Verity_fee_schedule by uew27684

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    Multnomah                                                                                                                                             Out Of Facility
  County/Verity Fee                                                                                                                                          Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                         135%

                                                                                                                                                        Verity Out of
                                                                                                                                             Verity per                                                                                          Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code          Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                        Verity Guidelines
                                                                                                                                               Unit                                                                                               Health Services Criteria                Tips
                                                                                                                                                          per Unit



                                                                                                                                                                                                      No minimum time requirement per
                                                                                                                                                                                                   occurrence. Includes a history, mental
                                                                                                                                                                                                                                                                                  CPT codes allow use by non-physician
                                                                                                                                                                                                      status, and a disposition, and may
                                                                                                                                                                                                                                                                               QMHP's. "Per Occurrence" Explanation:
                                                                                                                                                                                                    include communication with family or
                                                                                                                                                                                                                                                                                  Bill one unit of service per assessment
                                                                                                                                                                                                         others, ordering and medical
                                                                                                                                                                                                                                                                                  episode (normally there would not be in
                                                                                                                                                                                                     interpretation of laboratory or other
                                                                                                                                                                                                                                                                              excess of one episode per day). Used in the
                                                                                                                                                                                                   medical studies. This service may be
                                                                                                                                                                                                                                                                                elicitation of a complete medical (including
                                                                                                                                                                                                  covered once, at the onset of an illness
                                                                                                                                                                                                                                                                               past, family, social) and psychiatric history,
                                                                                                                                                                                                   or suspected illness. It may be utilized
                                                                                                                                                                                                                                                                              establishment of diagnosis, and an evaluation
                                                                                                                                                                                                      again for the same patient if a new
                                                            PMHNP or                                                                                                                                                                                                          of the patient's ability and willingness to work
                        Psychiatric Diagnostic Interview                                           Adult SMI, Adult OP,                                                     Must include face to episode of illness occurs after a hiatus,
      90801 AS                                           Physician Assistant    Per occurrence                                $195.00         $195.00        $263.25                                                                                                         to solve the patient's mental problem. Includes
                        examination                                                                  Child/Adol OP                                                                  face             or on admission, or readmission, to
                                                                (PA)                                                                                                                                                                                                           a complete mental status exam. Information
                                                                                                                                                                                                  inpatient status due to complications of
                                                                                                                                                                                                                                                                                  may be obtained from the patient, other
                                                                                                                                                                                                 the underlying condition. However, best
                                                                                                                                                                                                                                                                              physicians and/or family. This service may be
                                                                                                                                                                                                      practices indicate that time, age or
                                                                                                                                                                                                                                                                                covered once, at the onset of an illness or
                                                                                                                                                                                                 disability may require a "confirmatory" or
                                                                                                                                                                                                                                                                              suspected illness. It may be utilized again for
                                                                                                                                                                                                       additional service be provided on
                                                                                                                                                                                                                                                                               the same patient if a new episode of illness
                                                                                                                                                                                                      another day. If more than 1 visit is
                                                                                                                                                                                                                                                                                 occurs after a hiatus, or on admission, or
                                                                                                                                                                                                     required to complete the diagnostic
                                                                                                                                                                                                                                                                                   readmission, to inpatient status due to
                                                                                                                                                                                                  evaluation documentation must clearly
                                                                                                                                                                                                                                                                                complications of the underlying condition.
                                                                                                                                                                                                    state the reason for a subsequent or
                                                                                                                                                                                                           confirmatory evaluation.



                                                                                                   Adult SMI, Adult OP,                                                     Must include face to                                                                              See MHO Code Workgroup Guidelines
      90801 AF          See 90801                               MD              Per occurrence                                $264.00         $264.00        $356.40                                  See Verity Guidelines 90801 AS
                                                                                                     Child/Adol OP                                                                  face                                                                                                 90801 AS
                                                          Licensed clinical                        Adult SMI, Adult OP,                                                     Must include face to                                                                              See MHO Code Workgroup Guidelines
     90801 AH           See 90801                                               Per occurrence                                $117.48         $117.48        $158.60                                  See Verity Guidelines 90801 AS
                                                            psychologist                             Child/Adol OP                                                                  face                                                                                                 90801 AS
                                                                                                   Adult SMI, Adult OP,                                                     Must include face to                                                                              See MHO Code Workgroup Guidelines
      90801 AJ          See 90801                              LCSW             Per occurrence                                $117.48         $117.48        $158.60                                  See Verity Guidelines 90801 AS
                                                                                                     Child/Adol OP                                                                  face                                                                                                 90801 AS




                                                                                                                                                                                                                                                                                  See above for "per occurrence"
                                                                                                                                                                                                       No minimum time requirement per                                        explanation Described as being used
                                                                                                                                                                                                      occurrence. Examination typically for                                       principally by child psychiatrists,
                                                                                                                                                                                                  children or individuals with communication
                                                                                                                                                                                                                                                                              psychologists and clinical social workers
                                                                                                                                                                                                barriers. This service may be covered once,
                                                                                                                                                                                                    at the onset of an illness or suspected                                   when they initially evaluate children who
                                                                                                                                                                                                illness. It may be utilized again for the same                                 do not have the ability to interact with
                        Interactive Psychiatric                                                                                                                                                    patient if a new episode of illness occurs                                ordinary verbal communication. This code
                        Diagnostic Interview                                                                                                                                                           after a hiatus, or on admission, or                                        may also be applied to the initial
                        examination using play                                                     Adult SMI, Adult OP,                                                     Must include face to readmission, to inpatient status due to                                      evaluation of adult patients with organic
      90802 AS                                                PMHNP             Per occurrence                                $211.25         $211.25        $285.19                               complications of the underlying condition.
                        equipment, physical devices,                                                 Child/Adol OP                                                                  face         However, best practices indicate that time,                                   mental deficits, or who are catatonic or
                        language interpreter, or other                                                                                                                                                    age or disability may require a                                     mute. Includes the same components as
                        mechanisms of communication                                                                                                                                                  "confirmatory" or additional service be                                    the Psychiatric Diagnosis Interview
                                                                                                                                                                                                provided on another day. If more than1 visit                                  Examination. However, in the interactive
                                                                                                                                                                                                     is required to complete the diagnostic                                  examination, the physician uses inanimate
                                                                                                                                                                                                evaluation documentation must clearly state
                                                                                                                                                                                                the reason for a subsequent or confirmatory
                                                                                                                                                                                                                                                                             objects, such as toys and dolls for a child,
                                                                                                                                                                                                  evaluation. This code not to be used with                                         physical aids and non-verbal
                                                                                                                                                                                                                     T1013.                                                   communications to overcome barriers to
                                                                                                                                                                                                                                                                                       therapeutic interaction.




                                                                                                   Adult SMI, Adult OP,                                                     Must include face to                                                                              See MHO Code Workgroup Guidelines
      90802 AF          See 90802 AS                            MD              Per occurrence                                $286.00         $286.00        $386.10                                  See Verity Guidelines 90802 AS
                                                                                                     Child/Adol OP                                                                  face                                                                                                 90802 AS
                                                                                                   Adult SMI, Adult OP,                                                     Must include face to                                                                              See MHO Code Workgroup Guidelines
      90802 AJ          See 90802 AS                           LCSW             Per occurrence                                $127.27         $127.27        $171.81                                  See Verity Guidelines 90802 AS
                                                                                                     Child/Adol OP                                                                  face                                                                                                 90802 AS


              Modifier Definitions:
              HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

              1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                    Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                     Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                 Unit                                                                                        Health Services Criteria                Tips
                                                                                                                                                           per Unit
                                                              Licensed clinical                       Adult SMI, Adult OP,                                             Must include face to                                                                              See MHO Code Workgroup Guidelines
     90802 AH           See 90802 AS                                               Per occurrence                              $127.27         $127.27     $171.81                               See Verity Guidelines 90802 AS
                                                                psychologist                            Child/Adol OP                                                          face                                                                                                 90802 AS



                                                                                                                                                                                                                                                                           CPT codes allow use by non-physician
                                                                                                                                                                                                For use with planned face-to-face,
                                                                                                                                                                                                                                                                        QMHP's. Used for the treatment of mental
                                                                                                                                                                                                insight oriented therapy. Normally
                                                                                                                                                                                                                                                                        illness and behavior disturbances in which
                                                                                                                                                                                                 limited to one occurrence per day
                                                                                                                                                                                                                                                                          the physician establishes a professional
                                                                                                                                                                                               within same agency. While a second
                                                                                                                                                                                                                                                                            contract with the patient and through
                                                                                                                                                                                                occurrence on the same day in the
                        Individual psychotherapy, insight                                                                                                                                                                                                                   definitive therapeutic communication,
                                                                                                                                                                                                same agency would be unusual, it
                        oriented, behavior modifying                                                                                                                                                                                                                          attempts to alleviate the emotional
                                                                                                                                                                                                may be medically necessary under
                        and/or supportive, in an office or                                            Adult SMI, Adult OP,                                                                                                                                                     disturbances, reverse or change
       90804                                                  Licensed QMHP        20 to 30 minutes                             $97.90          $48.95        $66.08         Face to face         certain circumstances. A second
                        outpatient facility, approximately                                              Child/Adol OP                                                                                                                                                       maladaptive patterns of behavior and
                                                                                                                                                                                                service in the same agency on the
                        20 to 30 minutes face-to-face                                                                                                                                                                                                                        encourage personality growth and
                                                                                                                                                                                                   same day requires substantial
                        with the patient.                                                                                                                                                                                                                                      development. While a variety of
                                                                                                                                                                                               supportive documentation regarding
                                                                                                                                                                                                                                                                              psychotherapeutic techniques are
                                                                                                                                                                                                  the necessity for such a visit. If 2
                                                                                                                                                                                                                                                                            recognized for coverage under these
                                                                                                                                                                                               distinct services are provided on the
                                                                                                                                                                                                                                                                        codes, the services must be performed by
                                                                                                                                                                                               same day , bill one line and 2 units -
                                                                                                                                                                                                                                                                             a person authorized by the state to
                                                                                                                                                                                                      NOT 2 lines , 1 unit each.
                                                                                                                                                                                                                                                                                    perform psychotherapy.



                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                               See MHO Code Workgroup Guidelines
      90804 AS          See 90804                            Physician Assistant   20 to 30 minutes                            $162.50          $81.25        $109.69        Face to face          See Verity Guidelines 90804
                                                                                                        Child/Adol OP                                                                                                                                                                 90804
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                               See MHO Code Workgroup Guidelines
      90804 AF          See 90804                                   MD             20 to 30 minutes                            $220.00         $110.00        $148.50        Face to face          See Verity Guidelines 90804
                                                                                                        Child/Adol OP                                                                                                                                                                 90804
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                               See MHO Code Workgroup Guidelines
     90804 AH           See 90804                                                  20 to 30 minutes                             $97.90          $48.95        $66.08         Face to face          See Verity Guidelines 90804
                                                                psychologist                            Child/Adol OP                                                                                                                                                                 90804
                                                                                                      Adult SMI, Adult OP,                                                                                                                                               See MHO Code Workgroup Guidelines
      90804 AJ          See 90804                                  LCSW            20 to 30 minutes                             $97.90          $48.95        $66.08         Face to face          See Verity Guidelines 90804
                                                                                                        Child/Adol OP                                                                                                                                                                 90804




                                                                                                                                                                                                     For use with planned face-to-face,
                                                                                                                                                                                                   insight oriented therapy. Service and
                                                                                                                                                                                                       resulting documentation must
                                                                                                                                                                                                    demonstrate both 20-30 minutes of
                                                                                                                                                                                                    psychotherapy IN ADDITION to the
                                                                                                                                                                                                   evaluation and management service
                        Individual psychotherapy, insight                                                                                                                                         rather than a single 20-30 minute visit
                        oriented, behavior modifying                                                                                                                                             that includes both. This service should
                        and/or supportive, in an office or                                                                                                                                          not be reported on the same day as
                                                                                                                                                                                                                                                                         Includes continuing medical diagnostic
                        outpatient facility, approximately                                            Adult SMI, Adult OP,                                                                             another psychotherapy and/or
      90805 AF                                                      MD             20 to 30 minutes                            $220.00         $110.00        $148.50        Face to face                                                                                 evaluations as well as pharmacologic
                        20 to 30 minutes face-to-face                                                   Child/Adol OP                                                                           pharmacologic management service on
                                                                                                                                                                                               the same day by the same provider. The
                                                                                                                                                                                                                                                                                      management.
                        with the patient, with medical
                        evaluation and management                                                                                                                                                  service does not necessarily include
                        services                                                                                                                                                                diagnostic evaluation. E/M services for
                                                                                                                                                                                                  established patients require 2 of the 3
                                                                                                                                                                                                key elements: HX (could be an interval
                                                                                                                                                                                                history); Exam (MMS + other elements,
                                                                                                                                                                                                     as required); or, Medical decision
                                                                                                                                                                                               making (medication adjustment, change,
                                                                                                                                                                                                                    etc).




                                                                                                      Adult SMI, Adult OP,                                                                                                                                               See MHO Code Workgroup Guidelines
      90805 AS          See 90805 AF                           PMHNP or PA         20 to 30 minutes                            $162.50          $81.25        $109.69        Face to face        See Verity Guidelines 90805 AF
                                                                                                        Child/Adol OP                                                                                                                                                               90805 AF


               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                       Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                     Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                   Verity Guidelines
                                                                                                                                                Unit                                                                                            Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    For use with planned face-to-face,
                                                                                                                                                                                               insight oriented therapy. Normally limited                                     CPT codes allow use by non-physician
                                                                                                                                                                                                 to one occurrence per day within same                                      QMHP's. Used for the treatment of mental
                                                                                                                                                                                                agency. While a second occurrence on                                       illness and behavior disturbances in which
                        Individual psychotherapy, insight                                                                                                                                      the same day in the same agency would                                         the physician establishes a professional
                        oriented, behavior modifying                                                                                                                                                  be unusual, it may be medically
                                                                                                                                                                                                                                                                               contract with the patient and through
                        and/or supportive, in an office or                                            Adult SMI, Adult OP,                                                                      necessary under certain circumstances.
       90806                                                  Licensed QMHP        45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face                                                                                      definitive therapeutic communication,
                        outpatient facility, approximately                                              Child/Adol OP                                                                          A second service in the same agency on
                                                                                                                                                                                                    the same day requires substantial                                           attempts to alleviate the emotional
                        45 to 50 minutes face-to-face
                                                                                                                                                                                                supportive documentation regarding the                                           disturbances, reverse or change
                        with the patient.
                                                                                                                                                                                                   necessity for such a visit. If 2 distinct                                   maladaptive patterns of behavior and
                                                                                                                                                                                                services are provided on the same day ,                                         encourage personality growth and
                                                                                                                                                                                                bill one line and 2 units - NOT 2 lines , 1                                                 development.
                                                                                                                                                                                                                 unit each.




                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90806 AS          See 90806                            Physician Assistant   45 to 50 minutes                            $162.50         $162.50        $219.38        Face to face           See Verity Guidelines 90806
                                                                                                        Child/Adol OP                                                                                                                                                                    90806
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90806 AF                                                      MD             45 to 50 minutes                            $220.00         $220.00        $297.00        Face to face           See Verity Guidelines 90806
                                                                                                        Child/Adol OP                                                                                                                                                                    90806
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
     90806 AH           See 90806                                                  45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face           See Verity Guidelines 90806
                                                                psychologist                            Child/Adol OP                                                                                                                                                                    90806
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90806 AJ          See 90806                                  LCSW            45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face           See Verity Guidelines 90806
                                                                                                        Child/Adol OP                                                                                                                                                                    90806




                                                                                                                                                                                                 For use with planned face-to-face, insight
                                                                                                                                                                                              oriented therapy. For use with planned face-
                                                                                                                                                                                                 to-face, insight oriented therapy. Service
                                                                                                                                                                                                     and resulting documentation,must
                                                                                                                                                                                                    demonstrate both 45-50 minutes of
                        Individual psychotherapy, insight                                                                                                                                           psychotherapy IN ADDITION to the
                        oriented, behavior modifying                                                                                                                                            evaluation and management service rather
                        and/or supportive, in an office or                                                                                                                                    than a single 45-50 minute visit that includes
                                                                                                                                                                                               both. This service should not be reported on                                 Includes continuing medical diagnostic
                        outpatient facility, approximately                                            Adult SMI, Adult OP,
      90807 AF                                                      MD             45 to 50 minutes                            $220.00         $220.00        $297.00        Face to face        the same day as another psychotherapy                                       evaluations as well as pharmacologic
                        45 to 50 minutes face-to-face                                                   Child/Adol OP                                                                          and/or pharmacologic management service                                                   management.
                        with the patient, with medical                                                                                                                                         on the same day by the same provider. The
                        evaluation and management                                                                                                                                                  service does not necessarily include
                        services                                                                                                                                                                  diagnostic evaluation. E/M services for
                                                                                                                                                                                                established patients require 2 of the 3 key
                                                                                                                                                                                               elements: HX (could be an interval history);
                                                                                                                                                                                               Exam (MMS + other elements, as required);
                                                                                                                                                                                                 or, Medical decision making (medication
                                                                                                                                                                                                         adjustment, change, etc).




                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90807 AS          See 90807 AF                           PMHNP or PA         45 to 50 minutes                            $162.50         $162.50        $219.38        Face to face         See Verity Guidelines 90807 AF
                                                                                                        Child/Adol OP                                                                                                                                                                  90807 AF




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                       Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                     Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                Unit                                                                                            Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                   For use with planned face-to-face,
                                                                                                                                                                                              insight oriented therapy. Verity considers
                                                                                                                                                                                                 this a very rare service. 75 minutes of
                                                                                                                                                                                                                                                                              CPT codes allow use by non-physician
                                                                                                                                                                                               individual psychotherapy is unusual with                                    QMHP's. Used for the treatment of mental
                                                                                                                                                                                                    any client, nearly impossible with                                     illness and behavior disturbances in which
                        Individual psychotherapy, insight
                                                                                                                                                                                                  children or persons with severe and                                        the physician establishes a professional
                        oriented, behavior modifying
                                                                                                                                                                                              persistent mental illness. Although Verity                                       contract with the patient and through
                        and/or supportive, in an office or                                            Adult SMI, Adult OP,
       90808                                                  Licensed QMHP        75 to 80 minutes                             $97.90         $127.27        $171.81        Face to face           limits total payment to one hour,                                          definitive therapeutic communication,
                        outpatient facility, approximately                                              Child/Adol OP
                                                                                                                                                                                                providers should account full usual and                                         attempts to alleviate the emotional
                        75 to 80 minutes face-to-face                                                                                                                                          customary charges for 75 to 80 minutes.                                           disturbances, reverse or change
                        with the patient.                                                                                                                                                         Service and resulting documentation                                          maladaptive patterns of behavior and
                                                                                                                                                                                              must demonstrate both 75-80 minutes of                                            encourage personality growth and
                                                                                                                                                                                                       psychotherapy. Additional
                                                                                                                                                                                                                                                                                            development.
                                                                                                                                                                                                 documentation justifying length of visit
                                                                                                                                                                                                                  required.




                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90808 AS          See 90808                            Physician Assistant   75 to 80 minutes                            $162.50         $211.25        $285.19        Face to face          See Verity Guidelines 90808
                                                                                                        Child/Adol OP                                                                                                                                                                    90808
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90808 AF          See 90808                                   MD             75 to 80 minutes                            $220.00         $286.00        $386.10        Face to face          See Verity Guidelines 90808
                                                                                                        Child/Adol OP                                                                                                                                                                    90808
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
     90808 AH           See 90808                                                  75 to 80 minutes                             $97.90         $127.27        $171.81        Face to face          See Verity Guidelines 90808
                                                                psychologist                            Child/Adol OP                                                                                                                                                                    90808
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90808 AJ          See 90808                                  LCSW            75 to 80 minutes                             $97.90         $127.27        $171.81        Face to face          See Verity Guidelines 90808
                                                                                                        Child/Adol OP                                                                                                                                                                    90808


                                                                                                                                                                                                For use with planned face-to-face, insight
                                                                                                                                                                                              oriented therapy. Verity considers this a very
                                                                                                                                                                                                    rare service. 75 minutes of individual
                                                                                                                                                                                                psychotherapy is unusual with any client,
                                                                                                                                                                                                nearly impossible with children or persons
                                                                                                                                                                                                with severe and persistent mental illness.
                                                                                                                                                                                               Although Verity limits total payment to one
                                                                                                                                                                                                 hour, providers should account full usual
                                                                                                                                                                                                     and customary charges for 75 to 80
                        Individual psychotherapy, insight                                                                                                                                               minutes. Service and resulting
                        oriented, behavior modifying                                                                                                                                           documentation must demonstrate both 75-
                        and/or supportive, in an office or                                                                                                                                    80 minutes of psychotherapy IN ADDITION
                                                                                                                                                                                               to the evaluation and management service                                     Includes continuing medical diagnostic
                        outpatient facility, approximately                                            Adult SMI, Adult OP,
      90809 AF                                                      MD             75 to 80 minutes                            $220.00         $286.00        $386.10        Face to face      rather than a single 75-80 minute visit that                                  evaluations as well as pharmacologic
                        75 to 80 minutes face-to-face                                                   Child/Adol OP                                                                            includes both. Additional documentation                                                 management.
                        with the patient, with medical                                                                                                                                             justifying length of visit required. This
                        evaluation and management                                                                                                                                             service should not be reported on the same
                        services                                                                                                                                                                    day as another psychotherapy and/or
                                                                                                                                                                                               pharmacologic management service on the
                                                                                                                                                                                              same day by the same provider. The service
                                                                                                                                                                                                  does not necessarily include diagnostic
                                                                                                                                                                                                 evaluation. E/M services for established
                                                                                                                                                                                              patients require 2 of the 3 key elements: HX
                                                                                                                                                                                              (could be an interval history); Exam (MMS +
                                                                                                                                                                                                 other elements, as required); or, Medical
                                                                                                                                                                                                decision making (medication adjustment,
                                                                                                                                                                                                                 change, etc).



                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90809 AS          See 90809 AF                           PMHNP or PA         75 to 80 minutes                            $162.50         $211.25        $285.19        Face to face        See Verity Guidelines 90809 AF
                                                                                                        Child/Adol OP                                                                                                                                                                  90809AF




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                         Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                      Service                    Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                   Verity Guidelines
                                                                                                                                                Unit                                                                                              Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    For use with planned face-to-face,
                                                                                                                                                                                                                                                                                CPT codes allow use by non-physician
                                                                                                                                                                                               insight oriented therapy. Normally limited
                                                                                                                                                                                                 to one occurrence per day within same                                         QMHP's. Used when the patient does
                        Individual Psychotherapy,                                                                                                                                                agency. While a second occurrence on                                             not have the ability to interact by
                        Interactive, using play                                                                                                                                                the same day in the same agency would                                            ordinary verbal communication, and
                        equipment, physical devices,                                                                                                                                                  be unusual, it may be medically                                           therefore non-verbal communication
                        language interpreter, or other                                                                                                                                          necessary under certain circumstances.                                          skills are employed. Patients may be
                                                                                                      Adult SMI, Adult OP,
       90810            mechanisms or non-verbal              Licensed QMHP        20 to 30 minutes                             $97.90          $48.95        $66.08         Face to Face      A second service in the same agency on                                        very young children, adult patients with
                                                                                                        Child/Adol OP
                        communication, in an office or                                                                                                                                               the same day requires substantial                                         organic mental deficits, or those who
                        outpatient facility, approximately                                                                                                                                      supportive documentation regarding the                                       are catatonic or mute. The clinician uses
                        20 to 30 minutes face-to-face                                                                                                                                              necessity for such a visit. If 2 distinct                                  inanimate objects, such as toys and dolls
                        with the patient.                                                                                                                                                       services are provided on the same day,                                         for a child, physical aids and non-verbal
                                                                                                                                                                                                 bill one line and 2 units - NOT 2 lines, 1                                    communications to overcome barriers to
                                                                                                                                                                                                    unit each. Typically for children or
                                                                                                                                                                                                                                                                                         therapeutic interaction.
                                                                                                                                                                                                individuals with communication barriers.




                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                    See MHO Code Workgroup Guidelines
      90810 AS          See 90810                            Physician Assistant   20 to 30 minutes                            $162.50          $81.25        $109.69        Face to Face           See Verity Guidelines 90810
                                                                                                        Child/Adol OP                                                                                                                                                                      90810
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                    See MHO Code Workgroup Guidelines
      90810 AF          See 90810                                   MD             20 to 30 minutes                            $220.00         $110.00        $148.50        Face to Face           See Verity Guidelines 90810
                                                                                                        Child/Adol OP                                                                                                                                                                      90810
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                    See MHO Code Workgroup Guidelines
     90810 AH           See 90810                                                  20 to 30 minutes                             $97.90          $48.95        $66.08         Face to Face           See Verity Guidelines 90810
                                                                psychologist                            Child/Adol OP                                                                                                                                                                      90810
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                    See MHO Code Workgroup Guidelines
      90810 AJ          See 90810                                  LCSW            20 to 30 minutes                             $97.90          $48.95        $66.08         Face to Face           See Verity Guidelines 90810
                                                                                                        Child/Adol OP                                                                                                                                                                      90810




                                                                                                                                                                                                For use with planned face-to-face, insight
                                                                                                                                                                                                  oriented therapy. Service and resulting                                     Used when the patient does not have the
                                                                                                                                                                                               documentation must demonstrate both 20-
                                                                                                                                                                                                                                                                                  ability to interact by ordinary verbal
                        Individual psychotherapy,                                                                                                                                             30 minutes of psychotherapy IN ADDITION
                                                                                                                                                                                               to the evaluation and management service                                      communication, and therefore non-verbal
                        Interactive, using play
                                                                                                                                                                                               rather than a single 20-30 minute visit that                                      communication skills are employed.
                        equipment, physical devices,
                                                                                                                                                                                                includes both. This service should not be                                    Patients may be very young children, adult
                        language interpreter, or other                                                                                                                                             reported on the same day as another                                         patients with organic mental deficits, or
                        mechanisms of non-verbal                                                                                                                                                   psychotherapy and/or pharmacologic
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                      those who are catatonic or mute. The
      90811 AF          communication, in an office or              MD             20 to 30 minutes                            $220.00         $110.00        $148.50        Face to Face       management service on the same day by
                                                                                                        Child/Adol OP                                                                            the same provider. The service does not                                      clinician uses inanimate objects, such as
                        outpatient facility, approximately
                                                                                                                                                                                                necessarily include diagnostic evaluation.                                     toys and dolls for a child, physical aids
                        20 to 30 minutes face-to-face
                                                                                                                                                                                              E/M services for established patients require                                       and non-verbal communications to
                        with the patient, with medical                                                                                                                                          2 of the 3 key elements: HX (could be an                                           overcome barriers to therapeutic
                        evaluation and management                                                                                                                                                  interval history); Exam (MMS + other
                                                                                                                                                                                                                                                                              interaction. Includes continuing medical
                        services                                                                                                                                                              elements, as required); or, Medical decision
                                                                                                                                                                                                making (medication adjustment, change,
                                                                                                                                                                                                                                                                                   diagnostic evaluations as well as
                                                                                                                                                                                              etc). Typically for children or individuals with                                       pharmacologic management.
                                                                                                                                                                                                          communication barriers.




                                                                                                      Adult SMI, Adult OP,                                                                                                                                                    See MHO Code Workgroup Guidelines
      90811 AS          See 90811 AF                           PMHNP or PA         20 to 30 minutes                            $162.50          $81.25        $109.69        Face to Face         See Verity Guideline 90811 AF
                                                                                                        Child/Adol OP                                                                                                                                                                    90811 AF




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                       Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                      Service                    Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                   Verity Guidelines
                                                                                                                                                Unit                                                                                            Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    For use with planned face-to-face,
                                                                                                                                                                                                                                                                              CPT codes allow use by non-physician
                                                                                                                                                                                               insight oriented therapy. Normally limited
                                                                                                                                                                                                 to one occurrence per day within same                                       QMHP's. Used when the patient does
                        Individual Psychotherapy,                                                                                                                                                agency. While a second occurrence on                                           not have the ability to interact by
                        Interactive, using play                                                                                                                                                the same day in the same agency would                                          ordinary verbal communication, and
                        equipment, physical devices,                                                                                                                                                  be unusual, it may be medically                                         therefore non-verbal communication
                        language interpreter, or other                                                                                                                                          necessary under certain circumstances.                                        skills are employed. Patients may be
                                                                                                      Adult SMI, Adult OP,
       90812            mechanisms or non-verbal              Licensed QMHP        45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face      A second service in the same agency on                                      very young children, adult patients with
                                                                                                        Child/Adol OP
                        communication, in an office or                                                                                                                                               the same day requires substantial                                       organic mental deficits, or those who
                        outpatient facility, approximately                                                                                                                                      supportive documentation regarding the                                     are catatonic or mute. The clinician uses
                        45 to 50 minutes face-to-face                                                                                                                                              necessity for such a visit. If 2 distinct                                inanimate objects, such as toys and dolls
                        with the patient.                                                                                                                                                       services are provided on the same day,                                       for a child, physical aids and non-verbal
                                                                                                                                                                                                 bill one line and 2 units - NOT 2 lines, 1                                  communications to overcome barriers to
                                                                                                                                                                                                    unit each. Typically for children or
                                                                                                                                                                                                                                                                                       therapeutic interaction.
                                                                                                                                                                                                individuals with communication barriers.




                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90812 AS          See 90812                            Physician Assistant   45 to 50 minutes                            $162.50         $162.50        $219.38        Face to face           See Verity Guidelines 90812
                                                                                                        Child/Adol OP                                                                                                                                                                    90812
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90812 AF          See 90812                                   MD             45 to 50 minutes                            $220.00         $220.00        $297.00        Face to face           See Verity Guidelines 90812
                                                                                                        Child/Adol OP                                                                                                                                                                    90812
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
     90812 AH           See 90812                                                  45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face           See Verity Guidelines 90812
                                                                psychologist                            Child/Adol OP                                                                                                                                                                    90812
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90812 AJ          See 90812                                  LCSW            45 to 50 minutes                             $97.90          $97.90        $132.17        Face to face           See Verity Guidelines 90812
                                                                                                        Child/Adol OP                                                                                                                                                                    90812




                                                                                                                                                                                                 For use with planned face-to-face, insight
                                                                                                                                                                                              oriented therapy. For use with planned face-
                                                                                                                                                                                                 to-face, insight oriented therapy. Service
                                                                                                                                                                                                     and resulting documentation must                                       Used when the patient does not have the
                                                                                                                                                                                                    demonstrate both 45-50 minutes of                                           ability to interact by ordinary verbal
                        Individual psychotherapy,                                                                                                                                                   psychotherapy IN ADDITION to the                                       communication, and therefore non-verbal
                        Interactive, using play                                                                                                                                                 evaluation and management service rather                                       communication skills are employed.
                        equipment, physical devices,                                                                                                                                          than a single 45-50 minute visit that includes
                                                                                                                                                                                               both. This service should not be reported on
                                                                                                                                                                                                                                                                           Patients may be very young children, adult
                        language interpreter, or other
                                                                                                                                                                                                 the same day as another psychotherapy                                       patients with organic mental deficits, or
                        mechanisms of non-verbal
                                                                                                      Adult SMI, Adult OP,                                                                     and/or pharmacologic management service                                        those who are catatonic or mute. The
      90813 AF          communication, in an office or              MD             45 to 50 minutes                            $220.00         $220.00        $297.00        Face to Face      on the same day by the same provider. The
                                                                                                        Child/Adol OP                                                                                                                                                       clinician uses inanimate objects, such as
                        outpatient facility, approximately                                                                                                                                          service does not necessarily include                                     toys and dolls for a child, physical aids
                        45 to 50 minutes face-to-face                                                                                                                                             diagnostic evaluation. E/M services for
                                                                                                                                                                                                                                                                                and non-verbal communications to
                        with the patient, with medical                                                                                                                                          established patients require 2 of the 3 key
                                                                                                                                                                                               elements: HX (could be an interval history);                                      overcome barriers to therapeutic
                        evaluation and management
                                                                                                                                                                                               Exam (MMS + other elements, as required);                                    interaction. Includes continuing medical
                        services
                                                                                                                                                                                                 or, Medical decision making (medication                                         diagnostic evaluations as well as
                                                                                                                                                                                                  adjustment, change, etc). Typically for                                          pharmacologic management.
                                                                                                                                                                                                children or individuals with communication
                                                                                                                                                                                                 barriers. Includes medical evaluation and
                                                                                                                                                                                                            management services.




                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90813 AS          See 90813 AF                           PMHNP or PA         45 to 50 minutes                            $162.50         $162.50        $219.38        Face to Face         See Verity Guidelines 90813 AF
                                                                                                        Child/Adol OP                                                                                                                                                                  90813 AF



               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                       Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                      Service                    Staff Code           Time/Units       Applicable Program Verity per Hour                 Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                Unit                                                                                            Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                                                               CPT codes allow use by non-physician
                        Individual psychotherapy,                                                                                                                                                                                                                           QMHP's. Used when the patient does not
                        interactive, using play                                                                                                                                                                                                                               have the ability to interact by ordinary
                                                                                                                                                                                                For use with planned face-to-face                                          verbal communication, and therefore non-
                        equipment, physical devices,
                                                                                                                                                                                                 therapy. Normally limited to one                                          verbal communication skills are employed.
                        language interpreter, or other
                                                                                                      Adult SMI, Adult OP,                                                                       occurrence per day within same                                            Patients may be very young children, adult
       90814            mechanisms or non-verbal              Licensed QMHP        75 to 80 minutes                             $97.90          $97.90        $132.17        Face to Face
                                                                                                        Child/Adol OP                                                                            agency. Typically for children or                                           patients with organic mental deficits, or
                        communication, in an office or                                                                                                                                                                                                                        those who are catatonic or mute. The
                                                                                                                                                                                                  individuals with communication
                        outpatient facility, approximately                                                                                                                                                                                                                 clinician uses inanimate objects, such as toys
                                                                                                                                                                                                              barriers.
                        75 to 80 minutes face-to-face                                                                                                                                                                                                                        and dolls for a child, physical aids and non-
                        with the patient.                                                                                                                                                                                                                                   verbal communications to overcome barriers
                                                                                                                                                                                                                                                                                      to therapeutic interaction.




                                                                PMHNP or
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90814 AS          See 90814                            Physician Assistant   75 to 80 minutes                            $162.50         $162.50        $219.38        Face to face          See Verity Guidelines 90814
                                                                                                        Child/Adol OP                                                                                                                                                                    90814
                                                                    (PA)
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90814 AF          See 90814                                   MD             75 to 80 minutes                            $220.00         $220.00        $297.00        Face to face          See Verity Guidelines 90814
                                                                                                        Child/Adol OP                                                                                                                                                                    90814
                                                              Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
     90814 AH           See 90814                                                  75 to 80 minutes                             $97.90          $97.90        $132.17        Face to face          See Verity Guidelines 90814
                                                                psychologist                            Child/Adol OP                                                                                                                                                                    90814
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90814 AJ          See 90814                                  LCSW            75 to 80 minutes                             $97.90          $97.90        $132.17        Face to face          See Verity Guidelines 90814
                                                                                                        Child/Adol OP                                                                                                                                                                    90814
                                                                                                                                                                                                For use with planned face-to-face, insight
                                                                                                                                                                                              oriented therapy. Verity considers this a very
                                                                                                                                                                                                    rare service. 75 minutes of individual
                                                                                                                                                                                                psychotherapy is unusual with any client,
                                                                                                                                                                                                nearly impossible with children or persons
                                                                                                                                                                                                with severe and persistent mental illness.
                                                                                                                                                                                               Although Verity limits total payment to one
                                                                                                                                                                                                 hour, providers should account full usual                                  Used when the patient does not have the
                                                                                                                                                                                                     and customary charges for 75 to 80
                                                                                                                                                                                                                                                                                ability to interact by ordinary verbal
                        Individual psychotherapy,                                                                                                                                                       minutes. Service and resulting
                                                                                                                                                                                               documentation must demonstrate both 75-                                     communication, and therefore non-verbal
                        Interactive, using play
                                                                                                                                                                                              80 minutes of psychotherapy IN ADDITION                                          communication skills are employed.
                        equipment, physical devices,
                                                                                                                                                                                               to the evaluation and management service                                    Patients may be very young children, adult
                        language interpreter, or other                                                                                                                                         rather than a single 75-80 minute visit that                                  patients with organic mental deficits, or
                        mechanisms of non-verbal                                                                                                                                                 includes both. Additional documentation
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                    those who are catatonic or mute. The
      90815 AF          communication, in an office or              MD             75 to 80 minutes                            $220.00         $220.00        $297.00        Face to Face          justifying length of visit required. This
                                                                                                        Child/Adol OP                                                                         service should not be reported on the same                                    clinician uses inanimate objects, such as
                        outpatient facility, approximately
                                                                                                                                                                                                    day as another psychotherapy and/or                                      toys and dolls for a child, physical aids
                        75 to 80 minutes face-to-face
                                                                                                                                                                                               pharmacologic management service on the                                          and non-verbal communications to
                        with the patient, with medical                                                                                                                                        same day by the same provider. The service                                         overcome barriers to therapeutic
                        evaluation and management                                                                                                                                                 does not necessarily include diagnostic
                                                                                                                                                                                                                                                                            interaction. Includes continuing medical
                        services                                                                                                                                                                 evaluation. E/M services for established
                                                                                                                                                                                              patients require 2 of the 3 key elements: HX
                                                                                                                                                                                                                                                                                 diagnostic evaluations as well as
                                                                                                                                                                                              (could be an interval history); Exam (MMS +                                          pharmacologic management.
                                                                                                                                                                                                 other elements, as required); or, Medical
                                                                                                                                                                                                decision making (medication adjustment,
                                                                                                                                                                                                    change, etc). Typically for children or
                                                                                                                                                                                                 individuals with communication barriers.
                                                                                                                                                                                                      Includes medical evaluation and
                                                                                                                                                                                              management services. Verity limits payment
                                                                                                                                                                                                                 to one hour.
                                                                                                      Adult SMI, Adult OP,                                                                                                                                                  See MHO Code Workgroup Guidelines
      90815 AS          See 90815                              PMHNP or PA         75 to 80 minutes                            $162.50         $162.50        $219.38        Face to Face        See Verity Guidelines 90815 AF
                                                                                                        Child/Adol OP                                                                                                                                                                  90815 AF




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                          Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                        Verity Guidelines
                                                                                                                                                Unit                                                                                               Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                         No minimum time requirement per
                                                                                                                                                                                                       occurrence. Normally limited to one
                                                                                                                                                                                                    occurrence per day within same agency.
                                                                                                                                                                                                    While a second occurrence on the same
                                                                                                                                                                                                         day in the same agency would be
                                                                                                                                                                                                     unusual, it may be medically necessary
                                                                                                                                                                                                     under certain circumstances. A second
                                                                                                                                                                                                                                                                              OMAP upper payment limit was based on
                                                                                                                                                                              Not specified. No service in the same agency on the same
                                                                                                                                                                                                        day requires substantial supportive                                    90 minute encounter. Used to describe
                                                                                                                                                                             "out of facility" rate
                        Family psychotherapy (without                                               Adult SMI, Adult OP,                                                                             documentation regarding the necessity                                       family participation in the treatment
       90846                                                   QMHP              Per occurrence                                 $97.90          $97.90        $132.17          available if the
                        the patient present)                                                          Child/Adol OP                                                                                       for such a visit. This is not to be                                 process of the patient where the primary
                                                                                                                                                                              service is phone considered marriage counseling for the
                                                                                                                                                                                                                                                                                purpose of such psychotherapy is the
                                                                                                                                                                                   contact.           family of the client. While discussion                                     treatment of the patient's condition.
                                                                                                                                                                                                    may be about the relationship of others,
                                                                                                                                                                                                          the focus must be on the client's
                                                                                                                                                                                                      treatment. Bill one unit of service per
                                                                                                                                                                                                       episode. However, if 2 distinct group
                                                                                                                                                                                                    services are provided on the same day,
                                                                                                                                                                                                     bill one line and 2 units - NOT 2 lines, 1
                                                                                                                                                                                                                      unit each.




                                                                                                    Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90846 AF          See 90846                                MD              Per occurrence                                $220.00         $220.00        $297.00            See 90846               See Verity Guidelines 90846
                                                                                                      Child/Adol OP                                                                                                                                                                         90846
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90846 TD          See 90846                                RN              Per occurrence                                $130.00         $130.00        $175.50            See 90846               See Verity Guidelines 90846
                                                                                                      Child/Adol OP                                                                                                                                                                         90846
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90846 AS          See 90846                             PMHNP              Per occurrence                                $162.50         $162.50        $219.38            See 90846               See Verity Guidelines 90846
                                                                                                      Child/Adol OP                                                                                                                                                                         90846
                                                          Licensed clinical                         Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
     90846 AH           See 90846                                                Per occurrence                                 $97.90          $97.90        $132.17            See 90846               See Verity Guidelines 90846
                                                            psychologist                              Child/Adol OP                                                                                                                                                                         90846
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90846 AJ          See 90846                              LCSW              Per occurrence                                 $97.90          $97.90        $132.17            See 90846               See Verity Guidelines 90846
                                                                                                      Child/Adol OP                                                                                                                                                                         90846




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                     Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                       Service                     Staff Code         Time/Units      Applicable Program Verity per Hour                  Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                Unit                                                                                          Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    No minimum time requirement per
                                                                                                                                                                                                  occurrence. Normally limited to one
                                                                                                                                                                                               occurrence per day within same agency.
                                                                                                                                                                                               While a second occurrence on the same
                                                                                                                                                                                                    day in the same agency would be
                                                                                                                                                                                                unusual, it may be medically necessary
                                                                                                                                                                                                under certain circumstances. A second
                                                                                                                                                                                               service in the same agency on the same                                    OMAP upper payment limit was based on
                                                                                                                                                                                                   day requires substantial supportive                                    90 minute encounter. Used to describe
                        Family psychotherapy (conjoint                                               Adult SMI, Adult OP,                                                                       documentation regarding the necessity                                       family participation in the treatment
       90847            psychotherapy) (with patient present)
                                                                     QMHP           Per occurrence                             $110.00         $110.00        $148.50        Face to Face
                                                                                                       Child/Adol OP                                                                                  for such a visit. This is not to be                                process of the patient where the primary
                                                                                                                                                                                                considered marriage counseling for the                                     purpose of such psychotherapy is the
                                                                                                                                                                                                 family of the client. While discussion                                     treatment of the patient's condition.
                                                                                                                                                                                               may be about the relationship of others,
                                                                                                                                                                                                     the focus must be on the client's
                                                                                                                                                                                                 treatment. Bill one unit of service per
                                                                                                                                                                                                 episode. However, if 2 distinct group
                                                                                                                                                                                               services are provided on the same day,
                                                                                                                                                                                                bill one line and 2 units - NOT 2 lines, 1
                                                                                                                                                                                                                 unit each.




                                                                                                     Adult SMI, Adult OP,                                                                                                                                                 See MHO Code Workgroup Guidelines
      90847 AF          See 90847                                     MD            Per occurrence                             $247.19         $247.19        $333.71        Face to Face          See Verity Guidelines 90847
                                                                                                       Child/Adol OP                                                                                                                                                                   90847
                                                                                                     Adult SMI, Adult OP,                                                                                                                                                 See MHO Code Workgroup Guidelines
      90847 TD          See 90847                                     RN            Per occurrence                             $146.07         $146.07        $197.19        Face to Face          See Verity Guidelines 90847
                                                                                                       Child/Adol OP                                                                                                                                                                   90847
                                                                                                     Adult SMI, Adult OP,                                                                                                                                                 See MHO Code Workgroup Guidelines
      90847 AS          See 90847                                   PMHNP           Per occurrence                             $162.50         $162.50        $219.38        Face to Face          See Verity Guidelines 90847
                                                                                                       Child/Adol OP                                                                                                                                                                   90847
                                                                Licensed clinical                    Adult SMI, Adult OP,                                                                                                                                                 See MHO Code Workgroup Guidelines
     90847 AH           See 90847                                                   Per occurrence                             $110.00         $110.00        $148.50        Face to Face          See Verity Guidelines 90847
                                                                  psychologist                         Child/Adol OP                                                                                                                                                                   90847
                                                                                                     Adult SMI, Adult OP,                                                                                                                                                 See MHO Code Workgroup Guidelines
      90847 AJ          See 90847                                    LCSW           Per occurrence                             $110.00         $110.00        $148.50        Face to Face          See Verity Guidelines 90847
                                                                                                       Child/Adol OP                                                                                                                                                                   90847




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                          Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                   Verity Guidelines
                                                                                                                                                Unit                                                                                               Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    No minimum time requirement per
                                                                                                                                                                                               occurrence. While a second occurrence on
                                                                                                                                                                                              the same day in the same agency would be
                                                                                                                                                                                                  unusual, it may be medically necessary
                                                                                                                                                                                                  under certain circumstances. A second
                                                                                                                                                                                                 service in the same agency on the same
                                                                                                                                                                                                    day requires substantial supportive
                                                                                                                                                                                                documentation regarding the necessity for                                     See "per occurrence" explanation above.
                                                                                                                                                                                                  such a visit. Bill one unit of service per                                    Group therapy sessions for multiple
                                                                                                                                                                                                   episode. However, if 2 distinct group
                        Multiple-family group                                                       Adult SMI, Adult OP,                                                                                                                                                         families when similar dynamics are
       90849                                                   QMHP              Per occurrence                                 $48.95          $48.95        $66.08         Face to Face      services are provided on the same day, bill
                        psychotherapy                                                                 Child/Adol OP                                                                              one line and 2 units - NOT 2 lines, 1 unit                                       occurring due to a commonality of
                                                                                                                                                                                              each. Incredible Years use of 90849 multiple                                     problems in the family members under
                                                                                                                                                                                               family group psychotherapy and H2027 60-                                                      treatment.
                                                                                                                                                                                                  minutes psychoeducation for incredible
                                                                                                                                                                                              years parent series 2 hour sessions. Family
                                                                                                                                                                                                socialization time not billable. Use H0004
                                                                                                                                                                                                 for in-between group sessions follow-up
                                                                                                                                                                                              phone contact. OK to bill out-of-facility rate if
                                                                                                                                                                                                                done off-site.




                        Multiple-family group                                                       Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgoup Guidelines
      90849 TD                                                   RN              Per occurrence                                 $65.00          $65.00        $87.75         Face to Face          See Verity Guidelines 90849
                        psychotherapy                                                                 Child/Adol OP                                                                                                                                                                        90849
                        Multiple-family group                                                       Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgoup Guidelines
      90849 AS                                                PMHNP              Per occurrence                                 $81.25          $81.25        $109.69        Face to Face          See Verity Guidelines 90849
                        psychotherapy                                                                 Child/Adol OP                                                                                                                                                                        90849




                                                                                                                                                                                                    No minimum time requirement per
                                                                                                                                                                                               occurrence. Limited to five occurrences per
                                                                                                                                                                                              day. Typically no more than 10 participants
                                                                                                                                                                                                 are allowed. Bill one unit of service per
                                                                                                                                                                                              episode. If 2 or more distinct group services
                                                                                                                                                                                               are provided on the same day, bill one line                                    See "per occurrence" explanation above.
                                                                                                                                                                                              and 2 or more units - NOT 2 or more lines, 1                                     However if 2 distinct group services are
                                                                                                                                                                                               unit each. Group psychotherapy for two or                                       provided on the same day , bill one line
                                                                                                                                                                                              more unrelated persons, other than multiple                                      and 2 units - NOT 2 lines , 1 unit each.
                                                                                                                                                                                               family group, i.e. “Incredible Years" if done                                   Psychotherapy administered in a group
                        Group psychotherapy (other                                                  Adult SMI, Adult OP,                                                                        off-site, culturally specific groups held on-
       90853                                                   QMHP              Per occurrence                                 $48.95          $48.95        $66.08         Face to Face      site at high schools or at specific agencies
                                                                                                                                                                                                                                                                                setting with a trained group leader in
                        than a multiple-family group)                                                 Child/Adol OP
                                                                                                                                                                                                  with target populations such as White                                       charge of several patients. Personal and
                                                                                                                                                                                              Shield. If agency staff billing for service has                                    group dynamics are discussed and
                                                                                                                                                                                                   office located where the services are                                      explored in a therapeutic setting allowing
                                                                                                                                                                                                provided then no out of facility POS code.                                     emotional catharsis, instruction, insight,
                                                                                                                                                                                                   Use for art therapy group if the group
                                                                                                                                                                                                                                                                                             and support.
                                                                                                                                                                                                  involves clinical psychotherapy and is
                                                                                                                                                                                              conducted by a registered art therapist. Use
                                                                                                                                                                                              code H2014 for other art skills based goups.
                                                                                                                                                                                              May be used for less than 45 min. for young
                                                                                                                                                                                                              children's groups.




                        Group psychotherapy (other                                                  Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90853 TD                                                   RN              Per occurrence                                 $65.00          $65.00        $87.75         Face to Face          See Verity Guidelines 90853
                        than a multiple-family group)                                                 Child/Adol OP                                                                                                                                                                         90853
                        Group psychotherapy (other                                                  Adult SMI, Adult OP,                                                                                                                                                       See MHO Code Workgroup Guidelines
      90853 AS                                                PMHNP              Per occurrence                                 $81.25          $81.25        $109.69        Face to Face          See Verity Guidelines 90853
                        than a multiple-family group)                                                 Child/Adol OP                                                                                                                                                                         90853



               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                      Oregon Health Plan Mental        MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                     Verity Guidelines
                                                                                                                                                Unit                                                                                           Health Services Criteria                     Tips
                                                                                                                                                           per Unit


                                                                                                                                                                                                   No minimum time requirement per
                                                                                                                                                                                                                                                                               See "per occurrence" explanation above.
                                                                                                                                                                                                       occurrence. Limited to five
                                                                                                                                                                                                                                                                                However if 2 distinct group services are
                                                                                                                                                                                                   occurrences per day. Typically no
                                                                                                                                                                                                                                                                                provided on the same day , bill one line
                                                                                                                                                                                                      more than 10 participants are
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                        and 2 units - NOT 2 lines , 1 unit each.
       90857            Interactive Group psychotherapy        QMHP              Per occurrence                                 $48.95          $48.95        $66.08           Face to Face        allowed. Bill one unit of service per
                                                                                                      Child/Adol OP                                                                                                                                                            Used when the patient does not have the
                                                                                                                                                                                                   episode. If 2 or more distinct group
                                                                                                                                                                                                                                                                                  ability to interact by ordinary verbal
                                                                                                                                                                                                   services are provided on the same
                                                                                                                                                                                                                                                                               communication, and therefore non-verbal
                                                                                                                                                                                                  day, bill one line and 2 or more units -
                                                                                                                                                                                                                                                                                  communication skills are employed.
                                                                                                                                                                                                    NOT 2 or more lines, 1 unit each.


                                                                                                    Adult SMI, Adult OP,                                                                                                                                                        See MHO Code Workgroup Guidelines
      90857 TD          See 90857                                RN              Per occurrence                                 $65.00          $65.00        $87.75           Face to Face           See Verity Guidelines 90857
                                                                                                      Child/Adol OP                                                                                                                                                                          90857
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                        See MHO Code Workgroup Guidelines
      90857 AS          Interactive Group psychotherapy       PMHNP              Per occurrence                                 $81.25          $81.25        $109.69          Face to Face           See Verity Guidelines 90857
                                                                                                      Child/Adol OP                                                                                                                                                                          90857




                                                                                                                                                                                                     No minimum time requirement per                                          Should be used when contact does not
                                                                                                                                                                                                      occurrence. Typically one service                                            include a significant amount of
                                                                                                                                                                                                       per day. A second occurrence                                             psychotherapy. See above for "per
                                                                                                                                                                                                      requires significant documentary                                        occurrence" explanation Used for the
                        Pharmacologic management,                                                                                                                             Not specified. No evidence. Further, it should be noted                                         patient whose psychotherapy is being
                        including prescription, use, and                                                                                                                     "out of facility" rate that the same provider should not                                        managed by another health professional
                                                                                                    Adult SMI, Adult OP,                                                                                                                     MD or Psychiatric Mental Health
      90862 AF          review of medication with no             MD              Per occurrence                                $220.00         $110.00        $148.50          available if the          report a psychotherapy or                                           and the billing physician is managing the
                                                                                                      Child/Adol OP                                                                                                                                Nurse Practitioner
                        more than minimal medical                                                                                                                             service is phone       psychotherapy + E/M on the same                                           psychotropic medication. The service
                        psychotherapy                                                                                                                                              contact.            day. Bill one unit of service per                                       includes 1) prescribing medication, 2)
                                                                                                                                                                                                     episode. If 2 or more distinct group                                    monitoring the effect of medication and its
                                                                                                                                                                                                     services are provided on the same                                        side effects, and adjusting the dosage.
                                                                                                                                                                                                    day, bill one line and 2 or more units -                                  Any psychotherapy provided is minimal
                                                                                                                                                                                                      NOT 2 or more lines, 1 unit each.                                          and is usually supportive in nature.




                                                                                                    Adult SMI, Adult OP,                                                                                                                     MD or Psychiatric Mental Health    See MHO Code Workgroup Guidelines
      90862 AS          See 90862 AF                       PMHNP or PA           Per occurrence                                $162.50          $81.25        $109.69          See 90862 AF                   See 90862 AF
                                                                                                      Child/Adol OP                                                                                                                                Nurse Practitioner                      90862 AF




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                                  Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                   Staff Code          Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                            Verity Guidelines
                                                                                                                                                Unit                                                                                                       Health Services Criteria                Tips
                                                                                                                                                           per Unit



                                                                                                                                                                                                            No minimum time requirement per
                                                                                                                                                                                                            occurrence. No limit to number of
                                                                                                                                                                                                    occurrences per day. Bill one unit of service
                                                                                                                                                                                                        per episode. If 2 or more distinct group
                                                                                                                                                                                                     services are provided on the same day, bill
                                                                                                                                                                                                        one line and 2 or more units - NOT 2 or
                                                                                                                                                                                                       more lines, 1 unit each. Documentation
                                                                                                                                                                                                      must justify each occurrence billed. To be
                                                                                                                                                                                                           used for a mental health provider to
                                                                                                                                                                                                         communicate with non-mental health
                        Environmental intervention for                                                                                                                        Not specified. No providers or with hospitals. Communication
                        medical management purposes                                                                                                                          "out of facility" rate with agencies, employers, or institutions on                                        Medical management on a psychiatric
                                                                                                    Adult SMI, Adult OP,
       90882            on a psychiatric patient's behalf        QMHP            Per occurrence                                $117.48          $70.49        $95.16           available if the       the client's behalf. Use for communication                                      patient's behalf with agencies, employers,
                                                                                                      Child/Adol OP                                                                                         with pharmacists and directions to
                        with agencies, employers or                                                                                                                           service is phone                                                                                         or institutions. May include phone calls
                                                                                                                                                                                                     pharmacies. Cannot be used for calling in
                        institutions                                                                                                                                               contact.
                                                                                                                                                                                                    refill requests to pharmacy. If a refill request
                                                                                                                                                                                                    is the initiation of the call but there is clinical
                                                                                                                                                                                                       exchange with caller then it can be used.
                                                                                                                                                                                                          Use for letter writing and developing
                                                                                                                                                                                                     treatment summaries for outside agencies.
                                                                                                                                                                                                    Code can be used for communication to non-
                                                                                                                                                                                                       mental health programs within the same
                                                                                                                                                                                                        agency, i.e. housing, employment. Use
                                                                                                                                                                                                        T1016 if services align better with case
                                                                                                                                                                                                                      management.




                                                                                                                                                                              Not specified. No
                                                                                                                                                                             "out of facility" rate
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                               See MHO Code Workgroup Guidelines
      90882 AF          See 90882                                 MD             Per occurrence                                $264.00         $132.00        $178.20          available if the             See Verity Guidelines 90882
                                                                                                      Child/Adol OP                                                                                                                                                                                 90882
                                                                                                                                                                              service is phone
                                                                                                                                                                                   contact.
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                               See MHO Code Workgroup Guidelines
      90882 TD          See 90882                                 RN             Per occurrence                                $156.00          $78.00        $105.30         Same as 90882                 See Verity Guidelines 90882
                                                                                                      Child/Adol OP                                                                                                                                                                                 90882
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                               See MHO Code Workgroup Guidelines
      90882 AS          See 90882                               PMHNP            Per occurrence                                $195.00          $97.50        $131.63         Same as 90882                 See Verity Guidelines 90882
                                                                                                      Child/Adol OP                                                                                                                                                                                 90882
                                                            Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                               See MHO Code Workgroup Guidelines
     90882 AH           See 90882                                                Per occurrence                                $117.48          $70.49        $95.16          Same as 90882                 See Verity Guidelines 90882
                                                              psychologist                            Child/Adol OP                                                                                                                                                                                 90882
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                               See MHO Code Workgroup Guidelines
      90882 AJ          See 90882                                LCSW            Per occurrence                                $117.48          $70.49        $95.16          Same as 90882                 See Verity Guidelines 90882
                                                                                                      Child/Adol OP                                                                                                                                                                                 90882




                                                                                                                                                                                                        No minimum time requirement per
                                                                                                                                                                                                         occurrence. No limit to number of                                             Interpretation or explanation of psychiatric or
                                                                                                                                                                                                       occurrences per day. Bill one unit of                                          other medical exams and procedures, or other
                        Interpretation or explanation of                                                                                                                                            service per episode. If 2 or more distinct                                         accumulated data to family or other persons,
                        results of psychiatric, other
                                                                                                                                                                              Not specified. No services are provided on the same day,                                                 or advising them how to assist patient. Used
                        medical examinations and
                                                                                                                                                                             "out of facility" rate bill one line and 2 or more units - NOT 2                                         when the treatment of the patient may require
                        procedures, or other                                                        Adult SMI, Adult OP,                                                                            or more lines, 1 unit each. Interpretation                                        explanations to the family, employers, or other
       90887                                                     QMHP            Per occurrence                                $117.48          $58.74        $79.30           available if the
                        accumulated data to family or                                                 Child/Adol OP                                                                                   or explanation of psychiatric or other                                              involved persons for their support in the
                                                                                                                                                                              service is phone medical exams or procedures, or other                                                       therapy process. This may include the
                        other responsible persons, or
                                                                                                                                                                                   contact.            accumulated data to family or other                                              reporting of examinations, procedures and
                        advising them how to assist
                        patient                                                                                                                                                                      persons. One-to-one meeting between                                               other accumulated data. May include phone
                                                                                                                                                                                                    prescriber and other staff advocating for                                         calls to the LMP (only) for increased access to
                                                                                                                                                                                                    treatment needs. Use for check-ins with                                             enhance medication management services.
                                                                                                                                                                                                     parents/teachers about child behavior.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                 Oregon Health Plan Mental          MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                   Staff Code          Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                      Health Services Criteria                       Tips
                                                                                                                                                           per Unit
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
      90887 AF          See 90887                                 MD             Per occurrence                                $264.00         $132.00        $178.20        Same as 90887         See Verity Guidelines 90887
                                                                                                      Child/Adol OP                                                                                                                                                                       90887
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
      90887 TD          See 90887                                 RN             Per occurrence                                $156.00          $78.00        $105.30        Same as 90887         See Verity Guidelines 90887
                                                                                                      Child/Adol OP                                                                                                                                                                       90887
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
      90887 AS          See 90887                               PMHNP            Per occurrence                                $195.00          $97.50        $131.63        Same as 90887         See Verity Guidelines 90887
                                                                                                      Child/Adol OP                                                                                                                                                                       90887
                                                            Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
     90887 AH           See 90887                                                Per occurrence                                $117.48          $58.74        $79.30         Same as 90887         See Verity Guidelines 90887
                                                              psychologist                            Child/Adol OP                                                                                                                                                                       90887
                                                                                                    Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
      90887 AJ          See 90887                                LCSW            Per occurrence                                $117.48          $58.74        $79.30         Same as 90887         See Verity Guidelines 90887
                                                                                                      Child/Adol OP                                                                                                                                                                       90887



                                                                                                                                                                                                                                                                            Includes the administration, interpretation and
                                                                                                                                                                                                                                            QMHP who is licensed           scoring of tests mentioned in the CPT
                        Psychological Testing with                                                                                                                                                                                                                     description and other medically accepted tests
                                                                                                    Adult SMI, Adult OP,                                                                                                                Psychologist or a Psychology
       96101            interpretation and report, per           QMHP               Per hour                                    $97.90          $97.90        $132.17         Face to face                 Max. of $500                                                    for evaluation of intellectual strengths,
                                                                                                      Child/Adol OP                                                                                                                    Intern supervised by a licensed
                        hour                                                                                                                                                                                                                                            psychopathology, psychodynamics, mental
                                                                                                                                                                                                                                                Psychologist.            health risks, insight, motivation and other
                                                                                                                                                                                                                                                                            factors influencing treatment and prognosis.



                                                            Licensed clinical                       Adult SMI, Adult OP,                                                                                                                                                     See MHO Code Workgroup Guidelines
     96101 AH           See 96101                                                   Per hour                                    $97.90          $97.90        $132.17         Face to face         See Verity Guidelines 96101         See Oregon Health Plan Criteria
                                                              psychologist                            Child/Adol OP                                                                                                                                                                       96101


                                                                                                                                                                                                Use for group skills-based training
                                                                                                                                                                                                45 min duration or more. Typically Activity Therapy, such as music, This is a group service focused on therapeutic
                                                                                                                                                                                                 no more than 10 participants are   dance, art or play therapies not    activities. May only bill if service lasted a
                        Activity Therapy related to the                                                                                                                                                                                                                  minimum of 45 minutes. Since definition
                                                                                                                                                                                                  allowed. No limit to number of     for recreation, related to the
                        care and treatment of a person's                                            Adult SMI, Adult OP,                                                                                                                                             states "45 minutes or more", multiple units may
     G0176 HN                                                    QMHA           Per Occurrence                                  $20.00          $20.00        $27.00          Face to face      occurrences per day. If 2 or more   care and treatment of patient's
                        disabling mental health                                                       Child/Adol OP                                                                                                                                                     only be billed if distinct activities occur in a
                                                                                                                                                                                               distinct group services are provided     disabling mental health        single day, for example a 45 minute cooking
                        condition, 45 minutes or more.
                                                                                                                                                                                               on the same day, bill one line and 2   problems, per session (45           group in the morning and a 45 minute
                                                                                                                                                                                               or more units - NOT 2 or more lines,         minutes or more)                 shopping group in the afternoon.
                                                                                                                                                                                                            1 unit each.


                                                                                                    Adult SMI, Adult OP,                                                                                                                   See Oregon Health Plan            See MHO Code Workgroup Guidelines
       G0176            See G0176 HN                             QMHP           Per Occurrence                                  $22.71          $22.71        $30.66          Face to face    See Verity Guidelines G0716 HN
                                                                                                      Child/Adol OP                                                                                                                         Guidelines G0176 HN                         G0176 HN




                                                                                                                                                                                                                                      Psychosocial skills development and
                                                                                                                                                                                                                                     rehabilitation services used to improve
                                                                                                                                                                                                                                     social functioning in areas important to    This is an individual skills training
                                                                                                                                                                                                  Use for individual skills based    maintaining or reestablishing residency
                                                                                                                                                                                                                                                                              service. May only bill if service lasted a
                                                                                                                                                                                              training 45 minutes or more. No limit in the community. Interventions are
                        Training and educational                                                                                                                                                                                      delivered on an individual basis and    minimum of 45 minutes. Since definition
                                                                                                                                                                                                to the number of occurrences per
                        services related to the care and                                                                                                                                                                                are individualized to meet specific states "45 minutes or more", multiple units
                                                                                                    Adult SMI, Adult OP,                                                                          day. Bill one unit of service per
     G0177 HN           treatment of a person's disabling        QMHA           Per Occurrence                                  $86.25          $86.25        $116.44         Face to face                                             goals and measurable objectives in       may only be billed if distinct activities
                                                                                                      Child/Adol OP                                                                           episode. If 2 or more distinct services the treatment plan. Interventions
                        mental health condition, 45                                                                                                                                                                                                                            occur in a single day, for example a 45
                                                                                                                                                                                                are provided on the same day, bill focus on developing and strengthening
                        minutes or more.                                                                                                                                                                                                                                      minute cooking group in the morning and
                                                                                                                                                                                              one line and 2 or more units - NOT 2 competencies in areas such as anger
                                                                                                                                                                                                                                       management, stress management,            a 45 minute shopping group in the
                                                                                                                                                                                                     or more lines, 1 unit each.
                                                                                                                                                                                                                                             conflict resolution, money                       afternoon.
                                                                                                                                                                                                                                       management, community mobility,
                                                                                                                                                                                                                                     symptom management and reduction.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                         Oregon Health Plan Mental             MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                       Verity Guidelines
                                                                                                                                                Unit                                                                                              Health Services Criteria                          Tips
                                                                                                                                                           per Unit
                                                                                                    Adult SMI, Adult OP,                                                                                                                       See Oregon Health Plan Criteria          See MHO Code Workgroup Guidelines
       G0177            See G0177 HN                           QMHP             Per Occurrence                                  $97.90          $97.90        $132.17           Face to face          See Verity Guidelines G0177 HN
                                                                                                      Child/Adol OP                                                                                                                                     G0177 HN                                   G0177 HN

                                                                                                                                                                                                       Use for screening in or out of service. No
                                                                                                                                                                                                        minimum time. Use when determining
                                                                                                                                                                                                        appropriateness for referring youth and
                                                                                                                                                                                                        adults for a mental health assessment.
                                                                                                                                                                                                     Does not take the place of a mental health
                                                                                                                                                                                                        assessment (MHA). If an individual is
                                                                                                                                                                                                      requesting a mental health assessment, a
                                                                                                                                                                                                          screening cannot be offered instead.
                                                                                                                                                                                                        However, if a single adult, parent, legal
                                                                                                                                                                                                        guardian or youth describe to a QMHP
                                                                                                                                                                                                    concerning issues, service providers may bill
                                                                                                                                                                                                                                                      Determination of a person's
                                                                                                                                                                                                      for the time used to determine if a MHA is
                                                                                                                                                                              Not specified. No            warranted. Minimally a provisional       immediate treatment needs to
                        Behavioral health screening to                                                                                                                       "out of facility" rate diagnosis must be given to be able to bill establish a provisional diagnosis
                                                                                                    Adult SMI, Adult OP,
       H0002            determine eligibility for              QMHP              Per occurrence                                 $48.95          $48.95        $66.08           available if the      this code and documentation must support        for the purpose of facilitating
                                                                                                      Child/Adol OP                                                                                      the diagnosis. State approved paired
                        admission to treatment program                                                                                                                        service is phone                                                         access to an appropriate
                                                                                                                                                                                                       diagnosis' are eligible for use, including
                                                                                                                                                                                   contact.                                                        provider for full assessment and
                                                                                                                                                                                                          V71.09. May occur when child is not
                                                                                                                                                                                                      present. If screening leads to concerning                treatment.
                                                                                                                                                                                                    information provider must refer for a MHA. If
                                                                                                                                                                                                       provider is serving child, use code when
                                                                                                                                                                                                      screening sibling or parent. Progress note
                                                                                                                                                                                                       must be kept & documented and should
                                                                                                                                                                                                    include: presenting problem description, risk
                                                                                                                                                                                                       screen, A&D or other medical concerns,
                                                                                                                                                                                                     clinical impression and plan. May be used
                                                                                                                                                                                                        with Mobile Crisis auth where they are
                                                                                                                                                                                                    called out and the client doesn't have a valid
                                                                                                                                                                                                                      MH dx code.




                                                                                                                                                                                                    No upper time limit per day. If more than 15
                                                                                                                                                                                                    minutes of service are provided in the same
                                                                                                                                                                                                       day, bill one line and the number of 15
                                                                                                                                                                                                     minute units that comes closest to the total
                                                                                                                                                                                                    service time - DO NOT use multiple lines, 1 Individual counseling or therapy        For QMHP services, this code gives the
                                                                                                                                                                                                       unit each. Treatment plan must specify      in the planned treatment of a       most flexibility in terms of time increments
                                                                                                                                                                              Not specified. No        behavioral health counseling to use this   client's problem(s) as identified    and many MHO's are encouraging its use
                                                                                                                                                                             "out of facility" rate    code. Example: Telephone counseling /      by an assessment and listed in        for QMHP therapy/counseling services.
                        Behavioral Health                   Non-licensed                            Adult SMI, Adult OP,                                                                                  intervention SMI client requesting
       H0004                                                                     Per 15 minutes                                 $97.90          $24.48        $33.04           available if the        counseling or help structuring their day.
                                                                                                                                                                                                                                                      the treatment plan. The          This code to be used for phone contact for
                        Counseling/Therapy                    QMHP                                    Child/Adol OP
                                                                                                                                                                              service is phone Clinical note needs to be able to show that            intended outcome is the          unplanned crises or phone contact may be
                                                                                                                                                                                   contact.                counseling occurred versus case           management, reduction or           planned if medically necessary, clinically
                                                                                                                                                                                                    management in any code that may be used          resolution of the identified         justified and included in the treatment
                                                                                                                                                                                                       with a telephone contact. Code and 15                  problems.                                      plan.
                                                                                                                                                                                                       minute increments addresses telephone
                                                                                                                                                                                                      calls made by prescribers. Do not use to
                                                                                                                                                                                                     replace 908 codes for planned face-to-face
                                                                                                                                                                                                                        therapy.




                                                                                                    Adult SMI, Adult OP,                                                                                                                           See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 AF           See H0004                                MD              Per 15 minutes                                $220.00          $55.00        $74.25             See H0004              See Verity Guidelines H0004
                                                                                                      Child/Adol OP                                                                                                                                  Guidelines H0004                               H0004
                                                                                                    Adult SMI, Adult OP,                                                                                                                           See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 TD           See H0004                                RN              Per 15 minutes                                $130.00          $32.50        $43.88             See H0004              See Verity Guidelines H0004
                                                                                                      Child/Adol OP                                                                                                                                  Guidelines H0004                               H0004
                                                                                                    Adult SMI, Adult OP,                                                                                                                           See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 AS           See H0004                             PMHNP              Per 15 minutes                                $162.50          $40.63        $54.84             See H0004              See Verity Guidelines H0004
                                                                                                      Child/Adol OP                                                                                                                                  Guidelines H0004                               H0004
                                                          Licensed clinical                         Adult SMI, Adult OP,                                                                                                                           See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 AH           See H0004                                                Per 15 minutes                                 $97.90          $24.48        $33.04             See H0004              See Verity Guidelines H0004
                                                            psychologist                              Child/Adol OP                                                                                                                                  Guidelines H0004                               H0004
                                                                                                    Adult SMI, Adult OP,                                                                                                                           See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 AJ           See H0004                              LCSW              Per 15 minutes                                 $97.90          $24.48        $33.04             See H0004              See Verity Guidelines H0004
                                                                                                      Child/Adol OP                                                                                                                                  Guidelines H0004                               H0004



               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                   Oregon Health Plan Mental               MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                        Health Services Criteria                            Tips
                                                                                                                                                           per Unit

                                                                                                                                                                                                See Verity Guidelines H0004. If more
                                                                                                                                                                                               than 15 minutes of service are provided
                                                                                                                                                                                                 in the same day, bill one line and the
                                                                                                                                                                                                number of 15 minute units that comes
                        Behavioral Health                                                                                                                                                        closest to the total service time - DO       See Oregon Health Plan               See MHO Code Workgroup Guidelines
     H0004 HN                                                  QMHA              Per 15 minutes       Incredible Years          $86.25          $21.56        $29.11          See H0004
                        Counseling/Therapy                                                                                                                                                        NOT use multiple lines, 1 unit each.          Guidelines H0005                               H0004
                                                                                                                                                                                                  QMHA may bill for Verity approved
                                                                                                                                                                                               evidence based practice such as follow-
                                                                                                                                                                                                   up phone contact with families in
                                                                                                                                                                                                      "Incredible Years" Program.




                                                                                                                                                                                                                                          Services provided by appropriately
                                                                                                                                                                                                                                           licensed (non-hospital) 24-hour
                        Behavioral Health; Short Term,                                                                                                                                                                                     child and adolescent psychiatric
                                                                                                                                                                                                                                            residential treatment facility for
                        Residential (non-hospital                                                   Child/Adol Psychiatric
                                                                                                                                                             No Out of                                                                        assessment, evaluation and           Room and board. Intensive Evaluation
       H0018            residential treatment program,),                           Per Diem         Residential Intensive       $0.00          $286.00                       Face to Face
                                                                                                                                                              Facility                                                                     stabilization of a child in a secure                Services.
                        without room and board, per                                                  Evaluation Services                                                                                                                     setting under the direction of a
                        diem                                                                                                                                                                                                              board certified child psychiatrist for
                                                                                                                                                                                                                                            up to 90 days. (No other code
                                                                                                                                                                                                                                           may be billed on the same day)




                                                                                                                                                                                                                                           Services provided by appropriately
                                                                                                                                                                                                                                                licensed 24-hour child and
                                                                                                                                                                                                                                            adolescent psychiatric residential
                                                                                                                                                                                                                                          treatment facility (non-medical, non-
                        Behavioral Health, Long Term,                                                                                                                                                                                       acute care where stay is typically
                        Residential Services (non-                                                                                                                                                                                        longer than 30 days). The program
                        medical, non-acute care in a                                                Child/Adol Psychiatric                                                                                                                        must provide a range of
                                                                                                                                                             No Out of                                                                                                          Room and board. Psychiatric Residential
       H0019            residential treatment program                              Per Diem              Residential            $0.00          $345.00                       Face to Face                                                       professional expertise and
                                                                                                                                                              Facility                                                                                                                       Treatment.
                        where stay is typically longer                                               Treatment Services                                                                                                                      treatment services that ensures
                        than 30 days), without room and                                                                                                                                                                                   appropriate and active treatment of
                        board, per diem                                                                                                                                                                                                      a current DSM Axis I diagnosis.
                                                                                                                                                                                                                                               Services must be expected to
                                                                                                                                                                                                                                              improve or maintain the child's
                                                                                                                                                                                                                                            functional level. (No other code
                                                                                                                                                                                                                                           may be billed on the same day)




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                 Oregon Health Plan Mental           MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                      Health Services Criteria                        Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                        Determination of a person's need
                                                                                                                                                                                                                                        for mental health services, based
                                                                                                                                                                                               No minimum time requirement. Only       on the collection and evaluation of
                                                                                                                                                                                                                                         data obtained through interview     "Per Occurrence" Explanation: Bill one
                                                                                                                                                                                               non-licensed QMHPs should use this
                                                                                                                                                                                                                                          and observation of a person's        unit of service per assessment episode
                                                                                                                                                                                               code for mental health assessments.
                                                                                                                                                                                                                                          mental history and presenting       (normally there would not be in excess of
                                                                                                                                                                                                 OAR 309-032-0535 (28)(a). Code
                                                                                                                                                                                                                                          problem(s). The assessment             one episode per day). Billed charges
                                                                                                                                                                                                   not reimbursable by Medicare.
                        Mental Health Assessment, by                                                Adult SMI, Adult OP,                                                                                                               concludes with documentation of a          should reflect either of the following
       H0031                                                   QMHP              Per occurrence                                $117.48         $117.48        $158.60        Face to face       (Assessment authorizations include
                        non-physician                                                                 Child/Adol OP                                                                                                                     diagnosis and a written treatment       approaches: 1) An agency average for
                                                                                                                                                                                                the following codes: H0031, H0002,     plan supported by the assessment       length of the service and provider type or
                                                                                                                                                                                                   T1023, and T1013. CASII and          and interview data. If a person is   2) variable charges for each unit of service
                                                                                                                                                                                               LOCUS are not required but may be           not in need of mental health      billed based on the length of that particular
                                                                                                                                                                                                         billed if completed.)              services, other disposition
                                                                                                                                                                                                                                                                                       episode or provider type.
                                                                                                                                                                                                                                        information, such as to whom the
                                                                                                                                                                                                                                           client was referred, shall be
                                                                                                                                                                                                                                             included in the client file.




                                                                                                                                                                                                                                                                              This code was added for the primary purpose
                                                                                                                                                                                                 No minimum time requirement. Bill                                                  of encountering Child and Family Team
                                                                                                                                                                                               one unit of service per episode. Use                                          meetings under the Children's System Change
                                                                                                                                                                                                                                        Activities to develop, evaluate,
                                                                                                                                                                                               for any client, not just ICTS. Can be                                           Initiative. It is only possible to encounter one
                                                                                                                                                                                                                                           or modify a client's mental        line item, per day, per client, per organization,
                                                                                                                                                                                                  used by each different discipline
                                                                                                                                                                                                                                           health services plan. This             in order to avoid the system rejecting it as
                                                                                                                                                                                                when multiple individuals from each
                                                                                                                                                                                                                                        would include the statement of        duplicate billing. Therefore, multiple staff from
                                                                                                                                                                                               agency attend. Each individual must
                                                                                                                                                                                                                                         treatment or service goals, of         the same organization cannot encounter the
                        Mental Health Service Plan                                                  Adult SMI, Adult OP,                                                                         maintain a separate progress note
       H0032                                                   QMHP              Per occurrence                                 $97.90          $97.90        $132.17        Face to face                                              clinical interventions designed to            service. However, staff from different
                        Development, by non-physician                                                 Child/Adol OP                                                                             for each date of service billed. Can
                                                                                                                                                                                                                                          achieve those goals, and an             organizations who are in attendance may
                                                                                                                                                                                                  also be used for development of                                              encounter this service. This code to be used
                                                                                                                                                                                                                                         evaluation of progress toward
                                                                                                                                                                                                treatment plan if you are developing                                         for service planning and/or treatment planning.
                                                                                                                                                                                                                                        those goals. This activity may
                                                                                                                                                                                                 with the client present. Any agency                                            Billed charges may be submitted at a higher
                                                                                                                                                                                                                                       be repeated periodically and the
                                                                                                                                                                                                  present may bill with appropriate                                                 level on a single line item to account for
                                                                                                                                                                                                                                             plan may be modified.
                                                                                                                                                                                                           documentation.                                                        multiple agency staff in attendance. As with
                                                                                                                                                                                                                                                                                 any code, charges must be based on cost
                                                                                                                                                                                                                                                                                                  allocation plan.




                                                                                                    Adult SMI, Adult OP,                                                                                                               See Oregon Health Plan Criteria
     H0032 TD           See H0032                                RN              Per occurrence                                $130.00         $130.00        $175.50        Face to face          See Verity Guidelines H0032                                         See MHO Code Wordgroup Guidelines H0032
                                                                                                      Child/Adol OP                                                                                                                               H0032

                                                                                                    Adult SMI, Adult OP,                                                                                                               See Oregon Health Plan Criteria
     H0032 HN           See H0032                              QMHA              Per occurrence                                 $86.25          $86.25        $116.44        Face to face          See Verity Guidelines H0032                                         See MHO Code Wordgroup Guidelines H0032
                                                                                                      Child/Adol OP                                                                                                                               H0032

                                                                                                    Adult SMI, Adult OP,                                                                                                               See Oregon Health Plan Criteria
     H0032 AS           See H0032                             PMHNP              Per occurrence                                $162.50         $162.50        $219.38        Face to face          See Verity Guidelines H0032                                         See MHO Code Wordgroup Guidelines H0032
                                                                                                      Child/Adol OP                                                                                                                               H0032

                                                                                                    Adult SMI, Adult OP,                                                                                                               See Oregon Health Plan Criteria
     H0032 AF           See H0032                                MD              Per occurrence                                $220.00         $220.00        $297.00        Face to face          See Verity Guidelines H0032                                         See MHO Code Wordgroup Guidelines H0032
                                                                                                      Child/Adol OP                                                                                                                               H0032




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                     Oregon Health Plan Mental             MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                     Verity Guidelines
                                                                                                                                                Unit                                                                                          Health Services Criteria                          Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                   No upper time limit per day. If more than
                                                                                                                                                                                                   15 minutes of service are provided in the
                                                                                                                                                                                                    same day, bill one line and the number
                                                                                                                                                                                                   of 15 minute units that comes closest to    Activities to instruct, prompt,
                                                                                                                                                                                                     the total service time - DO NOT use                                          Generally face to face. May include
                                                                                                                                                                              No "out of facility"                                              remind or educate clients,
                                                                                                                                                                                                   multiple lines, 1 unit each. May be used                                      phone contact for unplanned crises or
                        Medication Training and                                                     Adult SMI, Adult OP,                                                     rate available if the                                              families, and/or significant
     H0034 HN                                                  QMHA              Per 15 minutes                                 $86.25          $21.56        $29.11                                 by Medication Aide who administers                                        phone contact may be planned if medically
                        Support, per 15 minutes                                                       Child/Adol OP                                                           service is phone                                               others in the correct procedures
                                                                                                                                                                                                   student medications, who monitor parent                                     necessary, clinically justified and included
                                                                                                                                                                                   contact.          permissions, doctors’ order, delivers    for maintaining a prescription
                                                                                                                                                                                                                                                                                        in the treatment plan.
                                                                                                                                                                                                    meds to each individual student at the         medication regimen.
                                                                                                                                                                                                   prescribed times, keeps records of each
                                                                                                                                                                                                   dose, maintains med balances, contacts
                                                                                                                                                                                                      parents and/or physicians for refills.




                                                                                                    Adult SMI, Adult OP,                                                                                                                   See Oregon Health Plan Criteria         See MHO Code Workgroup Guidelines
       H0034            See H0034 HN                           QMHP              Per 15 minutes                                 $97.90          $24.48        $33.04         Same as H0034 HN        See Verity Guidelines H0034 HN
                                                                                                      Child/Adol OP                                                                                                                                 H0034 HN                                  H0034 HN
                                                                                                    Adult SMI, Adult OP,                                                                                                                   See Oregon Health Plan Criteria         See MHO Code Workgroup Guidelines
     H0034 TD           See H0034 HN                             RN              Per 15 minutes                                $130.00          $32.50        $43.88         Same as H0034 HN        See Verity Guidelines H0034 HN
                                                                                                      Child/Adol OP                                                                                                                                 H0034 HN                                  H0034 HN
                                                                                                    Adult SMI, Adult OP,                                                                                                                   See Oregon Health Plan Criteria         See MHO Code Workgroup Guidelines
     H0034 AS           See H0034 HN                          PMHNP              Per 15 minutes                                $162.50          $40.62        $54.84         Same as H0034 HN        See Verity Guidelines H0034 HN
                                                                                                      Child/Adol OP                                                                                                                                 H0034 HN                                  H0034 HN




                                                                                                                                                                                                                                                Structured developmental or
                                                                                                                                                                                                                                           rehabilitative programs designed to
                                                                                                                                                                                                   Code use is limited to no more than       improve or remediate a person's
                                                                                                                                                                                                     five hours per day and limited to     basic functioning in daily living and
                                                                                                                                                                                                    services as defined in the Oregon       community living. Programs shall
                                                                                                                                                                                                   Mental Health Plan Criteria. If more       include a mixture of individual,
                        Community Psychiatric
                                                                                                    Adult SMI, Child/Adol                                    No Out of                                than 15 minutes of service are             group and activity therapy
       H0036            Supportive Treatment, face-to-    QMHA or QMHP           Per 15 minutes                                 $20.00           $5.00                          Face to Face
                                                                                                            OP                                                Facility                              provided in the same day, bill one         components and shall include
                        face, per 15 minutes                                                                                                                                                                                                  therapeutic treatment oriented
                                                                                                                                                                                                    line and the number of 15 minute
                                                                                                                                                                                                   units that comes closest to the total    toward development of a person's
                                                                                                                                                                                                   service time - DO NOT use multiple      emotional and physical capability in
                                                                                                                                                                                                             lines, 1 unit each.              areas of daily living, community
                                                                                                                                                                                                                                               integration, and interpersonal
                                                                                                                                                                                                                                                         functioning.




                                                                                                                                                                                                   Therapeutic Day School programs
                                                                                                                                                                                                    only. If more than 15 minutes of
                                                                                                     Therapeutic Day
                        Community Psychiatric                                                                                                                                                       service are provided in the same
                                                                                                     School and Early                                        No Out of
     H0036 HA           Supportive Treatment, face-to-    QHMA or QMHP           Per 15 minutes                                 $20.00           $5.00                          Face to Face       day, bill one line and the number of
                                                                                                    Childhood Programs                                        Facility
                        face, per 15 minutes                                                                                                                                                      15 minute units that comes closest to
                                                                                                           only
                                                                                                                                                                                                  the total service time - DO NOT use
                                                                                                                                                                                                        multiple lines, 1 unit each.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                   Oregon Health Plan Mental               MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                        Health Services Criteria                            Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                          Services provided by appropriately
                                                                                                                                                                                                                                             licensed child and adolescent
                                                                                                                                                                                                                                           community-based psychiatric day
                                                                                                                                                                                                                                         treatment facilities to children with a
                                                                                                                                                                                                                                          primary Axis I DSM diagnosis, and
                                                                                                                                                                                                                                           their families. The program must
                                                                                                                                                                                                                                            provide a range of professional
                                                                                                                                                                                                                                               expertise and individualized
                        Community psychiatric
                                                                                                                                                             No Out of                                                                        treatment services, including
       H0037            supportive treatment program,                               Per diem            OP Child/Adol           $0.00          $153.50                       Face to Face                                                                                               Psychiatric Day Treatment.
                                                                                                                                                              Facility                                                                         psychiatric services, family
                        per diem                                                                                                                                                                                                            treatment and other therapeutic
                                                                                                                                                                                                                                               activities integrated with an
                                                                                                                                                                                                                                             accredited education program.
                                                                                                                                                                                                                                          Services must provide at least four
                                                                                                                                                                                                                                          hours/day in preschool - fifth grade
                                                                                                                                                                                                                                          and five hours/day in sixth - twelfth
                                                                                                                                                                                                                                           grade programs for a minimum of
                                                                                                                                                                                                                                                    230 days per year.




                                                                                                                                                                                              No upper time limit per day. If more than 15
                                                                                                                                                                                              minutes of service are provided in the same
                                                                                                                                                                                                  day, bill one line and the number of 15      Services provided by peers
                                                                                                                                                                                               minute units that comes closest to the total
                                                                                                                                                                                                                                                (mental health consumers)
                                                                                                                                                                                              service time - DO NOT use multiple lines, 1
                                                                                                                                                                                              unit each. Former and/or current clients who         include a wide range of
                                                                                                                                                                                                 are now paid employees of a community             supports, services, and
                                                                                                                                                                                              mental health program that do not qualify as advocacy that contribute to a
                                                                                                                                                                                              QMHA are considered a 'peer' and therefore         client's ability to engage in
                                                                                                                                                                                                 provider can bill H0038 for their services      ongoing treatment. These
                        Self-help/peer services, per 15                                             Adult SMI, Adult OP,                                                                      when the individual is employed in a mental
       H0038                                                    Peer             Per 15 minutes                                 $60.00          $15.00        $20.25          No limitation     health service role. Use of peer services
                                                                                                                                                                                                                                             services may include but are not
                        min                                                                           Child/Adol OP
                                                                                                                                                                                                must be identified in treatment plan to be      limited to: self-help support
                                                                                                                                                                                              billable. These services may include but are        groups, drop-in centers,
                                                                                                                                                                                              not limited to: self-help support groups, drop- outreach services, education
                                                                                                                                                                                              in centers, outreach services, education and        and advocacy. Persons
                                                                                                                                                                                               advocacy. Persons performing this activity
                                                                                                                                                                                                                                               performing this activity have
                                                                                                                                                                                               have experience in treatment and recovery.
                                                                                                                                                                                                 Billed activities require supervision. For    experience in treatment and
                                                                                                                                                                                                      each date of service using code                      recovery.
                                                                                                                                                                                              documentation must show service provided,
                                                                                                                                                                                                     time spent and signature of peer.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                  Oregon Health Plan Mental             MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                Unit                                                                                       Health Services Criteria                          Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                           Services provided in a properly
                                                                                                                                                                                                                                          licensed 24-hour facility by non-
                                                                                                                                                                                                                                         medical professionals within their
                                                                                                                                                                                                                                        scopes of licensure or certification.
                                                                                                                                                                                                                                            Services must be reasonably
                        Respite Care Services, not in                                                                                                        No Out of                                                                   expected to improve or maintain
     H0045 HB                                                                       Per diem         Adult SMI, Adult OP        $0.00          $260.00                       Face to Face                                                                                       Non-medical facility-based respite care.
                        the Home, per diem                                                                                                                    Facility                                                                   the condition and functional level
                                                                                                                                                                                                                                               and prevent relapse or
                                                                                                                                                                                                                                         hospitalization. Services include
                                                                                                                                                                                                                                        assessment, supervision, structure
                                                                                                                                                                                                                                               and support, and case
                                                                                                                                                                                                                                                    coordination.




                        Respite Care Services, not in                                                                                                        No Out of                                                                  See Oregon Health Plan Criteria
       H0045                                                                        Per diem            Child/Adol OP           $0.00          $145.00                       Face to Face                                                                               Non-medical facility-based respite care.
                        the Home, per diem                                                                                                                    Facility                                                                           H0045 HB



                                                                                                                                                                                               No upper time limit per day. If more than
                                                                                                                                                                                               15 minutes of service are provided in the
                                                                                                                                                                                                same day, bill one line and the number Services delivered by a QMHP
                                                                                                                                                                                               of 15 minute units that comes closest to        related to the prescribing,
                        Comprehensive Medication                                                    Adult SMI, Adult OP,                                                                          the total service time - DO NOT use       dispensing, administration and
       H2010                                                   QMHP              Per 15 minutes                                 $97.90          $24.48        $33.04          No limitation
                        Services, per 15 minutes                                                      Child/Adol OP                                                                            multiple lines, 1 unit each. Out of facility management of medications.
                                                                                                                                                                                               differential for face-to-face services only.      Use 90882 for calls to
                                                                                                                                                                                                Appropriately licensed staff should use                pharmacy.
                                                                                                                                                                                               908 codes unless face-to-face limitation
                                                                                                                                                                                                               prevents use.



                                                                                                    Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2010 TD           See H2010                                RN              Per 15 minutes                                $130.00          $32.50        $43.88          No limitation        See Verity Guidelines H2010
                                                                                                      Child/Adol OP                                                                                                                                H2010
                                                                                                    Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2010 AS           See H2010                             PMHNP              Per 15 minutes                                $162.50          $40.63        $54.84          No limitation        See Verity Guidelines H2010
                                                                                                      Child/Adol OP                                                                                                                                H2010
                                                                                                    Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2010 AF           See H2010                                MD              Per 15 minutes                                $220.00          $55.00        $74.25          No limitation        See Verity Guidelines H2010
                                                                                                      Child/Adol OP                                                                                                                                H2010



                                                                                                                                                                                               No upper time limt per day . If more
                                                                                                                                                                                                                                      Unplanned face-to-face acute
                                                                                                                                                                                                   than 15 minutes of service are
                                                                                                                                                                                                                                      non-hospital intervention by a
                                                                                                                                                                                                provided in the same day, bill one
                                                                                                                                                                                                                                          QMHP that is needed
                                                                                                                                                                                                line and the number of 15 minute
                                                                                                                                                                                                                                       immediately in response to
                        Crisis intervention services, per                                           Adult SMI, Adult OP,                                                                       units that comes closest to the total
       H2011                                                   QMHP              Per 15 minutes                                $117.48          $29.38        $39.66         Face to face                                              actual or perceived threat of
                        15 min                                                                        Child/Adol OP                                                                            service time - DO NOT use multiple
                                                                                                                                                                                                                                     harm to self or others, or risk of
                                                                                                                                                                                                  lines, 1 unit each. OK to use for
                                                                                                                                                                                                                                        substantial and immediate
                                                                                                                                                                                               Emergency Department visits made
                                                                                                                                                                                                                                       deterioration of mental and
                                                                                                                                                                                                 by OP providers. Use 90882 or
                                                                                                                                                                                                                                          emotional functioning.
                                                                                                                                                                                                 T1016 if not a crisis intervention.



                        Crisis intervention services, per                                           Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2011 HN                                                  QMHA              Per 15 minutes                                $103.50          $25.87        $34.93         Face to face          See Verity Guideline H2011
                        15 min                                                                        Child/Adol OP                                                                                                                                H2011
                        Crisis intervention services, per                                           Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2011 AF                                                    MD              Per 15 minutes                                $264.00          $66.00        $89.10         Face to face          See Verity Guideline H2011
                        15 min                                                                        Child/Adol OP                                                                                                                                H2011
                        Crisis intervention services, per                                           Adult SMI, Adult OP,                                                                                                                See Oregon Health Plan Criteria
     H2011 TD                                                    RN              Per 15 minutes                                $156.00          $39.00        $52.65         Face to face          See Verity Guideline H2011
                        15 min                                                                        Child/Adol OP                                                                                                                                H2011


               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                Oregon Health Plan Mental              MHO Code Workgroup Guidelines and
  CPT/HCPC Code                      Service                 Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                     Health Services Criteria                           Tips
                                                                                                                                                           per Unit
                        Crisis intervention services, per                                           Adult SMI, Adult OP,                                                                                                              See Oregon Health Plan Criteria
     H2011 AS                                                  PMHNP             Per 15 minutes                                $195.00          $48.74        $65.80         Face to Face          See Verity Guideline H2011
                        15 min                                                                        Child/Adol OP                                                                                                                              H2011




                                                                                                                                                                                                                                      Children's psychiatric day treatment
                                                                                                                                                                                                                                          services as defined in H0037,
                                                                                                                                                                                                                                      except provided on an hourly basis
                                                                                                                                                                                                                                       when an enrolled client's absence
                                                                                                                                                                                                                                          or transition precludes client's
                        Behavioral Health Day                                                                                                                No Out of
       H2012                                                QMHP or QMHA            Per hour            Child/Adol OP           $36.00          $36.00                       Face to face                                              receipt of the minimum number of             Psychiatric Day Treatment.
                        Treatment, per hour                                                                                                                   Facility
                                                                                                                                                                                                                                      per diem hours required for H0037.
                                                                                                                                                                                                                                        Services must be included in the
                                                                                                                                                                                                                                      client's treatment plan, documented
                                                                                                                                                                                                                                        in the client's clinical record, and
                                                                                                                                                                                                                                         provided by a QMHP or QMHA.




                        Psychiatric health facility                                                 Adult SMI, Adult OP,                                     No Out of
       H2013                                                                        Per diem                                   $520.00         $520.00                                                                                                                                      Subacute
                        service, per diem                                                             Child/Adol OP                                           Facility




                                                                                                                                                                                                                                           A program of rehabilitation
                                                                                                                                                                                                                                         designed to reduce or resolve
                                                                                                                                                                                                                                        identified barriers and improve
                                                                                                                                                                                                                                           social functioning in areas
                                                                                                                                                                                                                                         important to establishing and
                                                                                                                                                                                                                                      maintain clients in the community;
                                                                                                                                                                                                                                       e.g., home, peer group, work or
                                                                                                                                                                                                Use for skills based group training school. Activities are delivered to
                                                                                                                                                                                                                                         more than one client and are    This is a group skills training service and
                        Skills Training and                                                         Adult SMI, Adult OP,                                                                       45 min duration or less. Service must
     H2014 HN                                                  QMHA              Per 15 minutes                                 $26.00           $6.50         $8.78         Face to Face                                                   designed to promote skill       cannot be used in continuation with
                        Development, per 15 minutes                                                   Child/Adol OP                                                                               also match Oregon Health Plan
                                                                                                                                                                                                                                        development in areas such as                      G0177.
                                                                                                                                                                                                         Service Criteria.                   decision-making, anger
                                                                                                                                                                                                                                           management and coping,
                                                                                                                                                                                                                                     community awareness and mobility,
                                                                                                                                                                                                                                             self esteem and money
                                                                                                                                                                                                                                          management. Skills training
                                                                                                                                                                                                                                          reduces symptomalogy and
                                                                                                                                                                                                                                       promotes community integration
                                                                                                                                                                                                                                               and job readiness.




                        Skills Training and                                                         Adult SMI, Adult OP,                                                                                                              See Oregon Health Plan Criteria           See MHO Code Workgroup Guideline
       H2014                                                   QMHP              Per 15 minutes                                 $29.52           $7.38         $9.96         Face to Face          See Verity Guideline H2014
                        Development, per 15 minutes                                                   Child/Adol OP                                                                                                                              H2014                                      H2014




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                             Oregon Health Plan Mental           MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                        Verity Guidelines
                                                                                                                                                Unit                                                                                                  Health Services Criteria                        Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                                    Individualized, community-based
                                                                                                                                                                                                     Max of 8 units per day. If more than 15        clinical interventions, delivered as
                                                                                                                                                                                                      minutes of service are provided in the              an alternative or addition to
                                                                                                                                                                                                     same day, bill one line and the number            traditional services, that are as
                                                                                                                                                                                                     of 15 minute units that comes closest to        likely or more likely to effectively
                                                                                                                                                                                                       the total service time - DO NOT use               treat a client's mental health
                                                                                                                                                                              Not specified. No        multiple lines, 1 unit each. Services         condition. Services may include
                                                                                                                                                                             "out of facility" rate     must meet the ICTS OAR's and are             informal supports and resources      Similar to T1005 but wraparound. Can
                        Community based wraparound
     H2021 HN                                                  QMHA              Per 15 minutes     Child/Adol OP (ICTS)        $99.20          $24.80        $33.48           available if the         provided in home, school and other            and are provided to a client and    use for Individual Skills Training utilizing
                        services, per 15 minutes
                                                                                                                                                                              service is phone environments. This code is to be used                      family members in order to                    15 minute unit.
                                                                                                                                                                                   contact.              for face to face and out of facility           promote, maintain, or restore
                                                                                                                                                                                                     services only, except for family search             successful community living.
                                                                                                                                                                                                    practices. It is allowable to use this code    Services are delivered as the result
                                                                                                                                                                                                    for in facility family search efforts. Other   of a collaborative planning process
                                                                                                                                                                                                    in facility services must use pre-existing       and are provided in a manner or
                                                                                                                                                                                                                standard CPT codes.                 place different from the traditional
                                                                                                                                                                                                                                                   manner or place of service delivery.




                                                                                                                                                                              Not specified. No
                                                                                                                                                                             "out of facility" rate
                                                                                                                                                                                                                                                   See Oregon Health Plan Criteria        See MHO Code Workgroup Guideline
       H2021            See H2021 HN                           QMHP              Per 15 minutes     Child/Adol OP (ICTS)       $112.60          $28.15        $38.00           available if the         See Verity Guideline H2021 HN
                                                                                                                                                                                                                                                            H2021 HN                                H2021 HN
                                                                                                                                                                              service is phone
                                                                                                                                                                                   contact.



                                                                                                                                                                                                       For clients with ICTS authorizations
                                                                                                                                                                                                      only.For pre-approved providers who
                                                                                                                                                                                                    meet the ICTS OAR's and are providing
                                                                                                                                                                              Not specified. No the most intensive level of wraparound
                                                                                                                                                                             "out of facility" rate service. Services are provided at all
                        Community based wraparound                                                                                                                                                                                            See Oregon Health Plan Criteria
     H2022 HN                                             QMHA or QMHP              Per diem        Child/Adol OP (ICTS)       $215.00         $215.00        $290.25          available if the hours of the day and week depending on                                                                       ICTS
                        services, per diem                                                                                                                                                                                                             H2021 HN
                                                                                                                                                                              service is phone the current family need. Services will be
                                                                                                                                                                                   contact.           provided in home, school, community
                                                                                                                                                                                                     and in facility. This code also includes
                                                                                                                                                                                                    family search practices. Blended QMHA
                                                                                                                                                                                                                 and QMHP rate.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                       Oregon Health Plan Mental           MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                     Verity Guidelines
                                                                                                                                                Unit                                                                                            Health Services Criteria                        Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                                                                     Psycho education involves teaching people
                                                                                                                                                                                                                                                                                   about their problem, how to treat it, and how to
                                                                                                                                                                                                     No upper time limit per day. If more     Activities to provide information    recognize signs of relapse so that they can get
                                                                                                                                                                                                         than 15 minutes of service are            and education to clients,           necessary treatment before their difficulty
                                                                                                                                                                                                      provided in the same day, bill one       families, and significant others        worsens or occurs again. Family psycho
                                                                                                                                                                              Not specified. No                                                                                     education includes teaching coping strategies
                                                                                                                                                                                                       line and the number of 15 minute      regarding mental disorders and
                                                                                                                                                                             "out of facility" rate                                                                                 and problem-solving skills to families, friends,
                        Psychoeducational service, per                                              Adult SMI, Adult OP,                                                                             units that comes closest to the total       their treatment. This activity
       H2027                                                   QMHP              Per 15 minutes                                 $25.00           $6.25         $8.44           available if the                                                                                        and/or caregivers to help them deal more
                        15 min                                                                        Child/Adol OP                                                                                  service time - DO NOT use multiple      acknowledges the importance of
                                                                                                                                                                              service is phone                                                                                        effectively with the individual. This code is
                                                                                                                                                                                                    lines, 1 unit each. Use for Incredible    involving significant others who         used for medication management groups.
                                                                                                                                                                                   contact.
                                                                                                                                                                                                    Years parent series 2 hour sessions.       may be essential in assisting a      Psycho education is not therpay or treatment.
                                                                                                                                                                                                          Use additionally for all other        client to maintain treatment to    It is designed to stand alone or to complement
                                                                                                                                                                                                          psychoeducation by QMHP.                          recover.                psychotherapy. It is designed to be part of an
                                                                                                                                                                                                                                                                                       overall treatment plan. It is different than
                                                                                                                                                                                                                                                                                               therapeutic group therapy.




                                                                                                    Adult SMI, Adult OP,                                                                                                                     See Oregon Health Plan Criteria         See MHO Code Workgroup Guideline
     H2027 TD           See H2027                                RN              Per 15 minutes                                 $33.20           $8.30        $11.20            See H2027              See Verity Guideline H2027
                                                                                                      Child/Adol OP                                                                                                                                     H2027                                    H2027
                                                                                                    Adult SMI, Adult OP,                                                                                                                     See Oregon Health Plan Criteria         See MHO Code Workgroup Guideline
     H2027 AS           See H2027                             PMHNP              Per 15 minutes                                 $44.08          $11.02        $14.88            See H2027              See Verity Guideline H2027
                                                                                                      Child/Adol OP                                                                                                                                     H2027                                    H2027




                                                                                                                                                                                                                                                   Therapeutic activities in a
                                                                                                                                                                                                                                                 structured setting designed to
                                                                                                                                                                                                   No upper time limit per day. If more      improve social functioning, promote
                                                                                                                                                                                                       than 15 minutes of service are         community integration and reduce
                                                                                                                                                                                                     provided in the same day, bill one      symptomatology in areas important
                                                                                                                                                                                                                                                to maintaining or reestablishing
                                                                                                    Adult SMI, Adult OP,                                                                             line and the number of 15 minute
     H2032 HN           Activity therapy, per 15 minutes       QMHA              Per 15 minutes                                 $86.25          $21.56        $29.11            Face-to-face                                                      residency in the community.
                                                                                                      Child/Adol OP                                                                                 units that comes closest to the total
                                                                                                                                                                                                                                              Activities may be delivered on an
                                                                                                                                                                                                    service time - DO NOT use multiple         individual or group basis and are
                                                                                                                                                                                                   lines, 1 unit each. This service to be           designed to promote skill
                                                                                                                                                                                                   delivered on an individual basis only.       development and meet specific
                                                                                                                                                                                                                                             goals and measurable objectives in
                                                                                                                                                                                                                                                       the treatment plan.




                                                                                                    Adult SMI, Adult OP,                                                                                                                     See Oregon Health Plan Criteria
       H2032            Activity therapy, per 15 minutes       QMHP              Per 15 minutes                                 $97.90          $24.48        $33.04            Face-to-face         See Verity Guideline H2032 HN
                                                                                                      Child/Adol OP                                                                                                                                   H2032 HN




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                Oregon Health Plan Mental              MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                     Health Services Criteria                           Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                     Intensive, time-limited, home-based
                                                                                                                                                                                                                                      services delivered by appropriately
                                                                                                                                                                                                                                           licensed, proprietary MST
                                                                                                                                                                                                                                             programs, consisting of
                                                                                                                                                                                               No upper time limit per day. If more     individualized, comprehensive,
                                                                                                                                                                                                  than 15 minutes of service are     integrated system interventions and
                                                                                                                                                                                                                                        empirically validated treatment
                                                                                                                                                                                                provided in the same day, bill one
                        Multisystemic therapy for                                                                                                                                                                                        approaches targeting multiple
       H2033                                                   QMHP              Per 15 minutes     OP Child/Adolescent        $100.00          $25.00        $33.75         Face-to-face       line and the number of 15 minute
                        juveniles, per 15 minutes                                                                                                                                                                                        systems involved with a client,
                                                                                                                                                                                               units that comes closest to the total     including peer, family, school,
                                                                                                                                                                                               service time - DO NOT use multiple neighborhood, indigenous support
                                                                                                                                                                                                         lines, 1 unit each.              network, and formal agency
                                                                                                                                                                                                                                          systems. MST is designed to
                                                                                                                                                                                                                                      promote behavior change in youth
                                                                                                                                                                                                                                          that have evidenced serious
                                                                                                                                                                                                                                     juvenile justice system involvement.




                                                                                                                                                                                                                                          Services provided in home or
                                                                                                                                                                                                                                         community to either a family or
                                                                                                                                                                                                                                       individual client, including services
                                                                                                                                                                                                                                        such as respite, aides, recreation,
                                                                                                                                                                                                                                         homemaker, behavior monitor,
                                                                                                                                                                                                                                      tutor or mentor, provided by agency
                                                                                                                                                                                                                                         staff under agency supervision.
                                                                                                                                                                                                                                        Agency supervision shall include
                        Respite Care, in the home, per                                                                                                                                                                                 training, supervision in adhering to
       S9125                                                                        Per diem            Child/Adol OP           $0.00           $70.00        $94.50         Face to Face
                        diem                                                                                                                                                                                                              the client treatment plan, and
                                                                                                                                                                                                                                          emergency back-up support.
                                                                                                                                                                                                                                       Travel time is factored into the rate
                                                                                                                                                                                                                                          and may not be billed under a
                                                                                                                                                                                                                                         separate code. Family support
                                                                                                                                                                                                                                             services are particularly
                                                                                                                                                                                                                                       appropriate when there are severe
                                                                                                                                                                                                                                           behavioral problems, which
                                                                                                                                                                                                                                                   increase risk.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                   Oregon Health Plan Mental                 MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                                        Health Services Criteria                              Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                        Services provided in home or
                                                                                                                                                                                                                                       community to either a family or
                                                                                                                                                                                                                                     individual client, including services
                                                                                                                                                                                                                                      such as respite, aides, recreation,
                                                                                                                                                                                                                                       homemaker, behavior monitor,
                                                                                                                                                                                               No upper time limit per day. If more tutor or mentor, provided by agency
                                                                                                                                                                                                  than 15 minutes of service are       staff under agency supervision.
                                                                                                                                                                                                                                      Agency supervision shall include      Similar to H2021 but respite care. May
                                                                                                                                                                                                provided in the same day, bill one
                        Respite Care Services, up to 15                                                                                                                                                                              training, supervision in adhering to use for consumer mentoring programs.
     T1005 HN                                                  QMHA             Up to 15 minutes        Child/Adol OP           $16.00           $4.00         $5.40         Not specified      line and the number of 15 minute
                        minutes                                                                                                                                                                                                         the client treatment plan, and     Upper payment limit 32 units/8 hours per
                                                                                                                                                                                               units that comes closest to the total    emergency back-up support.                           day.
                                                                                                                                                                                               service time - DO NOT use multiple Travel time is factored into the rate
                                                                                                                                                                                                         lines, 1 unit each.            and may not be billed under a
                                                                                                                                                                                                                                       separate code. Family support
                                                                                                                                                                                                                                           services are particularly
                                                                                                                                                                                                                                     appropriate when there are severe
                                                                                                                                                                                                                                         behavioral problems, which
                                                                                                                                                                                                                                                 increase risk.




                        Respite Care Services, up to 15                                                                                                                                                                                  See Oregon Health Plan Criteria              See Mho Code Workgroup Guideline
       T1005                                                   QMHP             Up to 15 minutes        Child/Adol OP           $18.17           $4.54         $6.13         Not specified       See Verity Guideline T1005 HN
                        minutes                                                                                                                                                                                                                   T1005 Hn                                       T1005 HN




                                                                                                                                                                                                                                         Sign language/oral interpreter services
                                                                                                                                                                                                                                           necessary to ensure the provision of
                                                                                                                                                                                                                                           services for individuals with hearing
                                                                                                                                                                                                                                                 impairments or in the primary
                                                                                                                                                                                               No upper time limit per day. If more          language of non-English speaking
                                                                                                                                                                                                   than 15 minutes of service are         individuals. Such interpreters will be
                                                                                                                                                                                                provided in the same day, bill one             linguistically appropriate and be
                                                                                                                                                                                                                                          capable of communicating in English
                                                                                                                                                                                                line and the number of 15 minute               and the primary language of the
                                                                                                                                                                                               units that comes closest to the total         individual and be able to translate
                        Sign Language or Oral
                                                                                                    Adult SMI, Adult OP,                                     No Out of                        service time - DO NOT use multiple                 clinical information effectively.
       T1013            Interpretive services, per 15        Interpreter         Per 15 minutes                                 $30.60           $7.65                       Face to Face                                                Reimbursement for interpreter services
                                                                                                      Child/Adol OP                                           Facility                            lines, 1 unit each. See provider
                        minutes                                                                                                                                                                                                               is only allowed when provided in
                                                                                                                                                                                                manual for instructions. Interpreter
                                                                                                                                                                                                                                          conjunction with another service such
                                                                                                                                                                                               code may not be used in addition to            as assessment, individual/family
                                                                                                                                                                                                 therapy or other codes if mental                therapy or group therapy, etc.
                                                                                                                                                                                              health provider is bi-lingual. Not to be   Whenever feasible, individuals should
                                                                                                                                                                                              used with interactive psychotherapy.          receive services from staff who are
                                                                                                                                                                                                                                                able to provide sign and/or oral
                                                                                                                                                                                                                                             interpretive services. In this case,
                                                                                                                                                                                                                                         interpreter services cannot be billed in
                                                                                                                                                                                                                                            addition to the therapeutic service.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                                         Oregon Health Plan Mental        MHO Code Workgroup Guidelines and
  CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                       Verity Guidelines
                                                                                                                                                Unit                                                                                              Health Services Criteria                     Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                    No upper time limit per day. If more than
                                                                                                                                                                                                    15 minutes of service are provided in the
                                                                                                                                                                                                     same day, bill one line and the number
                                                                                                                                                                                                     of 15 minute units that comes closest to          Services provided for
                                                                                                                                                                                                       the total service time - DO NOT use       coordinating the access to and
                                                                                                                                                                              Not specified. No         multiple lines, 1 unit each. Can and       provision of services from
                                                                                                                                                                             "out of facility" rate should be billed for services provided       agencies, establishing service
                        Case Management, per 15                                                     Adult SMI, Adult OP,
       T1016                                                   QMHP              Per 15 minutes                                 $97.90          $24.48        $33.05           available if the             during hospitalization. Case             linkages, advocating for           May include phone calls
                        minutes                                                                       Child/Adol OP
                                                                                                                                                                              service is phone           management one-to-one meeting          treatment needs, and providing
                                                                                                                                                                                   contact.             between prescriber and other staff            assistance in obtaining
                                                                                                                                                                                                     "advocating for treatment needs". Use      entitlements based on mental or
                                                                                                                                                                                                    90882 if documentation aligns better with           emotional disability.
                                                                                                                                                                                                        that service. Case management is
                                                                                                                                                                                                          payable only when it is the sole
                                                                                                                                                                                                            responsibility of this agency.




                                                                                                                                                                                                     No upper time limit per day. If more
                                                                                                                                                                                                         than 15 minutes of service are
                                                                                                                                                                                                       provided in the same day, bill one
                                                                                                                                                                                                       line and the number of 15 minute
                                                                                                                                                                                                      units that comes closest to the total
                                                                                                                                                                              Not specified. No service time - DO NOT use multiple
                                                                                                                                                                             "out of facility" rate lines, 1 unit each. Can and should be
                                                                                                    Adult SMI, Adult OP,                                                                                                                    See Oregon Health Plan Criteria        See MHO Code Workgroup Guideline
     T1016 HN           See T1016                              QMHA              Per 15 minutes                                 $86.25          $21.56        $29.11           available if the        billed for services provided during
                                                                                                      Child/Adol OP                                                                                                                                    T1016                                   T1016
                                                                                                                                                                              service is phone        hospitalization. Case management
                                                                                                                                                                                   contact.               one-to-one meeting between
                                                                                                                                                                                                            prescriber and other staff
                                                                                                                                                                                                       "advocating for treatment needs".
                                                                                                                                                                                                      Case management is payable only
                                                                                                                                                                                                      when it is the sole responsibility of
                                                                                                                                                                                                                   this agency.



                                                                                                                                                                              Not specified. No
                                                                                                                                                                             "out of facility" rate
                        Case Management, per 15                                                     Adult SMI, Adult OP,                                                                                                                        See Oregon Health Plan Criteria    See MHO Code Workgroup Guideline
      T1016 TD                                                   RN              Per 15 minutes                                $130.00          $32.50        $43.88           available if the          See Verity Guideline T1016
                        minutes                                                                       Child/Adol OP                                                                                                                                        T1016                               T1016
                                                                                                                                                                              service is phone
                                                                                                                                                                                   contact.




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                               Out Of Facility
  County/Verity Fee                                                                                                                                            Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                           135%

                                                                                                                                                          Verity Out of
                                                                                                                                               Verity per                                                                                    Oregon Health Plan Mental             MHO Code Workgroup Guidelines and
   CPT/HCPC Code                     Service                  Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                  Verity Guidelines
                                                                                                                                                 Unit                                                                                         Health Services Criteria                          Tips
                                                                                                                                                            per Unit




                                                                                                                                                                                                                                               Screening or evaluation of the
                                                                                                                                                                                                                                              mental health service needs of
                                                                                                                                                                                                No minimum time requirement. Use only
                                                                                                                                                                                                                                                 clients for consideration of
                                                                                                                                                                                                for each CASII or LOCUS level of need
                        Screening to determine the                                                                                                                                                                                            admission to inpatient hospital
                                                                                                                                                                                                      determination administered.
                        appropriateness of                                                                                                                                                                                                      psychiatric programs, partial
                                                                                                                                                                                                 Documentation consists of completed
                                                                                                                                                                                                                                               psychiatric hospital programs,
                        consideration of an individual for                                                                                                                                       LOCUS or CASII. Determination does
                                                                                                     Adult SMI, Adult OP,                                                                                                                   residential treatment, or outpatient
        T1023           participation in a specified            QMHP              Per occurrence                                 $97.90          $32.65        $44.08         Not specified       not require face-to-face since initial
                                                                                                       Child/Adol OP                                                                                                                         treatment services. This service
                        program, project, or treatment                                                                                                                                           Level of Care determination follows a
                                                                                                                                                                                                                                                 differs from a mental health
                        protocol, per encounter (15 - 20                                                                                                                                          mental health assessment. Annual
                                                                                                                                                                                                                                           assessment in that the activity may
                        minutes)                                                                                                                                                                updates don’t have to be face-to-face if
                                                                                                                                                                                                                                           require not only the evaluation of a
                                                                                                                                                                                                mental health assessment update is less
                                                                                                                                                                                                                                             client's treatment needs, but also
                                                                                                                                                                                                           than 60 days old.
                                                                                                                                                                                                                                           an evaluation of available treatment
                                                                                                                                                                                                                                                            options.




Additional CPT codes



                                                                                                                                                                                                                                                                                       Initial inpatient consultation for a new or
                                                                                                                                                                                                                                                                                   established patient, which requires these three
                                                                                                                                                                                                                                                                                   key componenets: a problem focused history;
                                                                                                                                                                                                                                                                                         a problem focused examination; and
                                                                                                                                                                                                                                                                                      straightforward medical decision making.
                                                                                                     Adult SMI, Adult OP,                                     No Out of
        99251           Initial inpatient consultation       MD or PMHNP             20 min.                                                     $54.17                                                                                                                             Counseling and/or coordination of care with
                                                                                                       Child/Adol OP                                           Facility
                                                                                                                                                                                                                                                                                      other providers or agencies are provided
                                                                                                                                                                                                                                                                                    consistent with the nature of the problem(s)
                                                                                                                                                                                                                                                                                        and the patient's and/or family's needs.
                                                                                                                                                                                                                                                                                     Usually, the presenting problem(s) are self
                                                                                                                                                                                                                                                                                                     limited or minor.




                                                                                                                                                                                                                                                                                       Initial inpatient consultation for a new or
                                                                                                                                                                                                                                                                                   established patient, which requires these three
                                                                                                                                                                                                                                                                                   key components: a problem focused history; a
                                                                                                                                                                                                                                                                                          problem focused examination; and
                                                                                                                                                                                                                                                                                      straightforward medical decision making.
                                                                                                     Adult SMI, Adult OP,                                     No Out of
        99252           Initial inpatient consultation       MD or PMHNP             40 min.                                                    $108.34                                                                                                                             Counseling and/or coordination of care with
                                                                                                       Child/Adol OP                                           Facility
                                                                                                                                                                                                                                                                                      other providers or agencies are provided
                                                                                                                                                                                                                                                                                     consistent with the nature of the problem's)
                                                                                                                                                                                                                                                                                        and the patient's and/or family's needs.
                                                                                                                                                                                                                                                                                    Usually, the presenting problem's) are of low
                                                                                                                                                                                                                                                                                                          severity.




                Modifier Definitions:
                HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

                1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls
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    Multnomah                                                                                                                                              Out Of Facility
  County/Verity Fee                                                                                                                                           Weight
Schedule Effective on
DOS 11/1/09 and after                                                                                                                                          135%

                                                                                                                                                         Verity Out of
                                                                                                                                              Verity per                                                                    Oregon Health Plan Mental   MHO Code Workgroup Guidelines and
  CPT/HCPC Code                      Service                 Staff Code           Time/Units        Applicable Program Verity per Hour                   Facility Rate Mode Limitations                 Verity Guidelines
                                                                                                                                                Unit                                                                         Health Services Criteria                Tips
                                                                                                                                                           per Unit




                                                                                                                                                                                                                                                            Initial inpatient consultation for a new or
                                                                                                                                                                                                                                                        established patient, which requires these three
                                                                                                                                                                                                                                                             key componenets: a detailed history; a
                                                                                                                                                                                                                                                          detailed examination; and medical decision
                                                                                                    Adult SMI, Adult OP,                                     No Out of                                                                                   making of low complexity. Counseling and/or
       99253            Initial inpatient consultation     MD or PMHNP              55 min.                                                    $162.51
                                                                                                      Child/Adol OP                                           Facility                                                                                    coordination of care with other providers or
                                                                                                                                                                                                                                                           agencies are provided consistent with the
                                                                                                                                                                                                                                                           nature of the problem(s) and the patient's
                                                                                                                                                                                                                                                        and/or family's needs. Usually, the presenting
                                                                                                                                                                                                                                                              problem(s) are of moderate severity.




                                                                                                                                                                                                                                                            Initial inpatient consultation for a new or
                                                                                                                                                                                                                                                        established patient, which requires these three
                                                                                                                                                                                                                                                             key componenets: a detailed history; a
                                                                                                                                                                                                                                                          detailed examination; and medical decision
                                                                                                    Adult SMI, Adult OP,                                     No Out of                                                                                   making of low complexity. Counseling and/or
       99254            Initial inpatient consultation     MD or PMHNP              80 min.                                                    $216.68
                                                                                                      Child/Adol OP                                           Facility                                                                                    coordination of care with other providers or
                                                                                                                                                                                                                                                           agencies are provided consistent with the
                                                                                                                                                                                                                                                           nature of the problem(s) and the patient's
                                                                                                                                                                                                                                                        and/or family's needs. Usually, the presenting
                                                                                                                                                                                                                                                              problem(s) are of moderate severity.




                                                                                                                                                                                                                                                            Initial inpatient consultation for a new or
                                                                                                                                                                                                                                                        established patient, which requires these three
                                                                                                                                                                                                                                                             key componenets: a detailed history; a
                                                                                                                                                                                                                                                          detailed examination; and medical decision
                                                                                                    Adult SMI, Adult OP,                                     No Out of                                                                                   making of low complexity. Counseling and/or
       99255            Initial inpatient consultation     MD or PMHNP              110 min.                                                   $297.94
                                                                                                      Child/Adol OP                                           Facility                                                                                    coordination of care with other providers or
                                                                                                                                                                                                                                                           agencies are provided consistent with the
                                                                                                                                                                                                                                                           nature of the problem(s) and the patient's
                                                                                                                                                                                                                                                        and/or family's needs. Usually, the presenting
                                                                                                                                                                                                                                                              problem(s) are of moderate severity.




                        Electroconvulsive Therapy                                                   Adult SMI, Adult OP,                                     No Out of
       90870                                                     MD                 Per unit                                                   $700.00
                        (ECT)                                                                         Child/Adol OP                                           Facility




               Modifier Definitions:
               HN - Bachelors degree level; HB - Adults age: 19 +; HA ChildAdol; TD-Nurse ; AF - Psychiatrist (MD); AJ - Clinical Social Worker; AH - Clinical Psychologist; AS - Psych. MH Nurse Practitioner

               1ccdd67e-6f43-41d1-b37b-232e05f6550e.xls

								
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