SUBSTANCE ABUSE ENCOUNTER REPORTING …

1 SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue CodesService Description HCPCS or CPT Codes Revenue Codes REPORTING Code Description REPORTING Units REPORTING Technique Claim Format (ASC X12N 837) CoverageScreening H0049, H0002N/AH0049- AMS Alcohol and/or drug screening for appropriateness for Face-to-face behavioral health screening to determine eligibility for admission to treatment program. EncounterLine Professional State PlanAssessment H0001N/AH0001- Individual face-to-face alcohol and/or drug assessment at the licensed provider level for the pupose of identifying functional and treatment needs and to formulate the basis for the Individualized Treatment Plan. ENCOUNTER (1 hour minimum) Line Professional State PlanIntensive Outpatient H0015 0906H0015- Alcohol and/or drug services; intensive outpatient (from 9 to 19 hours of structured programming per week based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education.

2 0906 Intensive Outpatient Services Chemical Dependency. DaySeries/Line (depends on other payers) Institutional or Professional (depends on other payers) State PlanOutpatient H0004, 90804 - 90815, 90826, H2035, H20360900, 0914, 0915, 0916, 0919H0004- Behavioral health counseling and therapy, per 15 minutes. 90804-90815, 90826 Psychotherapy (individual).H2035- An hour of outpatient alcohol/other drug treatment services. H2036- Per diem outpatient alcohol/other drug treatment to code descriptions Series/Line (depends on other payers) Institutional or Professional (depends on other payers) State PlanH0005, 90846, 90847, 90849 90853, 90857, H2027, H2035, H20360900, 0914, 0915, 0916, 0919H0005- Alcohol and/or drug services; group counseling by a clinician. Family or group therapy90846, 90847, 90849, 90853, 90857 - Psychotherapy (group).

3 H2027- Didactics H2035- An hour of outpatient alcohol/other drug treatment services. H2036- Per diem outpatient alcohol/other drug treatment to code descriptions Series/Line (depends on other payers) Institutional or Professional (depends on other payers) State PlanPharmacologic Support MethadoneH0020 N/AH0020- Alcohol and/or drug services; Methadone administration and/or service (provision of the drug by a licensed program). ENCOUNTER Line Professional State PlanFY2009 Page 2 of 5( ) SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue CodesService Description HCPCS or CPT Codes Revenue Codes REPORTING Code Description REPORTING Units REPORTING Technique Claim Format (ASC X12N 837) CoverageSubacute Detoxification H0010 , H0012, H00141002H0010- Alcohol and/or drug services; subacute detoxification; medically monitored residential detox (ASAM Level ).

4 H0012- Alcohol and/or drug services; subacute detoxification; clinically managed residential detox; non-medical or social detox setting (ASAM Level ). H0014 - Alcohol and/or drug services; ambulatory detoxification without extended onsite monitoring (ASAM Level ). 1002 Residential treatment chemical dependency. Day (refer to code descriptions) Series Institutional or Professional (depends on other payers) Additional b3 Residential Treatment H0018, H0019 1002H0018- Alcohol and/or drug services; short-term residential (non-hospital residential treatment program). H0019- Alcohol and/or drug services; long-term residential (non-medical, non-acute care in residential treatment program where stay istypically longer than 30 days).

5 1002 Residential treatment chemical dependency. Day Series Institutional or Professional (depends on other payers) Additional b3 Early InterventionH0022N/AH0022 - Alcohol and/or drug services; Intervention Service (Early Intervention). Any planned intervention that may assist a person to abstain for AOD Professional Block, PA2 Recovery Support ServicesT1012N/AT1012 - Alcohol and/or drug services; Recovery Support and Skills Development. Activites to develop client community integration and recovery Professional Block, PA2FY2009 Page 3 of 5( ) SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue CodesService Description HCPCS or CPT Codes Revenue Codes REPORTING Code Description REPORTING Units REPORTING Technique Claim Format (ASC X12N 837) CoverageResidential Room and BoardS9976N/AS9976 - Lodging, per diem, not otherwise or Professional (depends on Block, PA2 Case Management H0006N/AH0006- services provided to link clients to other essential medical, educational, social and/or other services.)

6 ENCOUNTER Line Professional Block, PA2 Laboratory Tests H0003, H0048, 80100, 80101N/AH0003 - Laboratory analysis of specimens to detect presence of alcohol or - Alcohol and drug testing, collection and handling only, specimens other than - Drug Professional Block, PA2, State Plan under methadoneTransportationT2001 - T2005, S0215, A0100, A0110N/ANon-emergency transportation services. Refer to code descriptions Line Professional Block, PA2 Psychiatric Evaluation90801, 90802N/A90801- Diagnostic interview Diagnostic interview examination using play equipment, physical devices, language interpreter or other mechanisms of communication.

7 EncounterLine Professional Block, PA2 Child Sitting ServicesT1009N/AT1009 - Care of the children of the individual receiving alcohol and/or SUBSTANCE ABUSE Professional Block, PA2 Pharmacologic Support Buprenorphine or SuboxoneH0033N/AH0033 -Oral medication administration, direct observation. (Use for Buprenorphine or Suboxone administration and/or service - provisionof the drug). ENCOUNTER Line Professional Block, PA2, Mediciad SavingsAccupuncture97810-97811N/A97810 - Accupuncture, 1 or more needles, initial 15 - Accupuncture, 1 or more needles, each additional 15 Line Professional Block, PA2 Physician Evaluation 99203-99205N/A99203 - Physician Evaluation/Exam (30 mins face-to-face).

8 99204 - Physician Evaluation/Exam (45 mins face-to-face).99205 - Physician Evaluation/Exam (60 mins face-to-face). ENCOUNTER Line Professional Block, PA2, State Plan under methadoneCodes For REPORTING FY2009 Page 4 of 5( ) SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue CodesMedication Review90862N/A90602 - Review of current (face-to-face)Line Professional Block, PA2FY2009 Page 5 of 5( ) SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue CodesModifierHAHBHCHDHGHHHJHQHRHSH9 Court-ordered (indicates that services were ordered by a court, probation officer and/or parole officer).Women's Specialty Services Pregnant/Parenting Women Program: (services provided in a program that treats pregnant women or women with dependent children).

9 Integrated Mental Health/ SUBSTANCE ABUSE Program (program specifically designed to provide integrated services to persons who need both mental health and SUBSTANCE ABUSE services, as planned in an integrated, individualized treatment Addiction Treatment Program (program specifically designed to provide opioid-treatment services (including but not limited to the provision of methadone).Employee Assistance Program (designates a service associated with and with Client Present (services provided to more than one client in a single treatment event, such that persons served share familial or significant other relationships).Group Setting (services provided to more than one client in a single treatment event, such that the clients have no particular relationship).Family/Couple without Client Present (services provided to multiple persons in a single treatment event in which some of the persons served share familial or significant other relationships, without the client present).)))

10 Adult Program- Non-Geriatric (services designed for persons age 18-64).Geriatric Program (services designed for adults age 65 and older).Modifiers for SUBSTANCE ABUSE HCPCS CodesDescriptionChild- Adolescent Program (services designed for persons under the age of 18).FY2009 Page 6 of 5( )