Association of Community Mental Health Centers of Kansas ...



Initial Units Authorized - Mental Health As of 3/1/15 SERVICE TYPECPT CODE/UNIT INFORMATIONCENPATICO Fax 1-866-694-3649Phone 1-866-896-7293AMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730ANNUAL LIMITS. RESET EACH CALENDAR YEAR. NEED OTR IF EXCEED UNITS LISTED.OPTUMFax 1-855-268-9392Phone 1-855-802-7095Psychiatric Diagnostic Interview – No Medical ServicesCPT Code – 90791Unit = VisitMaximum 1 unit per day1 session within 6 rolling months 5 sessions5 sessions Psychiatric Diagnostic Interview – With Medical ServicesCPT Code – 90792Unit = VisitMaximum 1 unit per day1 session within 6 rolling monthsIncluded in Psychiatric Diagnostic Interview – No Medical Services 5 sessions Admission EvaluationNot applicableRefer to Psychiatric Diagnostic InterviewRefer to Psychiatric Diagnostic InterviewRefer to Psychiatric Diagnostic InterviewOutpatient Individual PsychotherapyCPT Codes – 90832, 90834, & 90837Unit = VisitMaximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per dayUnlimited benefit Unlimited benefit Unlimited benefitOutpatient Individual Psychotherapy with Medical Management (Add on Services)CPT Codes – 90833, 90836, & 90838Unit = VisitMaximum 1 unit of 90832, 90833, 90834, 90836, 90837, or 90838 per dayUnlimited benefit Unlimited benefitUnlimited benefitFamily PsychotherapyCPT Code – 90847Unit = VisitMaximum 1 unit per dayUnlimited benefit Unlimited benefitUnlimited benefitFamily Psychotherapy in the HomeCPT Code – 90847 HKUnit = equal to or less than 90 minutesMaximum 1 unit per day Unlimited benefit Unlimited benefitUnlimited benefitGroup PsychotherapyCPT Code – 90853Unit = VisitMaximum 1 unit per dayUnlimited benefit Unlimited benefitUnlimited benefitSERVICE TYPECPT CODE/UNIT INFORMATIONCENPATICO Fax 1-866-694-3649Phone 1-866-896-7293AMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730ANNUAL LIMITS. RESET EACH CALENDAR YEAR. NEED OTR IF EXCEED UNITS LISTED.OPTUM Fax 1-855-268-9392Phone 1-855-802-7095Psychological Testing & Neuropsychological TestingRequires completion of a separate OTR (i.e., KanCare Psychological & Neuropsychological Testing Request Form)CPT Codes - 96101, 96102, 96103, 96118, 96119, & 96120 Unit = Hour (With exception of 96120 Unit = Visit)Maximum 6 units per day6 hours for codes: 96101, 96102, 96103, 96118, 96119, & 96120 6 hours6 hoursOTR is needed if provider is billing more than 6 hours on the same dayOffice Visits/Medication Management – New PatientCPT Codes – 99201, 99202, 99203, 99204, & 99205Unit = VisitMaximum 1 unit 99XXX code per dayUnlimited benefitUnlimited benefitUnlimited benefitOffice Visits/Medication Management – Existing PatientCPT Codes – 99211, 99212, 99213, 99214, & 99215Unit = VisitMaximum 1 unit 99XXX code per dayUnlimited benefitUnlimited benefitUnlimited benefitInpatient or Nursing Facility CareConsultationCPT Codes – 99221, 99223, 99231, 99233, 99238, 99239, 99304, 99305, 99306, 99307, 99308, 99309, & 99310Unit = VisitMaximum 1 unit 99XXX code per dayUnlimited benefitUnlimited benefitUnlimited benefitCPSTCPT Code – H0036Unit = 15 minutes48 units (12 hours) per quarter* 144 units (36 hours) 96 units (24 hours) for H0036, H0036 HA, & H0036 HB Reset each calendar year (As of 3/1/15)Evidence based CPST practices (i.e., IDDT, Strengths Based, & Supported Employment) are not included in this limit.SERVICE TYPECPT CODE/UNIT INFORMATIONCENPATICO Fax 1-866-694-3649Phone 1-866-896-7293AMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730ANNUAL LIMITS. RESET EACH CALENDAR YEAR. NEED OTR IF EXCEED UNITS LISTED.OPTUM Fax 1-855-268-9392Phone 1-855-802-7095Peer SupportCPT Code – H0038Unit = 15 minutes1000 units (250 hours)Units authorized after initial units will be in 150 unit increments.Unlimited benefitUnlimited benefitCrisis InterventionCPT Code – H2011Unit = 15 minutesMaximum 96 units per day288 units (72 hours) per episodeRequires evaluation by QMHPAwaiting definition of an episode.Unlimited benefit Re-evaluation by QMHP every 72 hours must be documented though Amerigroup does NOT need to be notified.Re-evaluation by QMHP every 72 hoursUnited will review all Crisis Services to ensure a H2011 HO (i.e., re-evaluation by a QMHP) was completed after 72 hours Psychosocial Rehabilitation Individual/Group – Child/AdultCPT Code – H2017Unit = 15 minutes3000 units (750 hours)3000 units (750 hours)1000 units (250 hours) Reset each calendar year (As of 3/1/15)TCMCPT Code – T1017Unit = 15 minutes60 units (15 hours) per quarter* 96 units (24 hours)96 units (24 hours)Reset each calendar year (As of 3/1/15)Case ConferenceCPT Codes – 99366, 99367, & 99368Unit = VisitMaximum 1 unit per day32 units Unlimited benefit32 unitsReset each calendar year (As of 3/1/15)Attendant Care 1915 (b) 3CPT Code – T1019Unit = 15 minutes2000 units (500 hours) Unlimited benefit400 units (100 hours)Reset each calendar year (As of 3/1/15)*If units exceed initial units authorized per quarter, an OTR would need to be submitted. Otherwise, units will automatically renew each quarter without an OTR. Initial Units Authorized - Substance Use Disorders SERVICE TYPECENPATICO AMERIGROUP OPTUM●Assessment/ReferralMaximum 1 unit per day1 within 6 rolling monthsNot listedListed under Auxiliary Services (State Plan) though limit not identified Individual CounselingMaximum 9 hours per rolling 7 days240 units over 6 months COMBINED WITH GROUP COUNSELING60 hours over 6 monthsINCLUDES ALL LEVEL 160 hours over 6 months INCLUDES ALL LEVEL 1Group CounselingMaximum 9 hours per rolling 7 days240 units over 6 months COMBINED WITH INDIVIDUAL COUNSELING60 hours over 6 months INCLUDES ALL LEVEL 160 hours over 6 months INCLUDES ALL LEVEL 1Case ManagementAuthorization required Number of units initially authorized not specified “Unlimited benefit” notedUnlimited benefitUnlimited benefitCrisis Intervention288 units (72 hours) per episodeAwaiting definition of an episode.Unlimited benefit60 hours over 6 monthsIntensive Outpatient Program (IOP)Maximum 1 unit per day45 days over 15 weeks45 days over 15 weeks 45 days over 15 weeksIntermediate (Short Term Residential)Maximum 1 unit per day14 days14 days14 daysReintegration (Long Term Residential)Maximum 1 unit per day30 days30 days30 daysPeer Support1000 units (250 hours)Unlimited benefit1000 units (250 hours)Social DetoxNot coveredNot covered Not coveredResidential Acute DetoxAcute detoxification 5 daysLevel 3.7D – To Be Determined Level 3.7D – Pending State Guidelines ●Prior authorization must be obtained for services other than Level 1, Level 2, Level 3.1, Level 3.3/5 & Level 3.7D. ................
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