Service Service Code(s) Duration: Frequency: Amount

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Effective Date 1 Service Service Code(s) Description of Service Utilization Management treatment Services Substance Abuse Assessment H0001 The assessment process provides an accurate diagnosis along with recommendations for follow-up or care. Recommendations may include addiction treatment or referrals to physical and mental health practitioners, family counselors, or other helping professionals. Completed Addiction Severity Index. *If a CADC-I completes the assessment it will not be counted completed until it has been reviewed and approved by the clinical supervisor. Duration: NA Frequency: NA Amount : One (1) assessment at admission and one (1) assessment at discharge. Four (4) assessment cap per client per year. Level Early Intervention/ Prevention Not a SAPTA covered Service /Certified Only Level services can occur in any appropriate setting as defined by ASAM Third Edition.

Effective Date 1 Service Service Code(s) Description of Service Utilization Management Treatment Services Substance Abuse Assessment H0001

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