SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes

Overview for Fiscal Year 2011 This encounter code and modifier chart, effective 10/1/2010, describes how submitted encounter codes and modifiers will be interpreted by MDCH and its actuarial team. A list of 12 modifiers is included on the last page of the coding chart. These modifiers can be used in combination with any of the HCPCS codes. “HD” is required for all qualified Women’s Specialty Services. “HH” is required for qualifying Integrated Substance Abuse/Mental Health Services. A modifier for Telemedicine (GT) has been added. Telemedicine is the use of an electronic media to link beneficiaries with health professionals in different locations. The examination of the beneficiary is performed via a real-time interactive audio and video telecommunications system. The beneficiary must be able to see and interact with the off-site practitioner at the time services are provided. H0050 Brief Intervention per 15 minute increments has been added to the chart to allow for services as part of a treatment plan under outpatient care. Coding options for Sub-acute Detoxification Services allows three separate codes based on ASAM level: H0010 (Medically Monitored III.7-D); H0012 (Clinically Managed III.2-D); and H0014 (Ambulatory without Extended Monitoring II.D.). The HCPCS Code of H0022 will designate Early Intervention Services. The HCPCS Code of T1012 will designate Recovery Support Services. Residential Room and Board will be reported under the S9976 per diem code. A selection of non-emergency Transportation HCPCS codes (T2001 through T2005, S0215, A0100, A0110) have been added to the chart. The T1009 code for Child Sitting Services allows CAs to report child care service encounter under qualified Women’s Specialty Services.

FY2008

Page 1 of 5

(09.05.07)

Behavioral health counseling and therapy. crisis intervention. intensive outpatient (from 9 to Day 19 hours of structured programming per week based on an individualized treatment plan). 90849.15 minutes of outpatient alcohol/other drug treatment services (brief intervention) Series/Line (depends on other payers) Individual Outpatient H0004. Refer to code descriptions 90804-90815.An hour of outpatient alcohol/other drug treatment services. and activity therapies or education. 90804 90815. 0916. 90857 . 90857. 0914. 90847. 90853. H2036. 90849 90853.Psychotherapy (group). H2035. H2036 0900. group counseling by a descriptions clinician. 0916. H2036.21.An hour of outpatient alcohol/other drug treatment services.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Service Description Assessment HCPCS or CPT Codes H0001 Revenue Codes N/A Reporting Code Description Reporting Units Reporting Technique Claim Format (ASC X12N 837) Professional Line H0001. H0050 . 0906 – Intensive Outpatient Services – Chemical Dependency. H2027. H2035. 90846. 0915. 90826. 90847.Alcohol and/or drug services. Methadone administration and/or service (provision of the drug by a licensed program). Family or group therapy 90846.15 minute units H2035.Alcohol and/or drug services. 0915. 0919 Refer to code H0005. H0004. Encounter Line Professional FY2009 Page 2 of 5 (10. H2035. H2036. counseling. per 15 minutes. 90826 – Psychotherapy (individual). Series/Line (depends on other payers) Institutional or Professional (depends on other payers) Outpatient (Combination) H0015 0906 H0015.Didactics . H2027. including assessment. 0914.Individual face-to-face alcohol and/or drug assessment at the Encounter (1 licensed provider level for the pupose of identifying functional and hour minimum) treatment needs and to formulate the basis for the Individualized Treatment Plan.Per diem outpatient alcohol/other drug treatment services.08) . 0919 Institutional or Professional (depends on other payers) Group Outpatient H0005.Per diem outpatient alcohol/other drug treatment services.Alcohol and/or drug services. Series/Line (depends on other payers) Institutional or Professional (depends on other payers) Pharmacologic Support – H0020 Methadone N/A H0020. H0050 0900.

H0019. N/A H0022 . subacute detoxification. ambulatory detoxification without extended onsite monitoring (ASAM Level I. long-term residential (nonmedical. per 15 minutes Day Series Institutional or Professional (depends on other payers) Early Intervention H0022 Encounter Line Professional Recovery Support Services T1012.Alcohol and/or drug services. T1012 .SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Service Description Subacute Detoxification HCPCS or CPT Codes H0010 .Alcohol and/or drug services. 1002 – Residential treatment – chemical dependency. H0012. 1002 – Residential treatment – chemical dependency. H0038 N/A T1012: Encounter H0038: 15 minutes Line Professional FY2009 Page 3 of 5 (10. H0038 . clinically managed residential detox.08) . non-medical or social detox setting (ASAM Level III.21.Peer services. non-acute care in residential treatment program where stay is typically longer than 30 days).2-D).D). H0014 Revenue Codes Reporting Code Description Reporting Units Day (refer to code descriptions) Reporting Technique Series Claim Format (ASC X12N 837) Institutional or Professional (depends on other payers) 1002 H0010. Activities to develop client community integration and recovery support.Alcohol and/or drug services. Intervention Service (Early Intervention). Residential Treatment H0018. H0019 1002 H0018. subacute detoxification.Alcohol and/or drug services. H0014 . short-term residential (nonhospital residential treatment program).Alcohol and/or drug services. Any planned intervention that may assist a person to abstain for AOD use.Alcohol and/or drug services. Recovery Support and Skills Development. H0012.Alcohol and/or drug services.7-D). medically monitored residential detox (ASAM Level III.

specimens other than blood. 90802 N/A Refer to code descriptions Encounter Line Professional Psychiatric Evaluation N/A 90801. collection and handling only. 97811 .Care of the children of the individual receiving alcohol and/or substance abuse services. A0100. Encounter Line Professional N/A Encounter Line Professional Physician Evaluation 99203-99205 N/A Encounter Line Professional FY2009 Page 4 of 5 (10. social and/or other services.Drug Screen.Diagnostic interview examination using play equipment. educational.Accupuncture. H0003 . H0048 . S0215. H0048.08) .Accupuncture. T1009 . 1 or more needles. language interpreter or other mechanisms of communication.Physician Evaluation/Exam (45 mins face-to-face). Reporting Units Day Encounter Reporting Technique Series Line Claim Format (ASC X12N 837) Institutional or Professional (depends on other payers) Professional Laboratory Tests H0003. 90802. 97810 .Lodging. 99205 . 99203 .Physician Evaluation/Exam (30 mins face-to-face). each additional 15 minutes.Physician Evaluation/Exam (60 mins face-to-face). initial 15 minutes. (Use for Buprenorphine or Suboxone administration and/or service provision of the drug).services provided to link clients to other essential medical. Line Professional Child Sitting Services T1009 N/A Encounter Line Professional Pharmacologic Support – H0033 Buprenorphine or Suboxone Accupuncture 97810-97811 N/A H0033 -Oral medication administration.T2005. physical devices. not otherwise specified. per diem. 80100-80101 .Diagnostic interview examination. 80100.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Codes For Reporting Service Description Residential Room and Board Case Management HCPCS or CPT Codes S9976 H0006 Revenue Codes N/A N/A Reporting Code Description S9976 . Non-emergency transportation services.21.Alcohol and drug testing. 1 or more needles. A0110 90801. H0006. 99204 . direct observation. 80101 N/A Encounter Line Professional Transportation T2001 .Laboratory analysis of specimens to detect presence of alcohol or drugs.

08) . Encounter (face.Review of current mdications.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Medication Review 90862 N/A 90602 .21.Line to-face) Professional FY2009 Page 5 of 5 (10.

such that persons served share familial or significant other relationships).SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Modifiers for Substance Abuse HCPCS Codes Modifier GT Description Telemedicine the use of an electronic media to link beneficiaries with health professionals in different locations. without the client present). HA Child.21. The examination of the beneficiary is performed via a real-time interactive audio and video telecommunications system. Employee Assistance Program (designates a service associated with and EAP. HH Integrated Mental Health/Substance Abuse Program (program specifically designed to provide integrated services to persons who need both mental health and substance abuse services.. HS H9 FY2009 Page 6 of 5 (10.Non-Geriatric (services designed for persons age 18-64). individualized treatment plan. as planned in an integrated. such that the clients have no particular relationship). probation officer and/or parole officer). HG Opioid Addiction Treatment Program (program specifically designed to provide opioid-treatment services (including but not limited to the provision of methadone). Court-ordered (indicates that services were ordered by a court. HR Family/Couple with Client Present (services provided to more than one client in a single treatment event. 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.Adolescent Program (services designed for persons under the age of 18). HD Women's Specialty Services Pregnant/Parenting Women Program: (services provided in a program that treats pregnant women or women with dependent children). HB Adult Program. The beneficiary must be able to see and interact with the off-site practitioner at the time services are provided via telemedicine.08) . HJ HQ Group Setting (services provided to more than one client in a single treatment event. HC Geriatric Program (services designed for adults age 65 and older).

21. PA2 State Plan Block. PA2 State Plan Block.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage State Plan Block. PA2 State Plan Block. PA2 FY2009 Page 7 of 5 (10.08) . PA2 State Plan Block.

PA2 State Plan Block.21. PA2 State Plan. Block. Block. PA2 Additional b3. PA2 FY2009 Page 8 of 5 (10.08) . Block.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage Additional b3.

State Plan under methadone Block. PA2 Block. Mediciad Savings Block. PA2 Block. PA2 Block.08) . PA2.21. PA2. PA2 Block. PA2. PA2 Block.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage Block. State Plan under methadone FY2009 Page 9 of 5 (10. PA2 Block.

08) . PA2 FY2009 Page 10 of 5 (10.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Block.21.

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