Facility/Program Preferred Codes Universal Services …

1 magellan Standard ServicesSimplified billing CodesRecommended billing Codes for the magellan Services listed - please use appropriate Codes as needed in other fields to complete the claim formFacility/ProgramUniversal Services List USL #Standard ServicesRevenue CodeType of Bill CodeCPT/HCPCS CodesHCPCS ModifierCPT/ HCPCS CodesHCPCS ModifierPlace of Service , Psychiatric0114, 0124, 0134, 0144, , Substance Use Disorders, Rehabilitation Treatment0118, 0128, 0138, 0148, , Substance-Induced Disorders0118, 0128, 0138, 0148, , Substance Use Disorders, Detoxification0116, 0126, 0136, 0146, , Eating Disorders0114, 0124, 0134, 0144, , 23 Hr Bed, , 23 Hr Bed, Substance Use Disorders, Rehabilitation Treatment0762 Residential Treatment, Psychiatric1001H0017 orH0018H0017 Treatment, Substance Use Disorders, Rehabilitation Treatment1002H0011 H0011 Treatment, Eating Disorders1001H0017 orH0018H0017 Based Sub-Acute Care, Psychiatric019X H0017 orH0018 orT2048 (Medicaid only)H0017 orH0018 orT2048 (Medicaid only)

2 Based Sub-Acute Care, Substance Use Disorders, Rehabilitation Treatment019X H0008 orH0010H0008 orH0010 Partial Hospitalization, Psychiatric0912 Hospitalization, Substance Use Disorders, Rehabilitation Treatment0912 Hospitalization, Eating Disorders0912 or0913H0035H0035 Intensive Outpatient Outpatient, Outpatient, Substance Use Disorders, Rehabilitation Outpatient, Eating Disorders0905S9480S9480 N/A - Bill inpatient Services on UB-04 form N/A - Bill inpatient Services on UB-04 form N/A - Bill inpatient Services on UB-04 form N/A - Bill inpatient Services on UB-04 formPreferred Codes for UB-04 BillingPreferred Codes for CMS 1500 billing N/A - Bill inpatient Services on UB-04 form N/A - Bill inpatient Services on UB-04 form N/A - Bill inpatient Services on UB-04 formSimplified billing 02/2018 magellan Standard ServicesSimplified billing CodesRecommended billing Codes for the magellan Services listed - please use appropriate Codes as needed in other fields to complete the claim formFacility/ProgramUniversal Services List Preferred Codes for UB-04 BillingPreferred Codes for CMS 1500 billing Therapy Services , Psychiatric/Substance Use Disorders091409150916 Use appropriate CPTsUse appropriate Aftercare ("Bridge Appointment") Behavior Analysis (Autism)Applicable HCPCS Codes for ABA Therapy (ECT)

3 090190870 or9087190870 , Substance Use Disorders, Detoxification0944 , Substance Use Disorders, Buprenorphine + HGH0014 + Maintenance0944 or 0529H0020 H0020 Stabilization0900 or Room045x99281 - 9928599281 - Health Therapy Home/Domiciliary or Rest Home VisitN/AApplicable CPT codesApplicable CPT codesAncillary Administrative Transportation / Ambulance Laboratory services030xH0003H0048H0003H0048 simplified billing 02/2018