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Uniform Service Coding Standards Manual

2019. Uniform Service Coding Standards Manual Updated: December 2018. Effective date: January 1, 2019. Table of Contents I. Introduction 6. a. Purpose 6. b. Manual Format 7. II. Capitated Behavioral Health Benefit under the Accountable Care Collaborative .. 8. a. Program Service Categories 8. i. Medicaid State Plan Services . 8. ii. Behavioral Health Program 1915(b)(3) Waiver Services .. 9. III Diagnoses . 10. a. Non-Covered Diagnoses 11. b. Covered Diagnoses 11. i. Mental Health Covered Diagnoses 12. ii. Substance Use Disorder Covered Diagnoses .. 12. IV Provider Types .. 12. a. Bachelor's Degree . 14. b. Certified Addiction Counselor (CAC) 14.

Uniform Service Coding Standards Manual 2018 Revised: June, 2018 Effective: July 1, 2018 6 I. Introduction The Colorado Department of Health Care Policy and Financing (HCPF) is the single state agency (SSA) responsible for the

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Transcription of Uniform Service Coding Standards Manual

1 2019. Uniform Service Coding Standards Manual Updated: December 2018. Effective date: January 1, 2019. Table of Contents I. Introduction 6. a. Purpose 6. b. Manual Format 7. II. Capitated Behavioral Health Benefit under the Accountable Care Collaborative .. 8. a. Program Service Categories 8. i. Medicaid State Plan Services . 8. ii. Behavioral Health Program 1915(b)(3) Waiver Services .. 9. III Diagnoses . 10. a. Non-Covered Diagnoses 11. b. Covered Diagnoses 11. i. Mental Health Covered Diagnoses 12. ii. Substance Use Disorder Covered Diagnoses .. 12. IV Provider Types .. 12. a. Bachelor's Degree . 14. b. Certified Addiction Counselor (CAC) 14.

2 I. Certified Assistant Addiction Counselor (CAC I) .. 14. ii. Certified Addiction Counselor (CAC II) .. 14. iii. Certified Senior Addiction Counselor (CAC III) . 14. c. Certified Prevention Specialist .. 15. d. Intern . 15. e. Licensed Addiction Counselor (LAC) . 15. f. Licensed Clinical Social Worker (LCSW) . 15. g. Licensed Marriage & Family Therapist (LMFT) .. 16. h. Licensed Professional Counselor (LPC) 16. i. Licensed Psychologist . 17. j. Peer Specialist (PS) .. 18. k. Physician Assistant (PA) 19. l. Professional Nurses . 19. i. Medical Assistant . 19. ii. Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) .. 20. iii. Registered Nurse/Registered Professional Nurse (RN).

3 20. iv. Advanced Practice Registered Nurse (APN) .. 21. v. Advanced Practice Nurse with Prescriptive Authority (RxN) .. 21. m. Psychiatrist . 21. n. Qualified Medication Administration Person (QMAP) . 21. o. Treatment Facility . 22. p. Unlicensed Doctorate . 23. q. Unlicensed Master's Degree .. 23. V. Place of Service (POS) 23. VI. Procedure Code Modifiers 26. a. colorado Community Behavioral Health Program/ Service Modifiers .. 26. VII. Procedure Categories .. 28. a. Prevention/Early Intervention Services . 28. Uniform Service Coding Standards Manual 2018. Revised: June, 2018. Effective: July 1, 2018. 2. i. Substance Use Prevention Services.

4 28. ii. Substance Use Intervention Services . 28. b. Crisis . 28. i. Psychotherapy for Crisis . 29. c. Screening Services 29. i. Behavioral Health Screening . 29. ii. Substance Use Screening 29. d. Assessment Services . 30. i. Diagnosis 30. ii. Psychological Testing/Neuropsychological Testing . 30. iii. Treatment/ Service Planning . 30. e. Peer Support/Recovery Services 31. f. Respite Care Services 31. g. Targeted Case Management (TCM) Services . 32. i. Behavioral Health TCM Services . 32. ii. Substance Abuse TCM Services . 32. h. Treatment Services 33. i. Psychotherapy . 33. ii. Medication Management 34. iii. Substance Use Treatment Services 34.

5 Iv. Other Professional Services 34. v. Intensive Treatment Services . 35. vi. Inpatient Services . 36. i. Evaluation and Management .. 36. i. Consultation Services 37. ii. Medical Team Conference . 38. j. Residential Services 38. i Supported Housing . 38. ii Alternative Care Facility (ACF) 38. iii. Assisted Living Residence (ALR) . 39. iv. Group Home 39. v. Psychiatric Residential Treatment Facility (PRTF) .. 39. vi. Residential Treatment Facility (RTF) 39. vii. Residential Child Care Facility (RCCF) . 40. viii. Acute Treatment Unit (ATU) 40. ix. Social Ambulatory Detoxification (Social Detox) . 40. x. Room and Board 40. k. Rehabilitation Services 41.

6 I. Clubhouse/Drop-In Center . 41. ii. Community Psychiatric Support Treatment Services (CPST) .. 41. iii. Psychosocial Rehabilitation (PSR) Services .. 41. iv. Assertive Community Treatment (ACT) 41. l. Vocational Services 42. Uniform Service Coding Standards Manual 2018. Revised: June, 2018. Effective: July 1, 2018. 3. VIII. Procedure Code Outline and Pages . 43. IX. Time Documentation Rules/ Standards . 345. a. Fifteen (15) Minute Time-Based Procedure Codes 345. b. One Hour Time-Based Procedure Codes .. 346. c. Time-Based Encounter Procedure Codes . 346. d. Consultation Services 346. e. Missed Appointments .. 347. X. Procedure Coding Best and Documentation 347.

7 I. Coding 347. ii. Responsibility for Code Assignments .. 347. iii. Technical Documentation Requirements . 347. XI. General Billing Guidelines .. 347. a. Claim Types .. 348. i. Institutional Claims 348. ii. Professional Claims 349. b. colorado HCPF Procedure Code Revisions .. 349. Appendix A colorado Health Network's (CHN) Encounter Design Matrix 351. Appendix B CDHS OBH Approved Procedure Code List . 355. Appendix C colorado Community Behavioral Health Procedure Code Categorization .. 367. Appendix D Peer Specialists Core Competencies 385. Appendix E Targeted Case Management .. 386. Appendix F Interactive Complexity . 388. Appendix G Evaluation and Management Procedure Codes.

8 389. Appendix H Abbreviations & Acronyms 403. Appendix I Revenue Codes Covered under the Capitated Behavioral Health Benefit 407. End Notes . 408. Current Procedural Terminology (CPT ) procedure codes, descriptors and other data are copyright 2016 American Medical Association (AMA). All Rights Reserved. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System (FARS)/Defense Federal Acquisition Regulation Supplement (DFARS). apply. Uniform Service Coding Standards Manual 2018. Revised: June, 2018. Effective: July 1, 2018. 4. This page is intentionally left blank. Uniform Service Coding Standards Manual 2018.

9 Revised: June, 2018. Effective: July 1, 2018. 5. I. Introduction The colorado Department of Health Care Policy and Financing (HCPF) is the single state agency (SSA) responsible for the administration of the colorado Medical Assistance Program (MAP). HCPF has developed a comprehensive array of covered mental health (MH) and substance abuse (SA) treatment services to assure that medically necessary, appropriate and cost effective behavioral health (BH) care is provided to eligible Medicaid Members through the colorado Capitated Behavioral Health Benefit under the Accountable Care Collaborative. The colorado Department of Human Services (CDHS), Office of Behavioral Health (OBH), is responsible for the administration of Service contracts that provide for mental health and substance abuse treatment provided to the non- Medicaid population.

10 The Coding pages for Medicaid and OBH are represented in separate section in order to clearly identify the Service Standards applicable to each funding source. The Medicaid pages are formatted in green, while the OBH pages are formatted in blue. a. Purpose The purpose of this Uniform Service Coding Standards (USCS) Manual is to achieve Uniform documenting and reporting of covered colorado Medicaid State Plan (required services), Behavioral Health Program 1915(b)(3) Waiver services (alternative or (b)(3) services) and OBH services. Standardizing the documentation and reporting of behavioral health (BH). encounters contributes to the accurate estimation of Service costs, development of actuarially sound capitation rates, and compliance with federal regulations for managed care utilization oversight.


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