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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

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(09.05.07)

Methadone administration and/or service (provision of the drug by a licensed program). counseling. H2027. 0914. H2036 0900.Alcohol and/or drug services. 0915.15 minutes of outpatient alcohol/other drug treatment services (brief intervention) Series/Line (depends on other payers) Individual Outpatient H0004.15 minute units H2035. 0914. 90857. H2027. H2036. H0050 0900.An hour of outpatient alcohol/other drug treatment services. 90826. H2035. intensive outpatient (from 9 to Day 19 hours of structured programming per week based on an individualized treatment plan). per 15 minutes. 90849.An hour of outpatient alcohol/other drug treatment services. 90847. 90849 90853.21. 0919 Institutional or Professional (depends on other payers) Group Outpatient H0005.Behavioral health counseling and therapy.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. Encounter Line Professional FY2009 Page 2 of 5 (10. 90853. 90857 .08) .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. 0916. Series/Line (depends on other payers) Institutional or Professional (depends on other payers) Pharmacologic Support – H0020 Methadone N/A H0020. H2035. 90826 – Psychotherapy (individual). H2036. including assessment. 0915.Alcohol and/or drug services. 0919 Refer to code H0005. crisis intervention. Refer to code descriptions 90804-90815. Family or group therapy 90846. and activity therapies or education. 0906 – Intensive Outpatient Services – Chemical Dependency.Didactics . 90846. 90804 90815. 90847. Series/Line (depends on other payers) Institutional or Professional (depends on other payers) Outpatient (Combination) H0015 0906 H0015.Per diem outpatient alcohol/other drug treatment services. group counseling by a descriptions clinician.Per diem outpatient alcohol/other drug treatment services. H2035. H0050 .Psychotherapy (group). H2036. 0916. H0004.Alcohol and/or drug services.

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

A0110 90801.Accupuncture.Care of the children of the individual receiving alcohol and/or substance abuse services.Physician Evaluation/Exam (30 mins face-to-face). 99205 . 99203 .Diagnostic interview examination. (Use for Buprenorphine or Suboxone administration and/or service provision of the drug). 1 or more needles. 80100. 97810 . per diem. 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 N/A Refer to code descriptions Encounter Line Professional Psychiatric Evaluation N/A 90801.Physician Evaluation/Exam (45 mins face-to-face). 90802. H0048 . T1009 . H0048. each additional 15 minutes. Encounter Line Professional N/A Encounter Line Professional Physician Evaluation 99203-99205 N/A Encounter Line Professional FY2009 Page 4 of 5 (10.08) . initial 15 minutes.Alcohol and drug testing.21. social and/or other services. not otherwise specified. S0215. collection and handling only.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 . H0003 .Accupuncture. 80100-80101 . 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. Non-emergency transportation services. specimens other than blood.Diagnostic interview examination using play equipment. A0100.services provided to link clients to other essential medical.T2005. H0006. 1 or more needles. language interpreter or other mechanisms of communication.Laboratory analysis of specimens to detect presence of alcohol or drugs.Physician Evaluation/Exam (60 mins face-to-face).Drug Screen. physical devices. direct observation.Lodging. educational. 97811 . 80101 N/A Encounter Line Professional Transportation T2001 . 99204 .

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

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

PA2 State Plan Block.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage State Plan Block. PA2 State Plan Block. PA2 State Plan Block. PA2 FY2009 Page 7 of 5 (10.21.08) . PA2 State Plan Block.

PA2 State Plan Block. PA2 Additional b3. PA2 State Plan.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage Additional b3.08) . Block. PA2 FY2009 Page 8 of 5 (10. Block.21. Block.

PA2 Block. PA2 Block. State Plan under methadone Block. Mediciad Savings Block. PA2 Block.21. PA2 Block. PA2. PA2. State Plan under methadone FY2009 Page 9 of 5 (10.08) . PA2 Block.SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Coverage Block. PA2 Block. PA2.

08) .SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes Block. PA2 FY2009 Page 10 of 5 (10.21.