Provider Service Code Guidelines - Providers - …

Billing Service CodesBundle Auth CodesUnits/FrequencyMaximum UnitsLevel of CareCommentsService DescriptionZ5008; T2023TJ1 Unit =1 MonthCare Management Co-OcurringH0046TJ1 Unit = 1 MonthCare Management - Behavioral Health HomeT2022HA1 Unit = 1 Month Care Management I/DD OnlyY9930 thru Y9999 CSC051 Unit = 1 DayOut of Home CareProvider Type 59 Initial auth: 120 daysY9930 thru Y9999 CSC052 Units = 1 DayOut of Home CareProvider Type 44 Initial auth: 120 daysH0043 HAU1Y9996, Y9997, Y9998 & Y9999T2016 HAU1, U2, U3, U4, U5 = DD OOH Service (Tx)T2033 HAU1, U2, U3, U4, U5= DD OOH Service (Tx)CSC262 Units = 1 DayOut of Home CareInitial auth: 120 daysH2020HA1 Unit = 1 DayUp to 5 DaysMissing DaysZ0170 CSC021 Unit = 1 HourPartial CareOP 912 - OP 913 CSC021 Unit = 1 HourPartial HospitalizationInitial auth up to 6 months, minimum 3 , 2 days/week, maximum 30hrs/wk, up to 5 hrs/day/weekend. Limit of 12 months/admission. For OOH referrals to PHP: Initial auth 90 days, all other parameters applyOP918 CSC021 Unit = 1 HourMaximum of 4 units per dayPsychological TestingRevised 06-29-16OP513, OP900, OP901, OP902, OP903, OP909, OP910, OP912, OP913, OP914, OP915, OP916, OP917, OP918, OP919, OP961 CSC021 Unit = is specific to each Rev CodeIndividual, Group and Family Therapy (outpatient), Medication Management, Initial Assessment/Evaluation 30 units for initial 30 days of CMO enrollment.

Individual, Group and Family Therapy (outpatient), Medication Management, Initial Assessment/Evaluation

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