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					               Version 7 - 12/05/2011                                                                                            MACSIS Service Eligibility RSC Crosswalk




 RSC will    RSC will Pay
                                                                                                                                                                                                                         SERVICE SUB-              MEDICAID
Pay during for Treatment Procedure Code                        Description                                                Definition                                             SERVICE CATEGORY
                                                                                                                                                                                                                          CATEGORY                  RATES
 Eligibility  Services
                                                                                   Mental health assessment is a clinical evaluation provided by an eligible
                                                                                   individual either at specified times or in response to treatment, or when
                                                                                   significant changes occur. It is a process of gathering information to
                                                                                   assess client needs and functioning in order to determine appropriate
                                                    MH ASSMT-PHYSICIAN (Diagnostic service/treatment based on identification of the presenting problem,                                                               Psychological Clinical
    Yes            Yes            90801                                                                                                                                  Assessment-Accreditation Not Required                                       $210.87
                                                            Assessment)            evaluation of mental status, and formulation of a diagnostic impression.                                                                Interview
                                                                                   The outcome of mental health assessment is to determine the need for
                                                                                   care, and recommend appropriate services/treatment and/or the need
                                                                                   for further assessment. Results of the mental health assessment shall
                                                                                   be shared with the client

                                                                                         Pharmacologic management service is a psychiatric/mental
                                                                                         health/medical intervention used to reduce/stabilize and/or eliminate
                                                            MH PHARM MGMT                psychiatric symptoms with the goal of improved functioning, including                                                         Psychological/Mental
    No             Yes            90862                                                  management and reduction of symptoms. Pharmacologic management                 Diagnosis and Treatment of Impairments                                       $210.87
                                                           (Medication/Somatic)                                                                                                                                         Health Counseling
                                                                                         services should result in well-informed/educated individuals and family
                                                                                         members and in decreased/minimized symptoms and
                                                                                         improved/maintained functioning for individuals receiving the service
                                                                                         Twenty-three hour observation bed means face-to-face evaluation, for up
                                                                                         to twenty-three hours duration under close medical/nursing supervision, of
                                                                                         an individual who presents an unpredictable risk of adverse consequences                                                      Psychological/Mental     Local Board Enter
    No             Yes            99236               23 HOUR OBSERVATION BED                                                                                           Diagnosis and Treatment of Impairments
                                                                                         due to intoxication, withdrawal potential and/or co-existing disorders for                                                     Health Counseling           rate here
                                                                                         the purpose of determining the appropriate treatment and plan for the next
                                                                                         level of care.

                                                                                         Medical Community Residential Treatment - Non Hospital Setting
                                                        MEDICAL COMMUNITY
                                                                                         O.A.C.3793:2-1-08 (U) (includes room and board) Billed per diem; Non-                                                         Psychological/Mental     Local Board Enter
    No             Yes        A0230 - A0239           RESIENTIAL: NON-HOSPITAL                                                                                          Diagnosis and Treatment of Impairments
                                                                                         Medicaid service; non-health care service. See H0018 and A0740 for                                                             Health Counseling           rate here
                                                              SETTING
                                                                                         unbundled billing.

                                                                                         Referral and information service means responding to inquiries from
                                                                                         people, usually by telephone, about services provided by the program or
    No              No        A0510 - A0519          REFERRAL AND INFORMATION            services provided by other health care organizations and contacting
                                                                                         another health care organization provider in order to obtain services for an
                                                                                         individual. This service does not include “hotline services”.


                                                                                         Consultation means assisting an individual in accessing alcohol and other
                                                                                         drug services or other necessary services generally occurring prior to
                                                                                         admission. Consultation is a cross-system or within-system collaboration on                                                 Psychological Feedback     Local Board Enter
    No             Yes        A0560 - A0569                  CONSULTATION                                                                                                Assessment-Accreditation Not Required
                                                                                         behalf of an individual to assist in assessment and triage decisions. This                                                   Session/Consultation          rate here
                                                                                         process may include family members or other significant persons. Within-
                                                                                         system does not include consultation within a treatment agency.

    No             No         A0610     -   A0619    INFORMATION DISSEMINATION
    No             No         A0620     -   A0629      EDUCATION (PREVENTION)
    No             No         A0630     -   A0639       COMM. BASED PROCESS
    No             No         A0640     -   A0649          ENVIRONMENTAL
    No             No         A0650     -   A0659        PROBLEM ID AND REF
    No             No         A0660     -   A0669           ALTERNATIVES
  Yes, In        Yes, In                                                                 Room and Board means room and board for clients enrolled in
conjunction    conjunction                                                                                                                                                                                                                      Local Board Enter
                              A0740 - A0749                ROOM AND BOARD                treatment for alcohol and/or drug abuse. It does not include clinical or                   MAINTENANCE                     Maintenance - OTHER
   with           with                                                                                                                                                                                                                              rate here
                                                                                         therapeutic services. Billed per diem.
Treatment      Treatment
                                                                                         Transportation-Accreditation Not Required means the provision of any
                                                                                         defined Transportation-Accreditation Not Required service cost for                                                              Transportation-
Yes - follow   Yes - follow                           Transportation-Accreditation Not                                                                                                                                                           Local Board Enter
                              A0750 - A0759                                              clients and/or participants of the program paid for or reimbursed by           Transportation-Accreditation Not Required   Accreditation Not Required -
RSC Policy     RSC Policy                                        Required                                                                                                                                                                            rate here
                                                                                         program. Must use Pseudo UCI for MACSIS billing. Billed as cost per                                                                  OTHER
                                                                                         month.

                                                                                         (Non-Medicaid; health care service) Urinalysis means the testing of an
                                                                                                                                                                                                                     Non-Medical Diagnostic     Local Board Enter
    Yes            Yes        A0780 - A0789              URINE DIP SCREENING             individual’s urine specimen to detect the presence of alcohol and other         Assessment-Accreditation Not Required
                                                                                                                                                                                                                       Service - OTHER              rate here
                                                                                         drugs. Urinalysis includes laboratory testing and/or urine dip screen.

                                                                                  Medical Community Residential Treatment - Hospital Setting
                                                         MEDICAL COMMUNITY        O.A.C.3793:2-1-08 (U) (includes room and board) Billed per diem; Non-                                                                Psychological/Mental     Local Board Enter
    No             Yes            A1210                                                                                                                                 Diagnosis and Treatment of Impairments
                                                    RESIDENTIAL: HOSPITAL SETTING Medicaid service; nonhealth care service. See H0017 and A0740 for                                                                     Health Counseling           rate here
                                                                                  unbundled billing.




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                                                                Non-medical Community Residential Treatment means a twenty-four-
                                                                hour rehabilitation facility, without twenty-four-hour-per-day
                                                                medical/nursing monitoring, where a planned program of
                                                                professionally directed evaluation, care and treatment for the
                                                                restoration of functioning for persons with alcohol and other drug
Yes - TIME                              NON-MEDICAL COMMUNITY                                                                                                                                   Psychological/Mental   Local Board Enter
                 Yes            A1220                           problems and/or addiction occurs. O.A.C.3793:2-1-08 (V) (includes                   Diagnosis and Treatment of Impairments
 LIMITED                                RESIDENTIAL TREATMENT                                                                                                                                    Health Counseling         rate here
                                                                room and board) Billed per diem; Non-Medicaid service; non-health care
                                                                service. See H0019 and A0740 for unbundled billing. THIS IS TIME
                                                                LIMITED TO NO MORE THAN 7-10 DAYS with 10 days MAX for
                                                                assessment and processing towards an approved IPE (plan for
                                                                services) prior to providing service.
                                                                Assessment service means the evaluation of an individual to determine the
                                                                nature and extent of his/her abuse, misuse and/or addiction to alcohol
   Yes           Yes            H0001        ASSESSMENT                                                                                             Assessment-Accreditation Not Required      Psychological Testing        $96.24
                                                                and/or other drugs. Assessment services shall consist of time limited,
                                                                structured, face-to-face sessions.
                                                                Laboratory Analysis (Medicaid service, health care service) Former                                                              Lab Testing, include
   Yes           Yes            H0003   LABORATORY URINALYSIS   MACSIS code was A0160. Billed per screen regardless of number of                    Assessment-Accreditation Not Required          cardiovascular/          $60.00
                                                                panels.                                                                                                                          electrodiagnostic1
                                                                Individual Counseling involves a one-to-one, face-to-face encounter
                                                                between a client and a counselor. Individual counseling means the
                                                                utilization of special skills to assist an individual in achieving treatment
                                                                objectives through the exploration of alcohol and other drug problems
                                                                and/or addiction and their ramifications, including an examination of
                                                                attitudes and feelings, consideration of alternative solutions and
                                                                decision making and/or discussing didactic materials with regard to                                                                                      AOD-$21.82
                                                                                                                                                                                                Psychological/Mental
   No            Yes            H0004     BH COUNS/THERAPY      alcohol and other drug-related problems. Individual counseling services             Diagnosis and Treatment of Impairments                             MH-Group-$9.87
                                                                                                                                                                                                 Health Counseling
                                                                can be provided at a program site certified by the Ohio Department of                                                                                   MH-Ind-$22.50
                                                                Alcohol and Drug Addiction Services or in the client’s natural
                                                                environment. O.A.C.3793:2-1-08 (N) BH counseling and Therapy was
                                                                assigned October 2002 effective for January 1, 2003. Code must be
                                                                used with HF (substance abuse) in modifier one position to be payable
                                                                by AOD. Billed in 15-minute increments; Medicaid service; health care
                                                                service. Former MACSIS code was A0120.


                                                                Group counseling means the utilization of special skills to assist two or
                                                                more individuals in achieving treatment objectives. This occurs through the
                                                                exploration of alcohol and other drug problems and/or addiction and their
                                                                ramifications, including an examination of attitudes and feelings,
                                                                consideration of alternative solutions and decision making and/or
                                                                discussing information related to alcohol and other drug related problems.
                                                                Group counseling services shall be provided at a program site certified by
                                                                the Ohio department of alcohol and drug addiction services or in the
                                                                client’s natural environment. The client to counselor ratio for group
                                                                                                                                                                                                Psychological/Mental
   No            Yes            H0005     GROUP COUNSELING      counseling shall not be greater than twelve to one. Group counseling shall          Diagnosis and Treatment of Impairments                                  $9.52
                                                                                                                                                                                                 Health Counseling
                                                                be documented per paragraphs (M) and (N) of rule 3793:2-1-06 of the
                                                                Administrative Code. Group sessions, which focus on helping individuals
                                                                increase awareness and knowledge of the nature, extent and harm of their
                                                                alcohol and drug addiction do not have a client to counselor ratio
                                                                requirement. Such group sessions can consist of lecture, viewing a video or
                                                                a structured discussion session and shall be documented per paragraph
                                                                (O)(1) of rule 3793:2-1-06 of the Administrative Code. The provision of
                                                                this type of group session shall not eliminate the requirement for group
                                                                counseling in outpatient and residential treatment.


                                                                Case management services means those activities provided to assist and
                                                                support individuals in gaining access to needed medical, social, educational
                                                                                                                                                                                             Treatment Service -
   No            Yes            H0006     CASE MANAGEMENT       and other services essential to meeting basic human needs. Case                     Diagnosis and Treatment of Impairments                                  $78.17
                                                                                                                                                                                             OTHER
                                                                management services may include interactions with family members, other
                                                                individuals or entities.

                                                                A crisis intervention service is a face-to-face interaction with a client that is
                                                                in response to a crisis or emergency situation experienced by themselves,
                                                                a family member and/or significant other. It begins with an evaluation of
                                                                what happened during the crisis and the individual’s response or responses
                                                                to it. An individual’s reaction to a crisis can include emotional reactions
                                                                                                                                                                                                Psychological/Mental
   No            Yes            H0007    CRISIS INTERVENTION    (such as fear, anger, guilt, anxiety, grief), mental reactions (such as             Diagnosis and Treatment of Impairments                                 $129.59
                                                                                                                                                                                                 Health Counseling
                                                                difficulty concentrating, confusion, nightmares), physical reactions (such as
                                                                headaches, dizziness, fatigue, stomach problems), and behavioral
                                                                reactions (sleep and appetite problems, isolation, restlessness).
                                                                Information about the individual’s strengths, coping skills, and social
                                                                support networks is also obtained.




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                                                            Acute hospital detoxification services are delivered based on treatment
                                                            protocols for detoxification in a hospital setting and are delivered by
                                                            medical and nursing professionals who provide twenty-four hour medically-
                                                            directed assessment and withdrawal management. Acute hospital
                                     ACUTE HOSPITAL         detoxification services are indicated for individuals whose
No        No            H0009
                                     DETOXIFICATION         intoxication/withdrawal signs and symptoms are sufficiently severe to
                                                            require primary medical and nursing care service and medical
                                                            management. Acute hospital detoxification services are to be delivered
                                                            under a defined set of physician approved policies and physician managed
                                                            procedures and medical protocols.

                                                            Sub-acute detoxification refers to detoxification services provided with
                                                            twenty-four-hour medical monitoring. Services are of brief duration and
                                                            linkage to other formal and informal services shall be made. Sub-acute
                                                            detoxification may be provided in a hospital setting as a step-down service
No        No            H0012   SUB ACUTE DETOXIFICATION
                                                            from acute detoxification, or may be provided in a free-standing setting
                                                            with medical monitoring. This service shall be supervised by a physician,
                                                            under a defined set of policies and procedures, who is licensed by the state
                                                            of Ohio medical board.

                                                            Ambulatory detoxification services means face-to-face interactions with an
                                                            individual who is suffering mild to moderate symptoms of withdrawal, for
                                                            the purpose of alcohol and/or drug detoxification. This service shall be
                                                            supervised by a physician, under a defined set of policies and procedures,
                                                            who is licensed by the state of Ohio medical board. Ambulatory                                                          Psychological/Mental
No       Yes            H0014   AMBULATORY DETOXIFICATION                                                                                  Diagnosis and Treatment of Impairments                              $193.87
                                                            detoxification services shall be provided by an outpatient program that is                                               Health Counseling
                                                            certified by the department of alcohol and drug addiction services.
                                                            Department certified halfway house and residential treatment programs
                                                            that want to provide ambulatory detoxification services need not obtain
                                                            outpatient certification from the department.

                                                            Intensive outpatient service means structured individual and group alcohol
                                                            and drug addiction activities and services that are provided at a certified                                             Psychological/Mental
No       Yes            H0015     INTENSIVE OUTPATIENT                                                                                     Diagnosis and Treatment of Impairments                              $136.90
                                                            treatment program site for a minimum of eight hours per week with                                                        Health Counseling
                                                            services provided at least three days per week.
                                                            Medical/somatic services means medical services, medication
No       Yes            H0016        MEDICAL/SOMATIC        administration services and the dispensing of medications in an alcohol and               MAINTENANCE                   Maintenance - OTHER        $176.28
                                                            other drug treatment program.

                                                            Medical community residential treatment means a twenty-four-hour
                                                            rehabilitation facility, with twenty-four-hour-a-day medical/nursing
                                BEHAVIORAL HEALTH MEDICAL   monitoring, where a planned program of professionally directed evaluation,
     Yes use with                                                                                                                                                                   Psychological/Mental   Local Board Enter
No                      H0017     COMMUNITY RESIDENTIAL     care and treatment for the restoration of functioning for persons with         Diagnosis and Treatment of Impairments
     code T1010                                                                                                                                                                      Health Counseling         rate here
                                       TREATMENT            alcohol and other drug problems and/or addiction occurs. It may be
                                                            affiliated with or located within a hospital, as part of the
                                                            inpatient/residential continuum or may be in a freestanding facility.

                                                            BH Medical Community Residential Treatment - Non Hospital Setting
                                BEHAVIORAL HEALTH MEDICAL
     Yes use with                                           O.A.C.3793:2-1-08 (U). National HCPCS excludes room and board. Bill                                                     Psychological/Mental   Local Board Enter
No                      H0018     COMMUNITY RESIDENTIAL                                                                                    Diagnosis and Treatment of Impairments
     code T1010                                             room and board as A0740. Billed per diem; Non-Medicaid service; non-                                                     Health Counseling         rate here
                                   TREATMENT NON-HOS
                                                            health care service.

                                                            Non-medical community residential treatment means a twenty-four-hour
                                 BEHAVIORAL HEALTH NON-     rehabilitation facility, without twenty-four-hour-per-day medical/nursing
     Yes use with                                                                                                                                                                   Psychological/Mental   Local Board Enter
No                      H0019      MEDICAL COMMUNITY        monitoring, where a planned program of professionally directed evaluation,     Diagnosis and Treatment of Impairments
     code T1010                                                                                                                                                                      Health Counseling         rate here
                                 RESIDENTIAL TREATMENT      care and treatment for the restoration of functioning for persons with
                                                            alcohol and other drug problems and/or addiction occurs.

                                                            Opioid agonist administration means the administration or dispensing of
                                                            opioid agonist to an individual only for the treatment of narcotic addiction
                                                            by an alcohol and other drug treatment program licensed by the
                                                            department of alcohol and drug addiction services as a opioid agonist
     Yes while on                                           program in accordance with section 3793.11 of the Revised Code. Opioid
No                      H0020   METHADONE ADMINISTRATION                                                                                              MAINTENANCE                   Maintenance - OTHER         $16.38
      RSC Plan                                              agonist shall be administered and/or dispensed at a program site which is
                                                            certified as a treatment program by the department of alcohol and drug
                                                            addiction services and is approved by the U.S. food and drug
                                                            administration for the use of opioid agonist in the treatment of narcotic
                                                            addiction.

                                                            Training service (non-prevention) means developing alcohol and/or drug
                                                            service skills of staff and personnel not employed by the agency (e.g.
No        No            H0021           TRAINING
                                                            counselors’/clinicians’ training on counseling techniques and approaches;
                                                            sessions for clinicians on the effect of various types of drugs).




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                                                               Intervention service means those activities that seek to detect alcohol
                                                               and/or other drug problems and addiction and to intervene in such a way
No         No            H0022          INTERVENTION
                                                               as to arrest the progression of such problems. It includes early intervention
                                                               services.
                                                               Outreach service means a planned approach to reach a target population
                                                               within their environment. The purpose of this approach is to prevent and/or
No         No            H0023            OUTREACH
                                                               address issues and problems as they relate to the use/abuse of alcohol or
                                                               drugs.
                                                               Hotline service means a program’s twenty-four hour per day, seven days
                                                               per week capability to respond to telephone calls often anonymous, made
No         No            H0030            BH HOTLINE
                                                               to a program for crisis assistance. The caller may or may not become a
                                                               client of the program.

                                                               Mental health assessment is a clinical evaluation provided by an eligible
                                                               individual either at specified times or in response to treatment, or when
                                                               significant changes occur. It is a process of gathering information to
                                                               assess client needs and functioning in order to determine appropriate
                                                               service/treatment based on identification of the presenting problem,                                                        Psychological Clinical
Yes       Yes            H0031     MH ASSMT-NON PHYSICIAN                                                                                      Assessment-Accreditation Not Required                                    $129.99
                                                               evaluation of mental status, and formulation of a diagnostic impression.                                                         Interview
                                                               The outcome of mental health assessment is to determine the need for
                                                               care, and recommend appropriate services/treatment and/or the need
                                                               for further assessment. Results of the mental health assessment shall
                                                               be shared with the client, by non-physician

                                                               Community psychiatric supportive treatment (CPST) service is a
                                                               rehabilitative service intended to maximize the reduction of symptoms
                                                               of mental illness in order to restore the individual’s functioning to the
                                                               highest level possible. CPST supports the individual’s ability to take
                                                               responsibility for managing his/her mental illness and achieving and                                                     Treatment Service -         Individual-$21.33
No        Yes            H0036      MH COMM PSYCH SUPP                                                                                         Diagnosis and Treatment of Impairments
                                                               maintaining his/her rehabilitative and/or recovery goals. CPST is a                                                      OTHER                         Group-$9.81
                                                               service comprised of individualized mental health activities as listed in
                                                               paragraph (D) of this rule which are delivered in a variety of locations
                                                               based upon the natural environment(s) of the individual, i.e., home and
                                                               community locations, per 15 minutes
                                                               Self-help/peer support service means individual or group interactions
                                                               conducted by persons receiving services, persons who have received
                                                               services, or their families or significant others, for the purpose of
                                                                                                                                                                                           Psychological/Mental     Local Board Enter
No        Yes            H0038        MH PEER SUPPORT          providing emotional support and understanding, sharing experiences in           Diagnosis and Treatment of Impairments
                                                                                                                                                                                            Health Counseling           rate here
                                                               coping with problems, and developing a network of people that provides
                                                               on-going support outside the formal mental health service system., per
                                                               15 minutes
                                                               Assertive community treatment (ACT) is a collaborative,
                                                               multidisciplinary team approach that shall include, at a minimum,
                                                               behavioral health counseling and therapy service, mental health
                                    ASSERTIVE COMMUNITY
No         No            H0040                                 assessment service, pharmacologic management service, community
                                     TREATMENT-CLINICAL
                                                               psychiatric supportive treatment (CPST) service, self-help/peer support
                                                               service, mental health crisis response service, substance abuse services,
                                                               and supported employment services, per diem

                                                               Non-Medicaid - Health Care; “Other mental health services” means
                                                               services other than those listed under divisions (A) to (Q) of section
                                                               340.09 of the Revised Code. Other mental health services may include
No         No            H0046      MH OTHER HEALTHCARE        representative payeeship, Transportation-Accreditation Not Required
                                                               and other supportive mental health services and may be offered by a
                                                               variety of entities, including YMCAs, churches, children’s cluster or
                                                               family and children first., per Hour

                                                           Acute hospital detoxification services are delivered based on treatment
                                                           protocols for detoxification in a hospital setting and are delivered by
                                                           medical and nursing professionals who provide twenty-four hour
                                 ALCOHOL AND/OR OTHER DRUG medically-directed assessment and withdrawal management. Acute
No         No            H0047       ABUSE SERVICES NOT    hospital detoxification services are indicated for individuals whose
                                    OTHERWISE SPECIFIED    intoxication/withdrawal signs and symptoms are sufficiently severe to
                                                           require primary medical and nursing care service and medical
                                                           management. Acute hospital detoxification services are to be delivered
                                                           under a defined set of physician approved policies and physician
                                                           managed procedures and medical protocols




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                                                                  Intensive home based treatment (IHBT) service is a comprehensive
                                                                  service provided to a youth and his or her family that integrates
                                                                  community psychiatric supportive treatment (CPST) service, mental
                                                                  health assessment service, crisis response, behavioral health counseling
                                      INTENSIVE HOME BASED        and therapy service, and social services with the goals of either                                                       Psychological/Mental   Local Board Enter
No       Yes            H2016                                     preventing the out-of-home placement or facilitating a successful              Diagnosis and Treatment of Impairments
                                        TREATMENT-CLINICAL                                                                                                                                 Health Counseling         rate here
                                                                  transition back to home. These intensive mental health services are
                                                                  provided in the home, school, and community settings, and should
                                                                  address and improve the mental health functioning of the youth in each
                                                                  of these domains
                                                                  Non-Medicaid - Non-Health Care; “Occupational therapy service” means
                                                                  the evaluation of learning and performance skills and analysis, selection
                                                                  and adaptation of activities for individuals whose abilities to cope with                                               Psychological/Mental   Local Board Enter
No       Yes        M1430 - M1439       MH OCCUP THERAPY                                                                                         Diagnosis and Treatment of Impairments
                                                                  daily living are threatened or impaired by developmental deficiencies,                                                   Health Counseling         rate here
                                                                  the aging process, environmental deprivation, physical, psychological, or
                                                                  social injury or illness, per hour
                                                                  Non-Medicaid - Non-Health Care; “Adjunctive therapy service” means
                                                                                                                                                                                          Psychological/Mental   Local Board Enter
No       Yes        M1440 - M1449      MH ADJUNCT THERAPY         interventions using a variety of media and activities to develop or            Diagnosis and Treatment of Impairments
                                                                                                                                                                                           Health Counseling         rate here
                                                                  maintain social or physical skills, per hour

                                                                  Non-Medicaid - Non-Health Care; School psychology services shall (1)
                                                                  Include mental health services related to school behavior and learning
                                                                  problems;(2) Be coordinated with school personnel, as appropriate, in
No        No        M1530 - M1539       MH SCHOOL PSYCH           the school setting attended by the person served; and(3) Be included in
                                                                  the “ISP” with evidence of coordination between and approval of mental
                                                                  health and educational personnel, and in consultation with the person
                                                                  served, and parent or guardian, as appropriate, per hour

                                                                  Non-Medicaid - Non-Health Care; “Adult educational service” means
                                                                  time-limited and structured educational interventions for adults, such as
No        No        M1540 - M1549         MH ADULT EDUC
                                                                  educational advising, literacy instruction, basic educational instruction or
                                                                  instruction in community and independent living skills, per hour

                                                                  Non-Medicaid - Non-Health Care; “Social and recreational service”
No        No        M1550 - M1559         MH SOCIAL REC           means a service that includes structured and non-structured activities
                                                                  and support to enhance the quality of life of the person served, per hour

                                                                  Non-Medicaid - Non-Health Care; Intensive home based treatment
                                                                  (IHBT) service is a comprehensive service provided to a youth and his
                                                                  or her family that integrates community psychiatric supportive
                                                                  treatment (CPST) service, mental health assessment service, crisis
                                       INTENSIVE HOME BASED
                                                                  response, behavioral health counseling and therapy service, and social
No        No        M1810 - M1819   TREATMENT-NONCLINICAL NOT
                                                                  services with the goals of either preventing the out-of-home placement
                                           MCD BILLABLE
                                                                  or facilitating a successful transition back to home. These intensive
                                                                  mental health services are provided in the home, school, and
                                                                  community settings, and should address and improve the mental health
                                                                  functioning of the youth in each of these domains., Daily

                                                               Non-Medicaid - Non-Health Care; Assertive community treatment
                                                               (ACT) is a collaborative, multidisciplinary team approach that shall
                                                               include, at a minimum, behavioral health counseling and therapy
                                   ASSERTIVE COMM TREATMENT-
No        No        M1910 - M1919                              service, mental health assessment service, pharmacologic management
                                  NONCLINICAL NOT MCD BILLABLE
                                                               service, community psychiatric supportive treatment (CPST) service,
                                                               self-help/peer support service, mental health crisis response service,
                                                               substance abuse services, and supported employment services, Daily

                                                                  Non-Medicaid - Non-Health Care; Residential Care, Includes room and
                                                                  board, and personal care 24/7 if specified in license. Rules in program
                                                                  or service agreement attached to housing are applicable. Treatment
No        No        M2200 - M2209      MH RESIDENTIAL CARE
                                                                  services are billed separately. May or May not be licensed by the State.
                                                                  Usually agency operated and staffed; provides 24-hour supervision in
                                                                  active treatment oriented or structured environment. Billing unit – Daily

                                                                  Non-Medicaid - Non-Health Care; Community Residence,Person living in
                                                                  an apt where they entered into an agreement that is NOT covered by
                                                                  Ohio tenant landlord law. Rules in program or service agreement
No        No        M2240 - M2249      MH COMM RESIDENCE          attached to housing. Refers to financial sponsorship and/or provision of
                                                                  some degree of on-site supervision for residents living in an apartment
                                                                  dwelling. Usually Board or agency owned. Treatment services are billed
                                                                  separately. Billing unit – Daily or Monthly




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                                                            Non-Medicaid - Non-Health Care; Foster Care, Living situations in which
                                                            the (child or adult) client resides with a non-related family or person in
No        No        M2250 - M2259      MH FOSTER CARE       that person’s home for purpose of receiving care, supervision,
                                                            assistance and accommodations. Treatment services are billed
                                                            separately Licensed through State. Billing unit – Daily
                                                            Non-Medicaid - Non-Health Care; Subsidized Housing,Person living in
                                                            an apt where they entered into a lease with accordance to Ohio tenant
                                                            landlord law or a mortgage and, in instances where ODMH allocated
No        No        M2260 - M2269   MH SUBSIDIZED HOUSING
                                                            funds have been used, an exit strategy for the subsidy has been
                                                            developed. Treatment services are billed separately. Billing unit –Daily
                                                            or Monthly
                                                            Non-Medicaid - Non-Health Care; Respite Care,Short-term living
                                                            environment, it may or may not be 24-hour care. Reasons for this type
No        No        M2270 - M2279     MH RESPITE CARE       of care are more environmental in nature. May provide supervision,
                                                            services and accommodations. Treatment services are billed separately.
                                                            Billing unit – Daily
                                                            Non-Medicaid - Non-Health Care; Crisis Care, Provision of short-term
                                                            care to stabilize person experiencing psychiatric emergency. Offered as                                                Psychological/Mental   Local Board Enter
No       Yes        M2280 - M2289      MH CRISIS CARE                                                                                     Diagnosis and Treatment of Impairments
                                                            an alternative to inpatient psychiatric unit. Staff 24 hours’ day/7 days a                                              Health Counseling         rate here
                                                            week. Treatment services are billed separately. Billing unit – Daily

                                                            Non-Medicaid - Non-Health Care; Temporary Housing, Non–hospital,
                                                            time limited residential program with an expected length of occupancy
                                                                                                                                                                                                          Local Board Enter
No       Yes        M2290 - M2299     MH TEMP HOUSING       and goals to transition to permanent housing. Includes room and board,                   MAINTENANCE                   Maintenance - OTHER
                                                                                                                                                                                                              rate here
                                                            with referral and access to treatment services that are billed separately.
                                                            Ohio tenant landlord law does NOT cover agreement. Billing unit – Daily

                                                            Non-Medicaid - Non-Health Care; Consumer Operated Svc means any
                                                            service or activity that is planned, developed, administered, delivered,
No        No        M3120 - M3129     MH CONSUMER OP        and evaluated by persons, a majority of whom are receiving or have
                                                            received inpatient mental health services or other mental health
                                                            services of significant intensity and duration, per Hour
                                                            Non-Medicaid - Health Care; “Other mental health services” means
                                                            services other than those listed under divisions (A) to (Q) of section
                                                            340.09 of the Revised Code. Other mental health services may include
No        No        M3140 - M3149   MH OTHER NON-HEALTH     representative payeeship, Transportation-Accreditation Not Required
                                                            and other supportive mental health services and may be offered by a
                                                            variety of entities, including YMCAs, churches, children’s cluster or
                                                            family and children first., per Hour
                                                            Non-Medicaid - Non-Health Care; “Prevention service” means action
                                                            oriented either toward reducing the incidence, prevalence, or severity of
                                                            specific types of mental disabilities or emotional disturbances; or actions
No        No        M4110 - M4119      MH PREVENTION        oriented toward population groups with multiple service needs and
                                                            systems that have been identified through recognized needs
                                                            assessment techniques. Included in this service are actions such as
                                                            personal and social competency building, stress management, and
                                                            systems change., per Hour
                                                            Non-Medicaid - Non-Health Care; “Consultation service” means a formal
                                                            and systematic information exchange between an agency and a person
                                                            other than a client, which is directed towards the development and
                                                                                                                                                                                   Psychological/Mental   Local Board Enter
No       Yes        M4120 - M4129     MH CONSULTATION       improvement of individualized service plans and/or techniques involved        Diagnosis and Treatment of Impairments
                                                                                                                                                                                    Health Counseling         rate here
                                                            in the delivery of mental health services. Consultation service can also
                                                            be delivered to a system (e.g., school or workplace) in order to
                                                            ameliorate conditions that adversely affect mental health., per Hour
                                                            Non-Medicaid - Non-Health Care; “Referral and information service”
                                                            means responses, usually by telephone, to inquiries from people about
No        No        M4130 - M4139    MH INFO & REFERRAL     services in the community. Referral may include contacting any agency
                                                            or a provider in order to secure services for the person requesting
                                                            assistance., Per Hour
                                                            Non-Medicaid - Non-Health Care; “Mental health education service”
                                                            means formal educational presentations made to individuals or groups
No        No        M4140 - M4149    MH COMMUNITY EDUC      that are designed to increase community knowledge of and to change
                                                            attitudes and behaviors associated with mental health problems, needs
                                                            and services, per Hour




                                                                                                                        Page 6
     Version 7 - 12/05/2011                                                                 MACSIS Service Eligibility RSC Crosswalk



                                                    Partial hospitalization is an intensive, structured, goal-oriented, distinct
                                                    and identifiable treatment service that utilizes multiple mental health
                                                    interventions that address the individualized mental health needs of the
                                                    client. Partial hospitalization services are clinically indicated by
                                                    assessment with clear admission and discharge criteria. The
                                                    environment at this level of treatment is highly structured, and there
                                                    should be an appropriate staff-to-client ratio in order to guarantee                                                     Psychological/Mental
No       Yes            S0201    MH PARTIAL HOSP                                                                                    Diagnosis and Treatment of Impairments                              $116.81
                                                    sufficient therapeutic services and professional monitoring, control, and                                                 Health Counseling
                                                    protection. The purpose and intent of partial hospitalization is to
                                                    stabilize, increase or sustain the highest level of functioning and
                                                    promote movement to the least restrictive level of care. The outcome is
                                                    for the individual to develop the capacity to continue to work towards
                                                    an improved quality of life with the support of an appropriate level of
                                                    care, per diem
                                                    Crisis intervention is that process of responding to emergent situations
                                                    and may include: assessment, immediate stabilization, and the
                                                    determination of level of care in the least restrictive environment in a
                                                    manner that is timely, responsive, and therapeutic. Crisis intervention
                                                    mental health services need to be accessible, responsive and timely in
                                                    order to be able to safely de-escalate an individual or situation, provide
                                                    hospital pre-screening and mental status evaluation, determine                                                           Psychological/Mental
No       Yes            S9484    MH CRISIS INTERV                                                                                   Diagnosis and Treatment of Impairments                              $154.35
                                                    appropriate treatment services, and coordinate the follow through of                                                      Health Counseling
                                                    those services and referral linkages. Outcomes may include: de-
                                                    escalating and/or stabilizing the individual and/or environment, linking
                                                    the individual to the appropriate level of care and services including
                                                    peer support, assuring safety, developing a crisis plan, providing
                                                    information as appropriate to family/significant others, and resolving
                                                    the emergent situation., per hour
                                                    Family counseling means the utilization of special skills in sessions with
                                                    individuals and their family members and/or significant others under the
                                                                                                                                                                             Psychological/Mental   Local Board Enter
No       Yes            T1006   FAMILY COUNSELING   guidance of a counselor to address family and relationship issues related to    Diagnosis and Treatment of Impairments
                                                                                                                                                                              Health Counseling         rate here
                                                    alcohol and other drug abuse and/or dependence for the purpose of
                                                    promoting recovery from addiction.
                                                    means care of the children of clients/participants receiving services from an
No        No            T1009      CHILDCARE
                                                    alcohol or other drug addiction program. Billed per hour.
                                                    means meals for clients/participants participating in an alcohol and/or
No        No            T1010         MEALS         other drug program in a non-residential setting. Billed per meal
                                                    (maximum 3 per day).




                                                                                                                  Page 7
              Version 7 - 12/05/2011                                                                                             MACSIS Service Eligibility RSC Crosswalk



                                                                                                                  ODADAS Medication Assisted Treatment Service
Medication assisted treatment means the services of a medical professional directly related to the use of medications to provide a whole patient approach to the treatment of substance abuse disorders. This includes, but is not limited to, services associated with
prescribing medications, the direct administration of medications and follow-up monitoring of patient health related to the use of medications. Medications utilized must be approved by the U.S. Food and Drug Administration specifically for the treatment of alcohol and/or
drug abuse or dependence. Medication assisted treatment does not include services as defined in section (T) and (X) of this rule. Medication assisted treatment shall be administered in the following manner:
(1) At an outpatient or residential program certified by the department of alcohol and drug addiction services or in the natural environment of the client.
(2) By a physician who is licensed by the state of Ohio medical board and is in compliance with any applicable waiver requirement related to the Drug
Addiction Treatment Act (DATA) of 2000. The physician is the only medical professional who may provide medication assisted treatment in the natural environment of the client.
(3) Services of a non physician medical professional must be directed by the treating physician and shall be considered a component of the medication assisted treatment service. The treating physician must be on the premises and immediately available to assist the non-
physician.
(4) Comply with all state and federal laws and regulations related to the administration, dispensing and prescribing of medication assisted treatment.

              Yes while on                           20 - 30 Minute Individual                                                                                                                                                                                Local Board Enter
     No                            90805                                           Medication Assisted Treatment Code                                                                       MAINTENANCE                            Maintenance - OTHER
               RSC Plan                         Psychotherapy with Medical E and M                                                                                                                                                                                rate here

              Yes while on                           45 - 50 Minute Individual                                                                                                                                                                                Local Board Enter
     No                            90807                                           Medication Assisted Treatment Code                                                                       MAINTENANCE                            Maintenance - OTHER
               RSC Plan                         Psychotherapy with Medical E and M                                                                                                                                                                                rate here

              Yes while on                           75 - 80 Minute Individual                                                                                                                                                                                Local Board Enter
     No                            90809                                           Medication Assisted Treatment Code                                                                       MAINTENANCE                            Maintenance - OTHER
               RSC Plan                         Psychotherapy with Medical E and M                                                                                                                                                                                rate here
                                                10 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99201         Evaluation and Management New          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                                Patient
                                                20 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99202         Evaluation and Management New          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                                Patient
                                                30 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99203         Evaluation and Management New          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                                Patient
                                                45 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99204         Evaluation and Management New          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                                Patient
                                                60 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99205         Evaluation and Management New          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                                Patient
                                                 5 Minute Providing or Supervising
              Yes while on                      Office or Other Outpatient Evaluation                                                                                                                                                                         Local Board Enter
     No                            99211                                                Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                             and Management Established                                                                                                                                                                                    rate here
                                                                Patient
                                                10 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99212             Evaluation and Management          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                          Established Patient
                                                15 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99213             Evaluation and Management          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                          Established Patient
                                                25 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99214             Evaluation and Management          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                          Established Patient
                                                40 Minute Office or Other Outpatient
              Yes while on                                                                                                                                                                                                                                    Local Board Enter
     No                            99215             Evaluation and Management          Medication Assisted Treatment Code                                                                  MAINTENANCE                            Maintenance - OTHER
               RSC Plan                                                                                                                                                                                                                                           rate here
                                                          Established Patient




                                                                                                                                                         Page 8

				
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