SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and …

SUBSTANCE ABUSE ENCOUNTER REPORTING

HCPCS and Revenue Codes

Service Description

HCPCS or CPT

Codes

Revenue

Codes

Reporting Code Description

Reporting

Units

Reporting Claim Format (ASC Coverage

Technique

X12N 837)

Screening

H0049, H0002

N/A

H0049- AMS Alcohol and/or drug screening for appropriateness for Encounter

treatment.

H0002- Face-to-face behavioral health screening to determine

eligibility for admission to treatment program.

Line

Professional

State Plan

Assessment

H0001

N/A

Line

H0001- 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.

Professional

State Plan

Intensive Outpatient

H0015

Outpatient

H0004, 90804 90815, 90826,

H2035, H2036

0900, 0914,

0915, 0916,

0919

H0005, 90846,

90847, 90849

90853, 90857,

H2027, H2035,

H2036

0900, 0914,

0915, 0916,

0919

Pharmacologic Support ¨C H0020

Methadone

FY2009

0906 H0015- Alcohol and/or drug services; intensive outpatient (from 9 to Day

19 hours of structured programming per week based on an

individualized treatment plan), including assessment, counseling,

crisis intervention, and activity therapies or education.

0906 ¨C Intensive Outpatient Services ¨C Chemical Dependency.

N/A

Series/Line

(depends on

other payers)

Institutional or

State Plan

Professional (depends on

other payers)

H0004- Behavioral health counseling and therapy, per 15 minutes. Refer to code

descriptions

90804-90815, 90826 ¨C Psychotherapy (individual).

H2035- An hour of outpatient alcohol/other drug treatment services.

H2036- Per diem outpatient alcohol/other drug treatment services.

Series/Line

(depends on

other payers)

Institutional or

State Plan

Professional (depends on

other payers)

Refer to code

H0005- Alcohol and/or drug services; group counseling by a

descriptions

clinician. Family or group therapy

90846, 90847, 90849, 90853, 90857 - Psychotherapy (group).

H2027- Didactics

H2035- An hour of outpatient alcohol/other drug treatment services.

H2036- Per diem outpatient alcohol/other drug treatment services.

Series/Line

(depends on

other payers)

Institutional or

State Plan

Professional (depends on

other payers)

Line

Professional

H0020- Alcohol and/or drug services; Methadone administration

and/or service (provision of the drug by a licensed program).

Page 2 of 5

Encounter

State Plan

(09.18.08)

SUBSTANCE ABUSE ENCOUNTER REPORTING

HCPCS and Revenue Codes

Service Description

HCPCS or CPT

Codes

Revenue

Codes

Reporting Code Description

Reporting

Units

Subacute Detoxification

H0010 , H0012,

H0014

1002 H0010- Alcohol and/or drug services; subacute detoxification;

medically monitored residential detox (ASAM Level III.7-D).

H0012- Alcohol and/or drug services; subacute detoxification;

clinically managed residential detox; non-medical or social detox

setting (ASAM Level III.2-D).

H0014 - Alcohol and/or drug services; ambulatory detoxification

without extended onsite monitoring (ASAM Level I.D).

1002 ¨C Residential treatment ¨C chemical dependency.

Residential Treatment

H0018, H0019

Day

1002 H0018- Alcohol and/or drug services; short-term residential (nonhospital residential treatment program).

H0019- Alcohol and/or drug services; long-term residential (nonmedical, non-acute care in residential treatment program where stay is

typically longer than 30 days).

1002 ¨C Residential treatment ¨C chemical dependency.

Early Intervention

H0022

N/A

H0022 - Alcohol and/or drug services; Intervention Service (Early

Intervention). Any planned intervention that may assist a person to

abstain for AOD use.

Recovery Support Services T1012

N/A

FY2009

Day (refer to

code

descriptions)

Reporting Claim Format (ASC Coverage

Technique

X12N 837)

Series

Institutional or

Additional

Professional (depends on b3

other payers)

Series

Institutional or

Additional

Professional (depends on b3

other payers)

Encounter

Line

Professional

Block, PA2

T1012 - Alcohol and/or drug services; Recovery Support and Skills Encounter

Development. Activites to develop client community integration and

recovery support.

Line

Professional

Block, PA2

Page 3 of 5

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SUBSTANCE ABUSE ENCOUNTER REPORTING

HCPCS and Revenue Codes

Codes For Reporting

Service Description

HCPCS or CPT

Codes

Revenue

Codes

Reporting Code Description

Reporting

Units

Reporting Claim Format (ASC Coverage

Technique

X12N 837)

Residential Room and

Board

S9976

N/A

S9976 - Lodging, per diem, not otherwise specified.

Day

Series

Institutional or

Block, PA2

Professional (depends on

Case Management

H0006

N/A

H0006- services provided to link clients to other essential medical,

educational, social and/or other services.

Encounter

Line

Professional

Block, PA2

Laboratory Tests

H0003, H0048,

80100, 80101

N/A

H0003 - Laboratory analysis of specimens to detect presence of

alcohol or drugs.

H0048 - Alcohol and drug testing, collection and handling only,

specimens other than blood.

80100-80101 - Drug Screen.

Encounter

Line

Professional

Block, PA2,

State Plan

under

methadone

Transportation

T2001 - T2005,

S0215, A0100,

A0110

N/A

Non-emergency transportation services.

Refer to code

descriptions

Line

Professional

Block, PA2

Psychiatric Evaluation

90801, 90802

N/A

90801- Diagnostic interview examination.

90802- Diagnostic interview examination using play equipment,

physical devices, language interpreter or other mechanisms of

communication.

Encounter

Line

Professional

Block, PA2

Child Sitting Services

T1009

N/A

T1009 - Care of the children of the individual receiving alcohol

and/or substance abuse services.

Encounter

Line

Professional

Block, PA2

Pharmacologic Support ¨C H0033

Buprenorphine or

Suboxone

N/A

H0033 -Oral medication administration, direct observation. (Use for Encounter

Buprenorphine or Suboxone administration and/or service - provision

of the drug).

Line

Professional

Block, PA2,

Mediciad

Savings

Accupuncture

97810-97811

N/A

97810 - Accupuncture, 1 or more needles, initial 15 minutes.

97811 - Accupuncture, 1 or more needles, each additional 15

minutes.

Encounter

Line

Professional

Block, PA2

Physician Evaluation

99203-99205

N/A

99203 - Physician Evaluation/Exam (30 mins face-to-face).

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

methadone

FY2009

Page 4 of 5

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SUBSTANCE ABUSE ENCOUNTER REPORTING

HCPCS and Revenue Codes

Medication Review

FY2009

90862

N/A

90602 - Review of current mdications.

Page 5 of 5

Encounter (face- Line

to-face)

Professional

Block, PA2

(09.18.08)

SUBSTANCE ABUSE ENCOUNTER REPORTING

HCPCS and Revenue Codes

Modifiers for Substance Abuse HCPCS Codes

Description

Modifier

HA

Child- Adolescent Program (services designed for persons under the age of 18).

HB

Adult Program- Non-Geriatric (services designed for persons age 18-64).

HC

Geriatric Program (services designed for adults age 65 and older).

HD

Women's Specialty Services Pregnant/Parenting Women Program: (services provided in a program that treats pregnant women or women with dependent children).

HG

Opioid Addiction Treatment Program (program specifically designed to provide opioid-treatment services (including but not limited to the provision of methadone).

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, as planned in an integrated, individualized treatment plan.

HJ

Employee Assistance Program (designates a service associated with and EAP.

HQ

Group Setting (services provided to more than one client in a single treatment event, such that the clients have no particular relationship).

HR

Family/Couple 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).

HS

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).

H9

Court-ordered (indicates that services were ordered by a court, probation officer and/or parole officer).

FY2009

Page 6 of 5

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