Association of Community Mental Health Centers of Kansas ...



Initial Units Authorized - Mental Health As of 4/1/14 SERVICE TYPECPT CODE/UNIT INFORMATIONCENPATICO Fax 1-866-694-3649Phone 1-866-896-7293LIFETIME LIMITSAMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730LIFETIME LIMITSOPTUMFax 1-855-268-9392Phone 1-855-802-7095LIFETIME LIMITSPsychiatric Diagnostic Interview – No Medical ServicesDifference between MCOsCPT Code – 90791Unit = VisitMaximum 1 unit per day1 within 6 rolling months 5 sessions per year(Annual limit which will reset each year)5 sessions per year (Annual limit which will reset each year) Psychiatric Diagnostic Interview – With Medical ServicesDifference between MCOsCPT Code – 90792Unit = VisitMaximum 1 unit per day1 within 6 rolling monthsCannot specifically locate – Unsure if included in above 5 sessions per year (Annual limit which will reset each year)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 (As of 1/1/14)No limits No limits (As of 4/1/14)Outpatient 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 (As of 1/1/14)No limits No limitsFamily PsychotherapyCPT Code – 90847Unit = VisitMaximum 1 unit per dayUnlimited benefit (As of 1/1/14)No limits No limits(As of 4/1/14)Family Psychotherapy in the HomeCPT Code – 90847 HKUnit = VisitMaximum 2 units per day (May bill 2 units if visit is greater than 90 minutes)Unlimited benefit (As of 1/1/14)No limits No limits(As of 4/1/14)Group PsychotherapyCPT Code – 90853Unit = VisitMaximum 1 unit per dayUnlimited benefit (As of 1/1/14)No limitsNo limits(As of 4/1/14)SERVICE TYPECPT CODE/UNIT INFORMATIONCENPATICO Fax 1-866-694-3649Phone 1-866-896-7293LIFETIME LIMITSAMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730LIFETIME LIMITSOPTUM Fax 1-855-268-9392Phone 1-855-802-7095LIFETIME LIMITSPsychological Testing & Neuropsychological TestingDifference between MCOsRequires 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 hours per calendar year(Annual limit which will reset each year)6 hoursOffice Visits/Medication Management – New PatientCPT Codes – 99201, 99202, 99203, 99204, & 99205Unit = VisitMaximum 1 unit 99XXX code per dayUnlimited benefitNo limits No limitsOffice Visits/Medication Management – Existing PatientCPT Codes – 99211, 99212, 99213, 99214, & 99215Unit = VisitMaximum 1 unit 99XXX code per dayUnlimited benefitNo limits No limitsInpatient 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 benefitNot listedNot listedCPSTDifference between MCOsCPT Code – H0036Unit = 15 minutes48 units per quarter* (As of 11/1/13) Although first quarter was only two months, full 48 units were provided.60 units (15 hours) during the first 30 daysExtension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units.96 units for H0036, H0036 HA, & H0036 HB (As of 1/1/14) 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 1-866-896-7293LIFETIME LIMITSAMERIGROUP Fax 1-800-505-1193Phone 1-800-454-3730LIFETIME LIMITSOPTUM Fax 1-855-268-9392Phone 1-855-802-7095LIFETIME LIMITSPeer SupportCPT Code – H0038Unit = 15 minutes1000 units (250 hours)Units authorized after initial units will be in 150 unit increments.No limits250 hours Crisis InterventionDifference between MCOsCPT Code – H2011Unit = 15 minutesMaximum 96 units per day288 units per episodeRequires evaluation by QMHPSusan Nay to provide definition of an episode.No limitsRe-evaluation by QMHP every 72 hours must be documented though Amerigroup does NOT need to be notified.Re-evaluation by QMHP every 72 hours Psychosocial Rehabilitation Individual/Group – Child/AdultCPT Code – H2017Unit = 15 minutes3000 units (750 hours)3000 units (750 hours)Extension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units.3000 units (750 hours) TCMDifference between MCOsCPT Code – T1017Unit = 15 minutes60 units per quarter* (As of 5/8/13, with the first quarter starting 4/1/13)48 units (12 hours) in the first 3 monthsExtension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units.96 units (As of 1/1/14)Case ConferenceCPT Codes – 99366, 99367, & 99368Unit = VisitMaximum 1 unit per day32 units No limits32 units Attendant Care 1915 (b) 3CPT Code – T1019Unit = 15 minutes2000 units No limits2000 units *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 dayDifference between MCOs1 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” notedNot listedUnlimitedCrisis InterventionDifference between MCOs288 units (72 hours) per episodeSusan Nay to provide definition of an episode.Not listed60 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 SupportDifference between MCOs1000 units (250 hours)Not listed 1000 units (250 hours)Social DetoxNot coveredNot listed Not coveredResidential Acute DetoxDifference between MCOsAcute 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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