Behavioral Health CORE Fee Schedule Effective June 1, 2016

Transcript

1 Service Description CPT/ HCPCS Code MOD 1 MOD 2 Modifier Description Interactive Complexity add-on code U1 Diagnostic Assessment (no medical) U2 Diagnostic Assessment (no medical) U3 Diagnostic Assessment (no medical) U2 GT Via interactive Diagnostic Assessment (no medical) U3 GT Via interactive level 3 Diagnostic Assessment (medical) U1 Diagnostic Assessment (medical) U2 Diagnostic Assessment (medical) U1 GT Via interactive Diagnostic Assessment (medical) U2 GT Via interactive Individual Outpatient Services (30 Individual Outpatient Services (30 Individual Outpatient Services (30 Individual Outpatient Services (30 Individual Psychotherapy w/ E&M (+30 minute Psychiatric Treatment Individual Psychotherapy w/ E&M- (+30 minute U U U U U U2 Rate Units Increment $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter 1

2 Psychatric Treatment Individual Psychotherapy w/ E&M- (+30 minute Individual Psychotherapy w/ E&M- (+30 minute Individual Outpatient Services (45 Individual Outpatient Services (45 Individual Outpatient Services (45 Individual Outpatient Services (45 Psychatric Treatment Individual Psychotherapy w/ E&M- (+ 45minute Psychatric Treatment Individual Psychotherapy w/ E&M- (+ 45minute Psychatric Treatment Individual Psychotherapy w/ E&M- (+ 45minute Psychatric Treatment Individual Psychotherapy w/ E&M- (+ 45minute U1 GT Via interactive U2 GT Via interactive U U U U U U U1 GT Via interactive U2 GT Via interactive U U U U5 Individual Outpatient Services (60 Individual Outpatient Services (60 Individual Outpatient Services (60 Individual Outpatient Services (60 Crisis Intervention U1 Crisis Intervention U2 Crisis Intervention U3 $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter 2

3 Crisis Intervention U1 Crisis Intervention U2 Crisis Intervention U3 Family Outpatient Services U2 Family Outpatient Services U3 Family Outpatient Services U4 Family Outpatient Services U5 Family Outpatient Services U2 Family Outpatient Services U3 Family Outpatient Services U4 Family Outpatient Services U5 Group Outpatient Services U2 Group Outpatient Services U3 Group Outpatient Services U4 Group Outpatient Services U5 Psychological Testing U2 Psychological Testing U3 Nursing Services U2 Nursing Services U3 Nursing Services U4 Nursing Services U2 Nursing Services U3 $ encounter $ encounter $ encounter $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes $ hour $ hour 3

4 Nursing Services U4 Medication Administration U2 Medication Administration U3 Medication Administration U4 E&M New Patient-10 minutes U1 E&M New Patient-10 minutes U2 E&M New Patient-10 minutes U1 GT Via interactive E&M New Patient- 10 minutes U2 GT Via interactive E&M New Patient- 20 minutes U1 E&M New Patient- 20 minutes U2 E&M New Patient-20 minutes U1 GT Via interactive E&M New Patient- 20 minutes U2 GT Via interactive E&M New Patient-30 minutes U1 E&M New Patient. 30 minutes U2 E&M New Patient- 30 minutes U1 GT Via interactive E&M New Patient-30 minutes U2 GT Via interactive $26.72 Per Contact $20.31 Per Contact $13.92 Per Contact $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter 4

5 E&M New Patient-45 minutes U1 E&M New Patient- 45 minutes U2 E&M New Patient-45 minutes U1 GT Via interactive E&M New Patient-45 minutes U2 GT Via interactive E&M New Patient-60 minutes U1 E&M New Patient-60 minutes U2 E&M New Patient- 60 minutes U1 GT Via interactive E&M New Patient-60 minutes U2 GT Via interactive E&M-Established Patient-5 minutes U1 E&M- Established Patient-5 minutes U2 E&M- Established Patient-5 minutes U1 GT Via interactive E&M- Established Patient-5 minutes U2 GT Via interactive E&M- Established Patient-10 minutes U1 E&M- Established Patient-10 minutes U2 E&M- Established Patient-10 minutes U1 GT Via interactive $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter 5

6 E&M- Established Patient 10 minutes U2 GT Via interactive E&M- Established Patient-15 minutes U1 E&M- Established Patient-15 minutes U2 E&M- Established Patient-15 minutes U1 GT Via interactive E&M- Established Patient-15 minutes U2 GT Via interactive E&M- Established Patient-25 minutes U1 E&M- Established Patient-25 minutes U2 E&M- Established Patient-25 minutes U1 GT Via interactive E&M- Established Patient-25 minutes U2 GT Via interactive E&M- Established Patient-40 minutes U1 E&M- Established Patient-40 minutes U2 E&M- Established Patient-40 minutes U1 GT Via interactive E&M- Established Patient-40 minutes U2 GT Via interactive Group Outpatient Services H0004 U2 HQ Group Outpatient Services H0004 U3 HQ $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ encounter $ 1 encounter $ encounter $ encounter $ encounter $ minutes $ minutes 6

7 Group Outpatient Services H0004 U4 HQ $ minutes Group Outpatient Services H0004 U5 HQ $ minutes Family Outpatient Services H0004 U2 HR Family Outpatient Services H0004 U3 HR Family Outpatient Services H0004 U4 HR Family Outpatient Services H0004 U5 HR Family Outpatient Services H0004 U2 HS Family Outpatient Services H0004 U3 HS Family Outpatient Services H0004 U4 HS Family Outpatient Services H0004 U5 HS Ambulatory Detox H0014 U2 Ambulatory Detox H0014 U3 Ambulatory Detox H0014 U4 SA Intensive Outpatient Program H0015 $ hour Crisis Stabilization Unit H0018 $ Per diem Opioid Maintenance H0020 U2 Opioid Maintenance H0020 U3 Opioid Maintenance H0020 U4 Peer Support-Whole Health and H0025 U3 Wellness Peer Support-Whole Health and H0025 U4 Wellness Peer Support-Whole Health and H0025 U5 Wellness Behavioral Health Assessment H0031 U2 $ encounter $ encounter $ encounter $ minutes 7

8 Behavioral Health Assessment H0031 U3 Behavioral Health Assessment H0031 U4 Behavioral Health Assessment H0031 U5 Service Plan Development H0032 U2 Service Plan Development H0032 U3 Service Plan Development H0032 U4 Service Plan Development H0032 U5 Intensive Family Intervention H0036 U3 Intensive Family Intervention H0036 U4 Intensive Family Intervention H0036 U5 Peer Supports (Group) H0038 U4 HQ Peer Supports (Group) H0038 U5 HQ Peer Supports (Individual) H0038 U4 Peer Supports (Individual) H0038 U5 Assertive Community Treatment H0039 U1 Assertive Community Treatment H0039 U2 Assertive Community Treatment H0039 U3 Assertive Community Treatment H0039 U4 Assertive Community Treatment H0039 U5 Community Support Team H0039 U3 TN Community Support Team H0039 U4 TN Community Support Team H0039 U5 TN $ minutes $ minutes $ hour $ hour $ minutes $ minutes $ minutes $ minutes $ minutes 8

9 Medication Administration H2010 U2 Medication Administration H2010 U3 Medication Administration H2010 U4 Medication Administration H2010 U5 Crisis Intervention H2011 U1 Crisis Intervention H2011 U2 Crisis Intervention H2011 U3 Crisis Intervention H2011 U4 Crisis Intervention H2011 U5 Group Outpatient Services H2014 U4 HQ Group Outpatient Services H2014 U5 HQ Family Outpatient Services H2014 U4 HR Family Outpatient Services H2014 U5 HR Family Outpatient Services H2014 U4 HR Family Outpatient Services H2014 U5 HR Family Outpatient Services H2014 U4 HQ Family Outpatient Services H2014 U5 HQ Community Support Individual H2015 U4 Community Support Individual H2015 U5 Addictive Disease Support Services H2015 U4 HF Addictive Disease Support Services H2015 U5 HF Psychosocial Rehab-Individual (PSR-1) H2017 U4 SA $33.40 Per Contact $25.39 Per Contact $17.40 Per Contact $12.97 Per Contact $ minutes $ minutes $ minutes $ minutes $ minutes $ minutes 9

10 Psychosocial Rehab-Individual (PSR-1) SA H2017 U5 Task Oriented Rehabilitation Services H2025 U4 Task Oriented Rehabilitation Services H2025 U5 Nursing Services T1001 U2 Nursing Services T1001 U3 Nursing Services T1001 U4 Nursing Services T1002 U2 Nursing Services T1002 U3 Nursing Services T1003 U4 Case Management Services T1016 U4 Case Management Services T1016 U5 $ minutes $ minutes 10

11 Modifier U1 U2 U3 U4 U5 HA HE HF HQ HR HS HT TN GT Description Physician/Psychiatrist Psychologist, Physician Assistant, Nurse, Clinical Nurse Specialist, Pharmacist Registered Nurse, Licensed Dietician, Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT) Licensed Practical Nurse (LPN); Licensed Associate Professional Counselor (LAPC); Licensed Master s Social Worker (LMSW); Licensed Associate Marriage and Family Therapy (LAMFT); Certified/Registered Addictions Counselors, Certified Peer Specialist, Trained Paraprofessionals and Certified Psychosocial Rehabilitation Specialist (CPRP) with a Bachelor s degree or higher in the social sciences/helping profession. Trained Paraprofessionals, Certified/Registered Addiction Counselors (CAC-1, RADT), Certified Peer Specialist, Certified Psychosocial Rehabilitation Professionals, and Qualified Medication Aides with at least a high school diploma/equivalent. Child and Adolescent Program Mental Health Program Substance Abuse Program Group Setting Family/Couple with client present Family/Couple without client present Multidisciplinary Team Rural Service Area Via Interactive audio and video telecommunication systems GA033747_PRO_LTR_ENG State Approved WellCare 2016 GA_04_16 GA6PROLTR75525E_Sched 11