Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-065 - Child Health Management Services Provider Manual Update Transmittal #58

Current through Register Vol. 49, No. 6, June, 2024
220.100
Benefit Limits for CHMS Diagnosis and Evaluation Procedures
Diagnosis and evaluation procedures are limited to two (2)
				diagnosis and evaluation encounters per state fiscal year (July 1 through June
				30). If additional diagnosis and evaluation services are required, the CHMS
				provider must request an extension of benefits from the Arkansas Foundation for
				Medical Care, Inc. (AFMC).
262.110
Diagnosis and Evaluation
			 Procedure Codes
The following diagnosis/evaluation procedure codes are limited
				to two (2) diagnosis and evaluation encounters per state fiscal year (July 1
				through June 30). If additional diagnosis and evaluation procedures are
				required, the CHMS provider must request an extension of benefits. Effective
				for claims received on and after
December 5, 2005,
modifiers
				UA and UB must be used instead of modifiers 52 and 22.
Procedure
Codes
90805
90807
90809
92506
92551
92552
92553
92555
92557
92567
92582
92585
92587
92588
96105
96111
96117
99201
99202
99203
99204
99205
Procedure Code
Required Modifier(s)
Description
90801
Diagnostic evaluation/review of records (1 unit = 15
						  minutes), maximum of 3 units; limited to 6 units per state fiscal
						  year
90887
Interpretation of diagnosis (1 unit = 15 minutes),
						  maximum of 3 units; limited to 6 units per state fiscal year
96100
UA, UB
Psychological testing battery (1 unit = 15 minutes),
						  maximum of 4 units; limited to 8 units per state fiscal year
97001
Evaluation for physical therapy (1 unit = 30 minutes),
						  maximum of 4 units per state fiscal year
97003
Evaluation for occupational therapy (1 unit = 30
						  minutes), maximum of 4 units per state fiscal year
97802
Nutrition Screening: Review of recent nutrition
						  history, medical record, current laboratory and anthropometric data and
						  conference with patient, caregiver or other CHMS professional (1 unit = 15
						  minutes). Maximum of 2 units; limited to 4 units per state fiscal
						  year
97802
U1
Nutrition Assessment: Assessment/evaluation of current
						  nutritional status through history of nutrition, activity habits and current
						  laboratory data, weight and growth history and drug profile; determination of
						  nutrition needs; formulation of medical nutrition therapy plan and goals of
						  treatment; a conference will be held with parents and/or other CHMS
						  professionals or a written plan for medical nutrition therapy management will
						  be provided (1 unit = 15 minutes). Maximum of 2 units; limited to 4 units per
						  state fiscal year
97802
U2
Comprehensive Nutrition Assessment:
						  Assessmentyevaluation of current nutritional status through initial history of
						  nutrition, activity and behavioral habits; review of medical records; current
						  laboratory data, weight and growth history, nutrient analysis and current
						  anthropometric data (when available); determination of energy, protein, fat,
						  carbohydrate and macronutrient needs; formulation of medical nutrition therapy
						  plan and goals of treatment. May conference with parent(s)/guardian or
						  caregivers and/or physician for implementation of medical nutrition therapy
						  management or provide a written plan for implementation (1 unit = 15 minutes).
						  Maximum of 4 units; limited to 8 units per state fiscal year
262.120
Treatment Procedure
			 Codes
The following treatment procedures are payable for services
				included in the child's treatment plan. Prior authorization is required for
all
CHMS treatment procedures. See section
				240.000 of this manual for prior
				authorization requirements. Effective for claims received on and after
December 5, 2005,
modifiers UA and UB must be used instead of
				modifiers 52 and 22.
Procedure
Codes
90804
90806
90808
90847
90849
97703
99211
99212
99213
99214
99215
Procedure Code
Required Modifier(s)
Description
T1024
Brief Consultation, on site - A direct service contact
						  by a CHMS professional on-site with a patient for the purpose of: obtaining the
						  full range of needed services; monitoring and supervising the patient's
						  functioning; establishing support for the patient and gathering information
						  relevant to the patient's individual treatment plan.
T1024
U1
Collateral Services, on site - Face-to-face contact
						  on-site by a CHMS professional with other professionals, caregivers or other
						  parties on behalf of an identified patient to obtain or provide relevant
						  information necessary to the patient's assessment, evaluation or
						  treatment.
90846
U4
Family therapy, on-site, for therapy as part of the
						  treatment plan, without the patient present (1 unit = 15 minutes)
90847
U4
Family therapy, on site, for therapy as part of the
						  treatment plan, with the patient present (1 unit = 15 minutes)
97150
Group occupational therapy (1 unit = 15 minutes),
						  maximum of 4 clients per group
Procedure Code
Required Modifier(s)
Description
99361
UA
Treatment Plan - Plan of treatment developed by CHMS
						  professionals and the patient's caregiver(s). Plan must include short- and
						  long-term goals and objectives and include appropriate activities to meet those
						  goals and objectives (1 unit = 15 minutes).
Procedure Code
Required Modifier(s)
Description
H2011
Crisis Management Visit, on site - An unscheduled/
						  unplanned direct service contact on site with the identified patient for the
						  purpose of preventing physical injury, inappropriate behavior or placement in a
						  more restrictive service delivery system (one unit = 15 minutes)
S9470
Nutrition Counseling/Consultation - Conference with
						  parent/guardian and/or PCP to provide results of evaluation, discuss medical
						  nutrition therapy plan and goals of treatment and education. May provide
						  detailed menus for home use and information on sources of special nutrition
						  products (1 unit = 30 minutes)
90853
-
Group Psychotherapy/counseling (1 unit = 5
						  minutes)
92507
-
Individual Speech Session (1 unit = 15
						  minutes)
92507
UB
Individual Speech Therapy by Speech-Language Pathology
						  Assistant (1 unit = 15 minutes)
92508
-
Group Speech Session (1 unit = 15 minutes), maximum of
						  4 clients per group
92508
UB
Group Speech Therapy by Speech-Language Pathology
						  Assistant (1 unit = 15 minutes), maximum of 4 clients per group
97110
-
Individual Physical Therapy (1 unit = 15
						  minutes)
97110
UB
Individual Physical Therapy by Physical Therapy
						  Assistant (1 unit = 15 minutes)
97150
-
Group Physical Therapy (1 unit = 15 minutes), maximum
						  of 4 clients per group
97150
U2
Group Occupational Therapy (1 unit = 15 minutes),
						  maximum of 4 clients per group
97150
U1, UB
Group Occupational Therapy by Occupational Therapy
						  Assistant (1 unit = 15 minutes), maximum of 4 clients per group
97150
UB
Group Physical Therapy by Physical Therapy Assistant (1
						  unit = 15 minutes), maximum of 4 clients per group
97530
-
Individual Occupational Therapy (1 unit = 15
						  minutes)
97530
UB
Individual Occupational Therapy by Occupational Therapy
						  Assistant (1 unit = 15 minutes)
97530 
						  U1
Developmental Motor Activity Services - Individualized
						  activities provided by, or under the direction of, an Early Childhood
						  Developmental Specialist to improve general motor skills by increasing
						  coordination, strength and/or range of motion. Activities will be directed
						  toward accomplishment of a motor goal identified in the patient's
						  individualized treatment plan as authorized by the responsible CHMS physician
						  (1 unit = 15 minutes)
97532 -
Cognitive Development Services - Individualized
						  activities to increase the patient's intellectual development and competency.
						  Activities will be those appropriate to carry out the treatment plan for the
						  patient as authorized by the responsible CHMS physician. Cognitive Development
						  Services will be provided by or under the direction of an Early Childhood
						  Developmental Specialist. Activities will address goals of cognitive and
						  communication skills development: (1 unit = 15 minutes).
97535 
						  UB
Self Care and Social/Emotional Developmental Services -
						  Individualized activities provided by or under the direction of an Early
						  Childhood Developmental Specialist to increase the patient's self-care skills
						  and/or ability to interact with peers or adults in a daily life
						  setting/situation. Activities will be those appropriate to carry out the
						  treatment plan for the patient as authorized by the responsible CHMS physician.
						  (1 unit = 15 minutes).
97803 -
Nutrition follow-up: Reassess recent nutrition history,
						  new anthropometer and laboratory data to evaluate progress toward meeting
						  medical nutritional goals. May include a conference with parent or other CHMS
						  professional (1 unit = 15 minutes).
262.130
CHMS Procedure Codes - Foster
			 Care Program
Refer to section
				202.000 of this manual for
				Arkansas Medicaid Participation Requirements for Providers of Comprehensive
				Health Assessments for Foster Children.
The following procedure codes are to be used for the mandatory
				comprehensive health assessments of children entering the Foster Care Program.
				Claims for these codes must be billed with a type of service (TOS) code "M"
				when filled on paper. These procedures
do not
require prior
				authorization. Effective for claims received on and after
December 5,
				2005,
modifiers UA and UB must be used instead of modifiers 52 and
				22.
Procedure Code
Required Modifier(s)
Description
T1016
Informing (1 unit = 15 minutes), maximum of 4
						  units
T1023
Staffing (1 unit = 15 minutes), maximum of 4
						  units
T1025
Developmental Testing
90801
U1
Diagnostic Interview, includes evaluation and reports
						  (1 unit = 15 minutes), maximum of 8 units
92506
U1
Speech Testing (1 unit = 15 minutes), maximum of 8
						  units
92551
U1
Audio Screen
92567
U1
Tympanometry
95961
UA
Cortical Function Testing
96100
U1, UA
Psychological Testing, 2 or more (1 unit = 15 minutes),
						  maximum of 8 units
96100
UA
Interpretation (1 unit = 15 minutes), maximum of 8
						  units
99173
Visual Screen
99205 99215
U1 U1
High Complex medical exam