Sheet1 by eTH3kKby

VIEWS: 4 PAGES: 15

									Included   Code
Yes        A0120
Yes        A0160

Yes        G0176
Yes        G0177
Yes        G9008
Yes        H0001
Yes        H0002
Yes        H0003
Yes        H0004
Yes        H0005
Yes        H0006
Yes        H0007
Yes        H0009
Yes        H0012
Yes        H0013
Yes        H0015
Yes        H0016
Yes        H0018
Yes        H0019
Yes        H0020
Yes        H0021
Yes        H0022
Yes        H0023
Yes        H0024
Yes        H0025
Yes        H0026
Yes        H0027
Yes        H0028
Yes        H0029
Yes        H0030
Yes        H0031
Yes        H0032
Yes        H0033
Yes        H0034
Yes        H0035
Yes        H0036
Yes        H0038
Yes        H0040
Yes        H0041
Yes        H0042
Yes        H0043
Yes        H0044
Yes        H0045
Yes        H0046
Yes        H0047
Yes        H0048
Yes        H1011
Yes        H2000
Yes        H2001
Yes        H2010
Yes   H2011
Yes   H2012
Yes   H2014
Yes   H2015
Yes   H2017
Yes   H2018
Yes   H2019
Yes   H2020
Yes   H2021
Yes   H2022
Yes   H2023
Yes   H2024
Yes   H2025
Yes   H2026
Yes   H2027
Yes   H2028
Yes   H2029
Yes   H2030
Yes   H2031
Yes   H2032
Yes   H2033
Yes   H2034
Yes   H2035
Yes   H2036
Yes   H2037
Yes   J1230
Yes   M0064
Yes   S0201
Yes   S5100
Yes   S5101
Yes   S5102
Yes   S5145
Yes   S5146
Yes   S5135
Yes   S5165
Yes   S9475
Yes   S9480
Yes   S9484
Yes   S9485
Yes   T1000
Yes   T1002
Yes   T1003
Yes   T1005
Yes   T1006
Yes   T1007
Yes   T1008
Yes   T1011
Yes   T1012
Yes   T1013
Yes   T1016
Yes   T1017
Yes   T1019
Yes   T1020

Yes   T1025

Yes   T1026
Yes   T2010
Yes   T2011
Yes   T2015
Yes   T2017
Yes   T2019

Yes   T2021
Yes   T2039

Yes   T2048




Yes      90801
Yes      90802
Yes      90804

Yes      90805
Yes      90806

Yes      90807
Yes      90808

Yes      90809
Yes      90810

Yes      90811
Yes      90812

Yes      90813
Yes      90814

Yes      90815
Yes      90845
Yes      90846
Yes      90847
Yes      90849
Yes      90853
Yes      90855
Yes      90857
Yes      90862
Yes      90865
Yes      90870
Yes      90871
Yes      90875
Yes      90876
Yes   90880
Yes   90882
Yes   90885
Yes   90887
Yes   90889
Yes   90899
Yes   96100
Yes   96110
Yes   96111
Yes   96115
Yes   96117
Yes   99205
Yes   99213
Yes   99381
Yes   99382
Yes   99383
Yes   99384
Yes   99385
Yes   99386
Yes   99387
Yes   99391
Yes   99392
Yes   99393
Yes   99394
Yes   99395
Yes   99396
Yes   99397
Description
Transportation - van, per trip
Transportation - private vehicle, per mile
Activity therapy, such as music, dance, art or play therapies not for recreation; 45 minutes or more per
session
Training and educational services; 45 minutes or more per session
Physician coordinated care oversight services
Alcohol and/or drug assessment service
Behavioral health screening service
Alcohol and/or drug screening analysis service
Behavioral health individual counseling service
Alcohol and/or drug group counseling service
Alcohol and/or drug case management service
Alcohol and/or drug crisis intervention service (outpatient)
Alcohol and/or drug ambulatory detoxification service
Alcohol and/or drug residential sub acute detoxification service (residential outpatient)
Alcohol and/or drug residential acute detoxification service (residential outpatient)
Alcohol and/or drug intensive outpatient service
Alcohol and/or drug medical/somatic service (intervention in ambulatory setting)
Behavioral health short-term residential service
Behavioral health long-term residential service
Alcohol and/or drug methadone administration and/or service
Alcohol and/or drug training service
Alcohol and/or drug intervention service (planned facilitation)
Alcohol and/or drug outreach service
Behavioral health prevention information dissemination service
Behavioral health prevention education service
Alcohol and/or drug prevention community-based process
Alcohol and/or drug prevention environmental service
Alcohol and/or drug prevention problem identification and referral service
Alcohol and/or drug prevention alternative service
Behavioral health hotline service
Mental health assessment by non-physician
Mental health service plan development by non-physician
Oral medication administration, direct observation
Medication training and support, per 15 minutes
Mental health partial hospitalization treatment, less than 24 hours
Community psychiatric supportive treatment, face to face, per 15 minutes
Self-help/peer service per 15 minutes
Assertive community treatment program, per diem
Foster care, child, non-therapeutic, per diem
Foster care, child, non-therapeutic, per month
Supported housing, per diem
Supported housing, per month
Respite care services, not in the home, per diem
Mental health services, not otherwise specified
Alcohol and/or drug services, not otherwise specified
Alcohol and/or drug testing, collection and handing only, specimens other than blood
Family assessment by licensed behavioral health professional for state defined purposes
Comprehensive multidisciplinary evaluation
Rehabilitation program, per 1/2 day
Comprehensive medication services, per 15 minutes
Crisis intervention service, per 15 min.
Behavioral health day treatment, per hour
Skills training and development, per 15 min.
Comprehensive community support services, per 15 min.
Psychosocial rehabilitation services, per 15 min.
Psychosocial rehabilitation services, per diem
Therapeutic behavioral service, per 15 min.
Therapeutic behavioral service, per diem
Community-based wrap-around services, per 15 min.
Community-based wrap-around services, per diem
Supported employment, per 15 min.
Supported employment, per diem
Ongoing support to maintain employment, per 15 min.
Ongoing support to maintain employment, per diem
Psycho-educational service, per 15 min.
Sexual offender treatment service, per 15 min.
Sexual offender treatment service, per diem
Mental health clubhouse service, per 15 min.
Mental health clubhouse service, per diem.
Activity therapy, per 15 min
Multisystemic therapy for juveniles, per 15 min.
Alcohol and/or drug halfway house services, per diem
Alcohol and/or drug treatment program per hour
Alcohol and/or drug treatment program per diem
Developmental delay, prevention activities, dependent child of client, per 15 min.
Injection, methadone HCL, up to 10 mg.
Brief office visit for the sole purpose of monitoring or changing drug prescriptions
Partial hospitalization services, less than 24 hours, per diem
Day care services, adult, per 15 min.
Day care services, adult, per half day.
Day care services, adult, per diem
Foster care, child, per diem
Foster care, child, per month
Adult companion level I (UB), level II (UA), per 15 min.
Environmental accessibility service, home modification
Ambulatory setting substance abuse treatment or detox services, per diem
Intensive outpatient psychiatric services, per diem
Crisis intervention mental health services, per hour
Crisis intervention mental health services, per diem
Nursing services, per 15 min. (various modifiers)
Nursing services - RN, per 15 min.
Nursing services, LPN, per 15 min.
Respite care level I (UA), level 2 (UB), per 15 min.
Alcohol and/or substance abuse services, family/couple counseling
Alcohol and/or substance abuse services, treatment plan development
Day treatment for individual alcohol and/or substance abuse services
Alcohol and/or substance abuse services, not otherwise specified
Alcohol and/or substance abuse services, skills development
Sign language or oral interpreter for alcohol and/or substance abuse services
Service coordination per 15 min.
Targeted case management
Personal care services, per 15 minutes
Personal care services, per diem
Intensive, extended multidisciplinary services provided in a clinic setting to children with complex needs, per
diem
Intensive, extended multidisciplinary services provided in a clinic setting to children with complex needs, per
hour
Preadmission Screening and Resident Review (PASRR) Level I
Preadmission Screening and Resident Review (PASRR) Level II
Pre-vocational training, per hour, group (HQ)
Community rehabilitation services, per 15 min. 1:1 (U4), 1:2 (U3), 1:3 (U2), 1:4+ (U1)
Supportive employment, individual, per 15 min, group (HQ)
Day habilitation 1:1 (U4), 1:2/3 (U3), 1:4/5 (U2), 1:6+ (U1), QMRP level I (U7), QMRP level II (U8) QMRP
level III (U9) per 15 min.
Environmental accessibility service - vehicle
Behavioral health; long-term care residential with room and board (where stay is typically longer than 30
days), per diem


Common Procedural Terminology IV (CPT-4) Procedure Set
(Additional relevant codes in use)


 Psychiatric diagnostic interview
 Interactive psychiatric diagnostic interview examination
 Individual psychotherapy, insight oriented (outpatient, 20-30 min, face to face)
 Individual psychotherapy, insight oriented with medical evaluations and management services (outpatient,
 20-30 min, face to face)
 Individual psychotherapy, insight oriented (outpatient, 45-50 min, face to face)
 Individual psychotherapy, insight oriented with medical evaluations and management services (outpatient,
 45-50 min, face to face)
 Individual psychotherapy, insight oriented (outpatient, 75-80 min, face to face)
 Individual psychotherapy, insight oriented with medical evaluations and management services (outpatient,
 75-80 min, face to face)
 Individual psychotherapy, interactive (outpatient, 20-30 min, face to face)
 Individual psychotherapy, interactive with medical evaluation and management services (outpatient, 20-30
 min, face to face)
 Individual psychotherapy, interactive (outpatient, 45-50 min, face to face)
 Individual psychotherapy, interactive with medical evaluation and management services (outpatient, 45-50
 min, face to face)
 Individual psychotherapy, interactive (outpatient, 75-80 min, face to face)
 Individual psychotherapy, interactive with medical evaluation and management services (outpatient, 75-80
 min, face to face)
 Medical Psychoanalysis
 Family psychotherapy (without patient present)
 Family psychotherapy (with patient present)
 Multiple family group psychotherapy
 Group psychotherapy (other than multiple family)
 Interactive individual medical psychotherapy
 Interactive group psychotherapy
 Pharmacologic management
 Narcosynthesis
 Electroconvulsive therapy (single seizure)
 Electroconvulsive therapy (multiple seizures, per day)
 Individual psychophysiological therapy (20-30 min)
 Individual psychophysiological therapy (45-50 min)
 Hypnotherapy
 Environment intervention
 Psychiatric evaluation of hospital records, tests, etc.
 Interpretation or explanation of results of psychiatric examinations, etc. to family or other
 Preparation of report of patient's status, history, etc. for physicians, agencies, or insurance
 Unlisted psychiatric service or procedure
 Comprehensive evaluation by psychologist
 Developmental testing, limited, per hour
 Developmental testing, extended, per hour every three years
 Neurobehavioral status exam
 Neurobehavioral testing battery
Comprehensive history and examination with medical decision making of high complexity, new patient
 Office visit, expanded, established patient
Annual medical evaluation, infant, new patient
Annual medical evaluation, early childhood, new patient
Annual medical evaluation, late childhood, new patient
Annual medical evaluation, adolescent, new patient
Annual medical evaluation, age 18 - 39, new patient
Annual medical evaluation, age 40 - 64, new patient
Annual medical evaluation, age 64 and up, new patient
Annual medical evaluation, infant, established patient
Annual medical evaluation, early childhood, established patient
Annual medical evaluation, late childhood, established patient
Annual medical evaluation, adolescent, established patient
Annual medical evaluation, age 18 - 39, established patient
Annual medical evaluation, age 40 - 64, established patient
Annual medical evaluation, age 64 and up, established patient

								
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