  beneficiary
* Diagnosis and pertinent interval history
* Rationale for and intervention used that must
						  coincide with the master treatment plan and improve the impact the
						  beneficiary's condition has on the spouse/family and/or improve marital/family
						  interactions between the beneficiary and the spouse/family
* Spouse/family response to intervention that includes
						  current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for next session, including any homework
						  assignments and/or crisis plans
* HIPPA-compliant release of information forms,
						  completed, signed and dated
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Information to support
						  the appropriateness of excluding the identified beneficiary must be documented
						  in the service note and medical record. Natural supports may be included in
						  these sessions when the nature of the relationship with the beneficiary and
						  that support's expected role in attaining treatment goals is documented. Only
						  one beneficiary per family per therapy session may be billed.
90846
Marital/Family Psychotherapy - Beneficiary is not
						  present
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90846
						  with no modifier to claim for services provided to beneficiaries ages 21 and
						  over.
90846
U7
Marital/Family Psychotherapy - Beneficiary is not
						  present
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90846
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine PCS 99
90847
HA, U3
SERVICE: Marital/Family Psychotherapy -
						  Beneficiary is present
DEFINITION:
Face-to-face treatment
						  provided to more than one member of a family simultaneously in the same session
						  or treatment with an individual family member (i.e., spouse or single parent)
						  that is specifically related to achieving goals identified on the beneficiary's
						  master treatment plan. The identified beneficiary must be present for this
						  service. Services are to be congruent with the age, strengths, needed
						  accommodations for disability and cultural framework of the beneficiary and
						  his/her family. These services are to be ufilized to identify and address
						  marital/family dynamics and improve/strengthen marital/family interactions and
						  functioning in relationship to the beneficiary, the beneficiary's condition and
						  the condition's impact on the marital/family relationship.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 48
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for addifional
						  requirements):
* Date of service
* Start and stop times of actual encounter with
						  beneficiary and spouse/family
* Place of service
* Participants present and relationship to
						  beneficiary
* Diagnosis and pertinent interval history
* Brief mental status of beneficiary and observations
						  of beneficiary with spouse/family
* Rationale for and description of intervention used
						  that must coincide with the master treatment plan and improve the impact the
						  beneficiary's condition has on the spouse/family and/or improve marital/family
						  interactions between the beneficiary and the spouse/family
* Beneficiary and spouse/family's response to
						  intervention that includes current progress or regression and prognosis
* Any ciianges indicated for the master treatment plan,
						  diagnosis or medication{s)
* Plan for next session, including any homework
						  assignments and/or crisis plans
* Staff signature/credentials/date of signature
* HIPAA-compiiant release of Information, completed,
						  signed and dated
NOTES and COMMENTS:
Natural supports may
						  be included in these sessions if justified in service documentation and if
						  supported in the master treatment plan. Only one beneficiary per family per
						  therapy session may be billed.
ADDITIONAL INFORMATION:
Use code 90847
						  with modifiers "HA, U3" to claim for services provided to beneficiaries under
						  age 21.
90847
Marital/Family Psychotherapy - Beneficiary is
						  present
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90847
						  with no modifier to claim for services provided to beneficiaries ages 21 and
						  over.
90847
U7
Marital/Family Psychotherapy - Beneficiary is
						  present
Use the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90847
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine POS 99
92507
HA
Individual Outpatient - Speech Therapy, Speech
						  Language Pathologist
Scheduled individual outpatient care provided by a
						  licensed speech pathologist supervised by a physician to a Medicaid-eligible
						  beneficiary for the purpose of treatment and remediation of a communicative
						  disorder deemed medically necessary. See the Occupational, Physical and Speech
						  Therapy Program Provider Manual for specifics of the speech therapy
						  services.
92507
HA, UB
Individual Outpatient - Speech Therapy, Speech
						  Language Pathologist Assistant
Scheduled individual outpatient care provided by a
						  licensed speech pathologist assistant supervised by a qualified speech language
						  pathologist to a Medicaid-eligible beneficiary for the purpose of treatment and
						  remediation of a communicative disorder deemed medically necessary. See the
						  Occupational, Physical and Speech Therapy Program Provider Manual for specifics
						  of the speech therapy services.
92508
HA
Group Outpatient - Speech Therapy, Speech
						  Language Pathologist
Contact between a group of Medicaid-eligible
						  beneficiaries and a speech pathologist for the purpose of speech therapy and
						  remediation.
See the Occupational, Physical and Speech Therapy
						  Provider IVIanual for specifics of the speech therapy services.
92508
HA, UB
Group Outpatient - Speech Therapy, Speech
						  Language Pathologist
Assistant
Contact between a group of iVledicaid-eligible
						  beneficiaries and a speech pathologist assistant for the purpose of speech
						  therapy and remediation. See the Occupational, Physical and Speech Therapy
						  Provider Manual for specifics of the speech therapy services.
90853
HA, U1
SERVICE: Group Outpatient - Group
						  Psychotherapy
DEFINITION:
Face-to-face interventions
						  provided to a group of beneficiaries on a regularly scheduled basis to improve
						  behavioral or cognitive problems which either cause or exacerbate mental
						  illness. The professional uses the emotional interactions of the group's
						  members to assist them in implementing each beneficiary's master treatment
						  plan. Services are to be congruent with the age, strengths, needed
						  accommodation for any disability and cultural framework of the beneficiary and
						  his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension:
100
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14)
AGE GROUP(S):
Ages 4 - 20; Under age 4 by
						  prior authorized medically needy exception
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual group encounter that
						  includes identified beneficiary
* Place of service
* Number of participants
* Diagnosis
* Focus of group
* Brief mental status and observations
* Rationale for group intervention and intervention
						  used that must coincide with master treatment plan
* Beneficiary's response to the group intervention that
						  includes current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for next group session, including any homework
						  assignments
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
This does NOT include
						  psyciiosocial groups. Beneficiaries eligible for Group Outpatient - Group
						  Psychotherapy must demonstrate the ability to benefit from experiences shared
						  by others, the ability to participate in a group dynamic process while
						  respecting the others' rights to confidentiality and must be able to integrate
						  feedback received from other group members. For groups of beneficiaries aged 18
						  and over, the minimum number that must be served in a specified group is 2. The
						  maximum that may be served in a specified group is 12. For groups of
						  beneficiaries under 18 years of age, the minimum number that must be served in
						  a specified group is 2. The maximum that may be served in a specified group is
						  10. A beneficiary must be 4 years of age to receive group therapy. Group
						  treatment must be age and developmentally appropriate (i.e., 16 year olds and 4
						  year olds must not be treated in the same group). Providers may bill for
						  services only at times during which beneficiaries participate in group
						  activities.
90853
Group Outpatient - Group
						  Psychotherapy
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90853
						  with no modifier to claim for services provided to beneficiaries ages 21 and
						  over.
H2012
HA
SERVICE: Therapeutic Day/Acute Day
						  Treatment
DEFINITION:
Short-term daily array of
						  continuous, highly-structured, intensive outpatient services provided by a
						  mental health professional. These services are for beneficiaries experiencing
						  acute psychiatric symptoms that may result in the beneficiary being in imminent
						  danger of psychiatric hospitalization and are designed to stabilize the acute
						  symptoms. These direct therapy and medical services are intended to be an
						  alternative to inpatient psychiatric care and are expected to reasonably
						  improve or maintain the beneficiary's condition and functional level to prevent
						  hospitalization and assist with assimilation to his/her community after an
						  inpatient psychiatric stay of any length. These services are to be provided by
						  a team consisting of mental health clinicians, paraprofessionals and nurses,
						  with physician oversight and availability. The team composition may vary
						  depending on clinical and programmatic needs but must at a minimum include a
						  licensed mental health clinician and physician who provide services and
						  oversight. Services are to be congruent with the age, strengths, needed
						  accommodation for any disability and cultural framework of the beneficiary and
						  his/her family.
These services must include constant staff supervision
						  of beneficiaries and physician oversight.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  32
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office
						  (11)
STAFF to CLIENT RATIO:
1:5 for ages 18 and
						  over; 1:4 for U18
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for
additional requirements):
* Start and stop times of actual program participation
						  by beneficiary
* Place of service
* Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and interventions used that must
						  coincide with the master treatment plan
* Beneficiary's response to the intervention must
						  include current progress or lack of progress toward symptom reduction and
						  attainment of goals
* Rationale for continued acute day service, including
						  necessary changes to diagnosis, master treatment plan or medication(s) and
						  plans to transition to less restrictive services
* Staff signature/credentials
NOTES and COMMENTS:
Providers may bill for
						  services only at times during which beneficiaries participate in program
						  activities. Providers are expected to sign beneficiaries in and out of the
						  program to provide medically necessary treatment therapies. However, in order
						  to be claimed separately, these therapies must be identified on the master
						  treatment plan and serve a treatment purpose which cannot be accomplished
						  within the day treatment setting.
See Section
						  219.110 for additional
						  information.
H2012
UA
Therapeutic Day/Acute Day Treatment
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2012
						  with modifier "UA" to claim for services provided to beneficiaries ages 21 and
						  over.
See Section
						  219.110 for additional
						  information.
H2011
HA
SERVICE: Crisis Intervention
DEFINITION:
Unscheduled, immediate,
						  short-term treatment activities provided to a Medicaid-eligible beneficiary who
						  is experiencing a psychiatric or behavioral crisis. Services are to be
						  congruent with the age, strengths, needed accommodation for any disability, and
						  cultural framework of the beneficiary and his/her family. These services are
						  designed to stabilize the person in crisis, prevent further deterioration and
						  provide immediate indicated treatment in the least restrictive setting. (These
						  activities include evaluating a Medicaid-eligible beneficiary to determine if
						  the need for crisis services is present.)
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Nursing Facility (32); Skilled Nursing Facility (31);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14); ICF/IID (54); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop time of actual encounter with
						  beneficiary and possible collateral contacts with caregivers or informed
						  persons
* Place of service (When 99 is used, specific location
						  and rationale for location must be included)
* Specific persons providing pertinent information in
						  relationship to beneficiary
* Diagnosis and synopsis of events leading up to crisis
						  situation
* Brief mental status and observations
* Utilization of previously established psychiatric
						  advance directive or crisis plan as pertinent to current situation OR rationale
						  for crisis intervention activities utilized
* Beneficiary's response to the intervention that
						  includes current progress or regression and prognosis
* Clear resolution of the current crisis and/or plans
						  for further services
* Development of a clearly defined crisis plan or
						  revision to existing plan
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
A psychiatric or
						  behavioral crisis is defined as an acute situation in which an individual is
						  experiencing a serious mental illness or emotional disturbance to the point
						  that the beneficiary or others are at risk for imminent harm or in which to
						  prevent significant deterioration of the beneficiary's functioning.
H2011
U7
Crisis Intervention
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2011
						  plus modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine PCS 99
Physician:
99201 99202 99203 99204 99212 99213 99214
PCNS& PANP:
HA, UB HA. UB HA, UB HA, UB HA, UB HA, UB HA, UB
SERVICE: Physical Examination - Psychiatrist or
						  Physician
Physical Examination - Psychiatric Mental Health
						  Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner
DEFINITION:
A general multisystem
						  examination based on age and risk factors to determine the state of health of
						  an enrolled RSPMI beneficiary.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension:
12
99201 99202 99203 99204 99212 99213 99214
HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA
ALLOWABLE PLACES OF SERVICE:
Office
						  (11)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Start and stop times of actual encounter with
						  beneficiary
* Date of service
* Place of service
* Identifying information
* Referral reason and rationale for examination
* Presenting problem(s)
* Health history
* Physical examination
* Laboratory and diagnostic procedures ordered
* Health education/counseling
* Identification of risk factors
* Mental status/clinical observations and
						  impressions
* ICD diagnoses
* DSM diagnostic impressions to include all five
						  axes
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Treatment recommendations for findings, medications
						  prescribed and indicated informed consents
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
This service may be
						  billed only by the RSPMI provider. The physician, Psychiatric Mental Health
						  Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner may not bill for an office visit, nursing home visit or any other
						  outpatient medical services procedure for the beneficiary for the same date of
						  sen/ice. Pharmacologic Management may not be billed on the same date of service
						  as Physical Examination, as pharmacologic management would be considered one
						  component of the full physical examination (office visit).
99212 99213 99214
HA, UB HA, UB HA, UB
SERVICE: Pharmacologic Management by Physician
						  (formerly Medication Maintenance by a physician)
DEFINITION:
Provision of service tailored
						  to reduce, stabilize or eliminate psychiatric symptoms by addressing individual
						  goals in the master treatment plan. This service includes evaluation of the
						  medication prescription, administration, monitoring and supervision and
						  informing beneficiaries regarding medication(s) and its potential effects and
						  side effects in order to make informed decisions regarding the prescribed
						  medications. Services must be congruent with the age, strengths, necessary
						  accommodations for any disability and cultural framework of the beneficiary and
						  his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 12
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Sclnool (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Nursing Facility (32); Skilled Nursing Facility
						  (31); ICF/UD (54); Telemedicine (99)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual encounter with
						  beneficiary
* Place of service (When 99 is used for telemedicine,
						  specific locations of the beneficiary and the physician must be
						  included)
* Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and intervention used that must
						  coincide with the master treatment plan
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Revisions indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for follow-up services, including any crisis
						  plans
* If provided by physician that is not a psychiatrist,
						  then any off label uses of medications should include documented consult with
						  the overseeing psychiatrist within 24 hours of the prescription being
						  written
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Applies only to
						  medications prescribed to address targeted symptoms as identified in the master
						  treatment plan.
99212 99213 99214
UB UB UB
Pharmacologic Management
by
Physician
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 99212,
						  99213 or 99214 with UB modifier to claim for services provided to beneficiaries
						  ages 21 and over.
99212 99213 99214
HA, SA HA, SA HA, SA
Pharmacologic Management by Psychiatric Mental
						  Health Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner
Apply the above definition for services provided to
						  beneficiaries ages U21.
99212 99213
SA SA
Pharmacologic Management by Psychiatric Mental
						  Health Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner
99214
SA
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 99212,
						  99213 or 99214 witii SA modifier to claim for sen/ices provided to
						  beneficiaries ages 21 and over.
T1502
SERVICE: Medication Administration by a Licensed
						  Nurse
DEFINITION:
Administration of a
						  physician-prescribed medication to a beneficiary. This includes preparing the
						  beneficiary and medication; actual administration of oral, intramuscular and/or
						  subcutaneous medication; observation of the beneficiary after administration
						  and any possible adverse reactions and returning the medication to its previous
						  storage.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Time of the specific procedure
* Place of service
* Physician's order must be included in medication
						  log
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Applies only to
						  medications prescribed to address targeted symptoms as identified in the master
						  treatment plan. Drugs and biologicals that can be self-administered shall not
						  be in this group unless there is a documented reason the patient cannot
						  self-administer. Non-prescriptions and biologicals purchased by or dispensed to
						  a patient are not covered.
H0034
HA, HQ
SERVICE: Group Outpatient - Pharmacologic
						  Management by a Physician
DEFINITION:
Therapeutic intervention
						  provided to a group of beneficiaries by a licensed physician involving
						  evaluation and maintenance of the Medicaid-eligible beneficiary on a medication
						  regimen with simultaneous supportive psychotherapy in a group setting. This
						  includes evaluating medication prescription; administration, monitoring and
						  supervision and informing beneficiaries regarding medication(s) and its
						  potential effects and side effects. Services are to be congruent with the age,
						  strengths, necessary accommodations for any disability and cultural framework
						  of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Homeless Shelter (04); Assisted Living Facility (13); Group Home (14)
AGE GROUP(S):
Ages 18 and over
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual group encounter that
						  includes identified beneficiary
* Place of service
* Number of participants
* Diagnosis and pertinent interval history
* Focus of group
* Brief mental status and observations
* Rationale for group intervention and intervention
						  used that must coincide with master treatment plan
* Beneficiary's response to the group intervention that
						  includes current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* If provided by physician that is not a psychiatrist,
						  then any off label uses of medications must include documented consultation
						  with the overseeing psychiatrist
* Plan for next group session, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
This service applies
						  only to medications prescribed to address targeted symptoms as identified in
						  the master treatment plan. This does NOT include psychosocial groups in
						  rehabilitative day programs or educational groups. The maximum that may be
						  served in a specified group is ten (10). Providers may bill for services only
						  at times during which beneficiaries participate in this program
						  activity.
36415
HA
SERVICE: Routine Venipuncture for Collection of
						  Specimen
DEFINITION:
The process of drawing a blood
						  sample through venipuncture (i.e., inserting a needle into a vein to draw the
						  specimen with a syringe or vacutainer) or collecting a urine sample by
						  catheterization as ordered by a physician or psychiatrist.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
1, per routine
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 12
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Assisted Living Facility (13); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Time of the specific procedure
* Place of sen/ice (When 99 is used, specific location
						  and rationale for location must be included)
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
This service may be
						  provided only to beneficiaries taking prescribed psychotropic medication or who
						  have a substance abuse diagnosis.
90887
HA
SERVICE: Collateral Intervention, Mental Health
						  Professional
DEFINITION:
A face-to-face contact by a
						  mental health professional with caregivers, family members, other
						  community-based service providers or other participants on behalf of and with
						  the expressed written consent of an identified beneficiary in order to obtain
						  or share relevant information necessary to the enrolled beneficiary's
						  assessment, master treatment plan and/or rehabilitation. The identified
						  beneficiary does not have to be present for this service. Services are to be
						  congruent with the age, strengths, needed accommodations for any disability and
						  cultural framework of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Patient's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Names and relationship to the beneficiary of all
						  persons involved
* Start and stop times of actual encounter with
						  collateral contact
* Place of Service (When 99 is used, specific location
						  and rationale for location must be included)
* Client diagnosis necessitating intervention
* Document how interventions used address goals and
						  objectives from the master treatment plan
* Information gained from collateral contact and how it
						  relates to master treatment plan objectives
* Impact of information received/given on the
						  beneficiary's treatment
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for next contact, if any
* Staff signature/credentials/Date of signature
NOTES and COMMENTS:
The collateral
						  intervention must be identified on the master treatment plan as a medically
						  necessary service. Medicaid WILL NOT pay for incidental or happenstance
						  meetings with individuals. For example, a chance meeting with a beneficiary's
						  adult daughter at the corner store which results in a conversation regarding
						  the well-being of the beneficiary may not be billed as a collateral
						  contact.
Billing for interventions performed by a mental health
						  professional must warrant the need for the higher level of staff licensure.
						  Professional interventions of a type which could be provided by a
						  paraprofessional will require documentation of the reason it was needed.
Contacts between individuals in the employment of RSPMI
						  agencies or facilities are not a billable collateral intervention.
90887
U7
Collateral Intervention, Mental Health
						  Professional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code 90887
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine PCS 99
90887
HA, UB
SERVICE: Collateral Intervention, Mental Health
						  Paraprofessional
DEFINITION:
A face-to-face contact by a
						  mental health paraprofessional with caregivers, family members, other
						  community-based service providers or other participants on behalf of and with
						  the expressed written consent of an identified beneficiary in order to obtain
						  or share relevant infonnation necessary to the enrolled beneficiary's
						  assessment, master treatment plan and/or rehabilitation. Services are to be
						  congruent with the age, strengths, needed accommodation for any disability and
						  cultural framework of the beneficiary and his/her family. The identified
						  beneficiary does not have to be present for this service.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Patient's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements:
* Date of service
* Names and relationship to the beneficiary of all
						  persons involved
* Start and stop times of actual encounter with
						  collateral contact
* Place of Service (When 99 is used, specific location
						  and rationale for location must be included)
* Client diagnosis necessitating intervention
* Document how interventions used address goals and
						  objectives from tlie master treatment plan
* Information gained from collateral contact and how it
						  relates to master treatment plan objectives
* Impact of information received/given on the
						  beneficiary's treatment
* Any changes indicated for the master treatment plan
						  which must be documented and communicated to the supervising MHP for
						  consideration
* Plan for next contact, if any
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Supervision by a
						  Mental Health Professional must be documented in personnel files and addressed
						  in accordance of agency's policies, quality assurance procedures, personnel
						  performance evaluations, reports of supervisors or other equivalent documented
						  method of supervision.
The collateral intervention must be identified on the
						  master treatment plan as a medically necessary service. Medicaid WILL NOT pay
						  for incidental or happenstance meetings with individuals. For example, a chance
						  meeting with a beneficiary's adult daughter at the corner store which results
						  in a conversation regarding the well-being of the beneficiary may not be billed
						  as a collateral contact. Contacts between individuals in the employment of
						  RSPMI agencies or facilities are not a billable collateral intervention.
H2011
HA, U6
SERVICE: Crisis Stabilization Intervention,
						  Mental Health Professional
DEFINITION:
Scheduled face-to-face
						  treatment activities provided to a beneficiary who has recently experienced a
						  psychiatric or behavioral crisis that are expected to further stabilize,
						  prevent deterioration and serve as an alternative to 24-hour inpatient care.
						  Services are to be congruent with the age, strengths, needed accommodation for
						  any disability and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop time of actual encounter with
						  beneficiary
* Place of service (When 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis and pertinent interval iiistory
* Brief mental status and observations
* Utilization of previously established psychiatric
						  advance directive or crisis plan as pertinent to current situation, OR
						  rationale for crisis intervention activities utilized
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for next session, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
A psychiatric or
						  behavioral crisis is defined as an acute situation in which an individual is
						  experiencing a serious mental illness or emotional disturbance to the point
						  that the beneficiary or others are at risk for imminent harm or in which to
						  prevent significant deterioration of the beneficiary's functioning.
H2011
U2
Crisis Stabilization Intervention, Mental Health
						  Professional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2011
						  with modifier "U2" to claim for services provided to beneficiaries ages 21 and
						  over.
H2011
U2, U7
Crisis Stabilization Intervention, Mental Health
						  Professional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2011
						  with modifier "U2, U7" to claim for services provided via telemedicine
						  only.
NOTE:
Telemedicine PCS 99
H2011
HA, U5
SERVICE: Crisis Stabilization Intervention,
						  Mental Health Paraprofessional
DEFINITION:
Scheduled face-to-face
						  treatment activities provided to a beneficiary who has recently experienced a
						  psychiatric or behavioral crisis that are expected to further stabilize,
						  prevent deterioration and serve as an alternative to 24-hour inpatient care.
						  Services are to be congruent with the age, strengths, needed accommodation for
						  any disability and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop time of actual encounter with
						  beneficiary
* Place of service (When 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis and pertinent interval history
* Behavioral observations
* Consult with MHP or physician regarding events that
						  necessitated this sen/ice and the review of the outcome of the
						  intervention
* Intervention used must coincide with the master
						  treatment plan, psychiatric advance directive or crisis plan which must be
						  documented and communicated to the supervising MHP
* Beneficiary's response to intervention that includes
						  current progress or regression
* Plan for next session, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
A psychiatric or
						  behavioral crisis is defined as an acute situation in which an individual is
						  experiencing a serious mental illness or emotional disturbance to the point
						  that the beneficiary or others are at risk for imminent harm or in which to
						  prevent significant deterioration of the beneficiary's functioning.
Supervision by a Mental Health Professional must be
						  documented and addressed in personnel files in accordance with the agency's
						  policies, quality assurance procedures, personnel performance evaluations,
						  reports of supervisors or other equivalent documented method of
						  supervision.
H2011
U1
Crisis Stabilization Intervention, Mental Health
						  Paraprofessional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2011
						  with modifier "U1" to claim for services provided to beneficiaries ages 21 and
						  over.
H2015
HA, U5
SERVICE: Intervention, Mental Health Professional
						  (formerly On-Site and Off-Site interventions, MHP)
DEFINITION:
Face-to-face medically
						  necessary treatment activities provided to a beneficiary consisting of specific
						  therapeutic interventions as prescribed on the master treatment plan to
						  re-direct a beneficiary from a psychiatric or behavioral regression or to
						  improve the beneficiary's progress toward specific goal(s) and outcomes. These
						  activities may be either scheduled or unscheduled as the goal warrants.
						  Services are to be congruent with the age, strengths, necessary accommodations
						  for any disability and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Start and stop times of actual encounter witin
						  beneficiary
* Date of service
* Place of service, (When 99 is used, specific location
						  and rationale for location must be included)
* Client diagnosis necessitating intervention
* Brief mental status and observations
* Document how interventions used address goals and
						  objectives from the master treatment plan
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis or medication(s)
* Plan for next intervention, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
Interventions of a
						  type that could be performed by a paraprofessional may not be billed at a
						  mental health professional rate unless the medical necessity for higher level
						  staff is clearly documented.
H2015
U6
Intervention, Mental Health
						  Professional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2015
						  with modifier "U6" to claim for services provided to beneficiaries ages 21 and
						  over.
H2015
U7
Intervention, Mental Health
						  Professional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2015
						  with modifier "U7" to claim for services provided via telemedicine only.
NOTE:
Telemedicine PCS 99
H2015
HA, U1
SERVICE: Intervention, Mental Health
						  Paraprofessional (formerly On-Site and Off-Site Intervention, Mental Health
						  Paraprofessional)
DEFINITION:
Face-to-face, medically
						  necessary treatment activities provided to a beneficiary consisting of specific
						  therapeutic interventions prescribed on the master treatment plan, which are
						  expected to accomplish a specific goal or objective listed on the master
						  treatment plan. These activities may be either scheduled or unscheduled as the
						  goal or objective warrants. Services are to be congruent with the age,
						  strengths, necessary accommodations for any disability and cultural framework
						  of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); Other Locations (99)
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual encounter with
						  beneficiary
* Place of service (When 99 is used, specific location
						  and rationale for location must be included)
* Client diagnosis necessitating intervention
* Document how interventions used address goals and
						  objectives from the master treatment plan
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Plan for next intervention, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
Billing for this
						  service does not include time spent transporting the beneficiary to a required
						  service, nor does it include time spent waiting while a beneficiary attends a
						  scheduled or unscheduled appointment. Supervision by a Mental Health
						  Professional must be documented and addressed in personnel files in accordance
						  with the agency's policies, quality assurance procedures, personnel performance
						  evaluations, reports of supervisors or other equivalent documented method of
						  supervision.
H2015
U2
Intervention, Mental Health
						  Paraprofessional
Apply the above definition and requirements.
ADDITIONAL INFORMATION:
Use code H2015
						  with modifier "U2" to claim for services provided to beneficiaries ages 21 and
						  over.
H2017
HA, U1
SERVICE: Rehabilitative Day Service for Persons
						  under Age 18
DEFINITION:
An array of face-to-face
						  rehabilitative day activities providing a preplanned and structured group
						  program for identified beneficiaries that improve emotional and behavioral
						  symptoms of youth diagnosed with childhood disorders, as distinguished from the
						  symptom stabilization function of acute day treatment. These rehabilitative day
						  activities are person- and family-centered, age-appropriate, recovery based,
						  culturally competent, must reasonably accommodate disability and must have
						  measurable outcomes. These activities are designed to assist the beneficiary
						  with compensating for or eliminating functional deficits and interpersonal
						  and/or environmental barriers associated with their mental illness. The intent
						  of these services is to enhance a youth's functioning in the home, school and
						  community with the least amount of ongoing professional intervention. Skills
						  addressed may include: emotional skills, such as
coping with stress, anxiety or anger; behavioral
						  sl[LESS THAN]iiis, such as positive peer interactions, appropriate
						  social/family interactions and managing overt expression of symptoms lil[LESS
						  THAN]e impulsivity and anger; daily living and self-care skills, such as
						  personal care and hygiene and daily structure/use of time; cognitive skills,
						  such as problem solving, developing a positive self-esteem and reframing, money
						  management, community integration and understanding illness, symptoms and the
						  proper use of medications and any similar skills required to implement a
						  beneficiary's master treatment plan.
DAILY MAXIMUM UNITS THAT MAY BE BILLED:
16
						  for ages 0-17
WEEKLY MAXIMUM OF UNITS THAT MAY BE BILLED:
80 for ages 0-17
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  School (03); Assisted Living Facility (13); Group Home (14); Other Locations
						  (99) (churches, community centers, space donated solely for clinical services
						  and appropriate community locations tied to the beneficiary's treatment
						  plan)
MAXIMUM PARAPROFESSIONAL STAFF to CLIENT RATIOS:
1:10 ratio maximum with the provision that client ratio must be reduced
						  when necessary to accommodate significant issues related to acuity,
						  developmental status and clinical needs.
AGEGROUP(S):
U18
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Start and stop times of actual program participation
						  by beneficiary
* Date of service
* Place of service
* Client diagnosis necessitating rehabilitative day
						  activities
* Behavioral observations
* Document how rehabilitative day activities used
						  address goals and objectives from the master treatment plan
* Beneficiary's participation and response to the
						  rehabilitative day activities
* Staff signature/credentials
* Supervising staff signature/credentials/date of
						  signature(s)
* A weekly summary, signed by a Mental Health
						  Professional (the supervising MHP, if applicable), describing rehabilitative
						  day activities provided and the beneficiary's progress or lack of progress in
						  achieving the treatment goal(s) and established outcomes to be
						  accomplished
NOTES and COMMENTS:
Providers may bill for
						  services only at times during which beneficiaries participate in program
						  activities. Providers are expected to sign beneficiaries in and out of the
						  program
to provide medically necessary treatment therapies.
						  However, in order to be claimed separately, these therapies must be identified
						  on the master treatment plan and serve a treatment purpose which cannot be
						  accomplished within the day treatment setting.
H2017
Rehabilitative Day Service for Persons Ages
						  18-20
Apply the above definition and requirements (except
						  Staff to Client Ratios, which are outlined below).
ADDITIONAL INFORMATION:
Use code H2017
						  with no modifier to claim for services provided to beneficiaries for ages
						  18-20.
DAILY MAXIMUM UNITS THAT MAY BE BILLED:
						  24
WEEKLY MAXIMUM OF UNITS THAT MAY BE BILLED:
120
MAXIMUM PARAPROFESSIONAL STAFF to CLIENT RATIOS:
1:15 ratio maximum with the provision that client ratio must be reduced
						  when necessary to accommodate significant issues related to acuity,
						  developmental status and clinical needs.
H2017
SERVICE: Adult Rehabilitative Day
						  Service
DEFINITION:
An array of face-to-face
						  rehabilitative day activities providing a preplanned and structured group
						  program for identified beneficiaries that aimed at long-term recovery and
						  maximization of self-sufficiency, as distinguished from the symptom
						  stabilization function of acute day treatment. These rehabilitative day
						  activities are person- and family-centered, recovery-based, culturally
						  competent, provide needed accommodation for any disability and must have
						  measurable outcomes. These activities assist the beneficiary with compensating
						  for or eliminating functional deficits and interpersonal and/or environmental
						  barriers associated with their chronic mental illness. The intent of these
						  services is to restore the fullest possible integration of the beneficiary as
						  an active and productive member of his/her family, social and work community
						  and/or culture with the least amount of ongoing professional intervention.
						  Skills addressed may include: emotional skills, such as coping with stress,
						  anxiety or anger; behavioral skills, such as proper use of medications,
						  appropriate social interactions and managing overt expression of symptoms like
						  delusions or hallucinations; daily living and self-care skills, such as
						  personal care and hygiene, money management and daily structure/use of time;
						  cognitive skills, such as problem solving, understanding illness and symptoms
						  and reframing; community integration skills and any similar skills required to
						  implement a beneficiary's master treatment plan.
DAILY MAXIMUM UNITS THAT MAY BE BILLED:
						  24
WEEKLY MAXIMUM OF UNITS THAT MAY BE BILLED:
120
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Assisted Living Facility (13); Group Home (14); Other Locations (99) (churches,
						  community centers, space donated solely for clinical services and appropriate
						  community locations tied to the beneficiary's treatment plan)
MAXIMUM PARAPROFESSIONAL STAFF to CLIENT RATIOS:
1:15
ratio maximum with the provision that client ratio must
						  be reduced when necessary to accommodate significant issues related to acuity,
						  developmental status and clinical needs.
AGE GROUP(S):
Ages 21 and over
DOCUMENTATION REQUIREMENTS
(See Section
						  226.200 for additional
						  requirements):
* Date of service
* Start and stop times of actual program participation
						  by beneficiary
* Place of service
* Client diagnosis necessitating rehabilitative day
						  activities
* Behavioral observations
* Document how rehabilitative day activities used
						  address goals and objectives from the master treatment plan
* Beneficiary's participation and response to the
						  rehabilitative day activities
* Staff signature/credentials
* Supervising staff signature/credentials/date of
						  signature(s)
* A weekly summary, signed by a Mental Health
						  Professional (the supervising MHP, if applicable), describing rehabilitative
						  day activities provided and the beneficiary's progress or lack of progress in
						  achieving the treatment goal(s) and established outcomes to be accomplished
						  through participation in rehabilitative day service.
NOTES and COMMENTS:
Rehabilitative Day
						  services do NOT include vocational services and training, academic education,
						  personal care or home health services, and purely recreational activities and
						  may NOT be used to supplant services which may be obtained or are required to
						  be provided by other means. Providers may bill for services only at times
						  during which beneficiaries participate in program activities. Providers are
						  expected to sign beneficiaries in and out of the program to provide medically
						  necessary treatment therapies. However, in order to be claimed separately,
						  these therapies must be identified on the master treatment plan and serve a
						  treatment purpose which cannot be accomplished within the day treatment
						  setting.