Covered Services and Rates
| CPT / HCPCS Code |
Modifier |
Prov Type & Spec for 7/1 |
Service Description |
Units |
Rate Per Unit |
Age |
|
Mental Health Services |
| 90801 |
|
8 (80)(81) |
Admission Evaluation - Psychiatric diagnostic interview examination |
Per Eval |
120.00 |
All |
| 9
(93)(94)(95) |
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 13(131) |
| 31(339)(351) |
| 90802 |
|
8
(80)(81) |
Admission Evaluation -
Interactive psychiatric diagnostic interview examination using play
equipment, physical devices, language interpreter, or other mechanisms of
communication |
Per Eval |
130.00 |
All |
|
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 13(131) |
| 31(339)(349)(351) |
| 96101 |
|
11
(111)(112)(122)(123) |
Psychological
testing, interpretation, and report by psychologist, per hour |
Per hour |
76.00 |
All |
| |
end date 8(183) |
|
|
|
|
| 96102 |
|
11 (111)(112)(122)(123) |
Psychological
testing by technician, per hour |
Per hour |
41.00 |
All |
| |
end date 8(183) |
|
|
|
|
| 96103 |
|
11 (111)(112)(122)(123) |
Psychological
testing by computer, including psychologist’s time for report writing |
Per hour |
26.00 |
All |
| |
end date 8(183) |
|
|
|
|
| 96118 |
|
|
Neuropsychological testing, interpretation, and report by
psychologist, per hour |
Per hour |
102.00 |
All |
| 9(93)(94)(95),
10(100) |
| 11
(111)(112)(122)(123) |
| 31(339)(349)(351) |
| 96119 |
|
|
Neuropsychological testing by technician, per
hour |
Per hour |
58.00 |
All |
| 9(93)(94)(95),
10(100) |
| 11
(111)(112)(122)(123) |
| 31(339)(349)(351) |
| 96120 |
|
|
Neuropsychological testing by computer,
including psychologist’s time for report writing |
Per hour |
44.00 |
All |
| 9(93)(94)(95),
10(100) |
| 11
(111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90847 |
|
8
(80)(81) |
Family
psychotherapy (conjoint psychotherapy) (with patient present) |
60 min. |
65.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90847 |
HK |
8
(80)(81) |
Family psychotherapy (conjoint psychotherapy)
(with patient present) provided in the home or community |
60 min. |
110.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90853 |
|
8
(80)(81) |
Group psychotherapy
(other than of a multiple-family group) |
60 min. |
22.24 |
All |
| end date 8(183) |
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90804 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility |
20 to 30
min. |
30.00 |
All |
| 13(131) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90806 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility |
45 to 50
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90808 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility, |
75 to 80
min. |
90.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90810 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility |
20 to 30
min. |
32.71 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90812 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility |
45 to 50
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90814 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility |
75 to 80
min. |
90.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| 90816 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting, |
20 to 30
min. |
30.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90818 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting, |
45 to 50
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90821 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting, |
75 to 80
min. |
90.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90823 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting |
45 to 50
min. |
33.81 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90826 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting |
75 to 80
min. |
45.61 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90828 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting |
20 to 30
min. |
62.65 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(122)(123) |
| 31(339)(349)(351) |
| 90805 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility with medical evaluation and management services |
20-30
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90807 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility with medical evaluation and management services |
45 to 50
min. |
86.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31 (339) |
| 90809 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in an
office or outpatient facility with medical evaluation and management services |
75 to 80
min. |
124.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90811 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility with medical evaluation and management services. |
20-30
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90813 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility with medical evaluation and management services |
45 to 50
min. |
87.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90815 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an office or
outpatient facility with medical evaluation and management services |
75 to 80
min. |
130.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90817 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting with medical evaluation and management services |
20-30
min. |
58.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90819 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting with medical evaluation and management services |
45 to 50
min. |
84.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90822 |
|
8
(80)(81) |
Individual
psychotherapy, insight oriented, behavior modifying and/or supportive, in aninpatient hospital, partial hospital
or residential care setting with medical evaluation and management services |
75 to 80
min. |
123.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90824 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting with medical
evaluation and management services |
20-30
min. |
60.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90827 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting with medical
evaluation and management services |
45 to 50
min. |
88.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 90829 |
|
8
(80)(81) |
Individual
psychotherapy, interactive, using play equipment, physical devices, language
interpreter, or other mechanisms of non-verbal communication, in an inpatient
hospital, partial hospital or residential care setting with medical
evaluation and management services |
75 to 80
min. |
127.00 |
All |
| end date 8(183) |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(339)(349)(351) |
| 99201 base & mod 32 multi age segments |
|
8(80-81) |
Office
or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a problem focused history; a
problem focused examination; straightforward medical decision making. Counseling and /or coordination of care
with other providers or agencies are provided consistent with the nature of
the problem(s)) and the patient's and/or family's needs. Usually, the presenting problem(s) are
self limited or minor. |
10 min. |
30.91 |
|
| 9(93)(94)(95),
10(100) |
mod 32 70.00 |
|
| 11(111)(122)(123) |
Ped-30.91 |
|
| |
|
|
| 31(339)(349)(351) |
|
|
| 99202 mod 32 only, multi age segments |
|
8(80-81) |
Office
or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: an expanded problem focused
history; an expanded problem focused examination; straightforward medical
decision making. Counseling and /or
coordination of care with other providers or agencies are provided consistent
with the nature of the problem(s)) and the patient's and/or family's
needs. Usually, the presenting
problem(s) are of low to moderate severity. |
20 min. |
50.66 |
|
| 09(093-095) |
mod 32 70.00 |
|
| 10(100), |
Ped-50.66 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99203 base & mod 32 multi age segments |
|
8(80)(81) |
Office
or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a detailed history; a detailed
examination; medical decision making of low complexity. Counseling and /or coordination of care
with other providers or agencies are provided consistent with the nature of
the problem(s)) and the patient's and/or family's needs. Usually, the presenting problem(s) are of
moderate severity. |
30 min. |
75.45 |
|
| 09(093-095) |
mod 32 75.45 |
|
| 10(100), |
Ped-75.45 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99204 base & mod 32 multi age segments |
|
8(80)(81) |
Office or other outpatient visit for the
evaluation and management of a new patient, which requires these three key
components: a comprehensive
history; a comprehensive examination; medical decision making of moderate
complexity. Counseling and /or
coordination of care with other providers or agencies are provided consistent
with the nature of the problem's) and the patient's and/or family's
needs. Usually, the presenting
problem(s) are of moderate to high severity. |
45 min. |
107.12 |
|
| 09(093-095) |
mod 32 107.12 |
|
| 10(100), |
Ped-107.12 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99205 base & mod 32 multi age segments |
|
8(80)(81) |
Office or other outpatient visit for the
evaluation and management of a new patient, which requires these three key
components: a comprehensive
history; a comprehensive examination; medical decision making of high
complexity. Counseling and /or
coordination of care with other providers or agencies are provided consistent
with the nature of the problem(s)) and the patient's and/or family's
needs. Usually, the presenting
problem(s) are of moderate to high severity. |
60 min. |
136.62 |
|
| 09(093-095) |
mod 32 136.62 |
|
| 10(100), |
Ped-136.62 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99211 mod 32 only, multi age segments |
|
8(80)(81) |
Office
or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician.
Usually, the presenting problem(s) are minimal. |
5 min. |
16.36 |
|
| 09(093-095) |
mod 32 70.00 |
|
| 10(100), |
Ped-16.36 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99212 mod 32 only, multi age segments |
|
8(80)(81) |
Office or other outpatient visit for the
evaluation and management of a new patient, which requires these three key
components: a comprehensive
history; a comprehensive examination; medical decision making of high
complexity. Counseling and /or
coordination of care with other providers or agencies are provided consistent
with the nature of the problem(s)) and the patient's and/or family's
needs. Usually, the presenting
problem(s) are of moderate to high severity. |
10 min. |
29.76 |
|
| 09(093-095) |
mod 32 70.00 |
|
| 10(100), |
Ped-29.76 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99213 mod 32 only, multi age segments |
|
8(80)(81) |
Office
or other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three key components: an
expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity.
Counseling and /or coordination of care with other providers or agencies are
provided consistent with the nature of the problem(s)) and the patient's
and/or family's needs. Usually, the
presenting problem(s) are of low to moderate severity. |
15 min. |
40.84 |
|
| 09(093-095) |
mod 32 70.00 |
|
| 10(100), |
Ped-40.84 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99214 mod 32 only, multi age segments |
|
8(80)(81) |
Office
or other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three key components: a
detailed history; a detailed examination; medical decision making of moderate
complexity. Counseling and /or
coordination of care
with other providers or agencies are provided consistent with the nature of
the problem(s)) and the patient's and/or family's needs. Usually, the presenting problem(s) are of
moderate to high severity. |
25 min. |
64.22 |
|
| 09(093-095) |
mod 32 70.00 |
|
| 10(100), |
Ped-64.22 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99215 mod 32 only, multi age segments |
|
8(80)(81) |
Office
or other outpatient visit for the evaluation and management of an established
patient, which requires at least two these three key components: a
comprehensive history; a comprehensive examination; medical decision making
of high complexity. Counseling and
/or coordination of care with other providers or agencies are provided
consistent with the nature of the problem(s)) and the patient's and/or
family's needs. Usually, the
presenting problem(s) are of moderate to high severity. |
40 min. |
94.00 |
|
| 09(093-095) |
mod 32 94.00 |
|
| |
Ped-94.00 |
|
| |
|
|
| 11(111)(122)(123),
31(339)(349)(351) |
|
|
| 99241 |
|
|
Office
Consultation for a new or established patient, which requires these three
components: |
15 min. |
38.97 |
All |
11 (111)(122)(123) |
* a problem focused history, |
| 9(93)(94)(95),
10(100) |
* a problem focused examination; and |
| 31(339)(349)(351), |
* straightforward medical decision making. |
| 08(80)(81) |
Usually,
the presenting problem(s) are self-limited or minor. |
| 99242 |
|
|
Office Consultation for a new or
established patient, which requires these three components: |
30 min. |
71.64 |
All |
| 11 (111)(122)(123) |
* an expanded problem focused history, |
| 9(93)(94)(95),
10(100) |
* an expanded problem focused examination; and |
| 31(339)(349)(351), |
* straightforward medical decision making. |
| 08(80)(81) |
Usually,
the presenting problem(s) are of low severity. |
| 99243 |
|
|
Office Consultation for a new or
established patient, which requires these three components: |
40 min. |
95.50 |
All |
| 11 (111)(122)(123) |
* a detailed history, |
| 9(93)(94)(95),
10(100) |
* a detailed examination; and |
| 31(339)(349)(351), |
* decision making of low complexity. |
| 08(80)(81) |
Usually,
the presenting problem(s) are of moderate severity. |
| 99244 |
|
|
Office Consultation for a new or
established patient, which requires these three components: |
60 min. |
134.41 |
All |
| 11 (111)(122)(123) |
* a comprehensive history, |
| 9(93)(94)(95),
10(100) |
* a comprehensive examination; and |
| 31(339)(349)(351), |
* medical decision making of high complexity. |
| 08(80)(81) |
Usually,
the presenting problem(s) are of moderate to high severity. |
| 99245 |
|
|
Office Consultation for a new or
established patient, which requires these three components: |
80 min. |
175.41 |
All |
| 11 (111)(122)(123) |
* a comprehensive history, |
| 9(93)(94)(95),
10(100) |
* a comprehensive examination; and |
| 08(80)(81) |
* medical decision making of moderate complexity. |
| 31(339)(349)(351), |
Usually,
the presenting problem(s) are of high severity. |
| 99251 |
|
|
Initial Inpatient Consultation
for a new or established patient, which requires these three components: |
20 min. |
30.20 |
All |
| 11 (111)(122)(123) |
* a problem focused history, |
| 9(93)(94)(95),
10(100) |
* a problem focused examination; and |
| 8
(80)(81) |
* straightforward medical decision making. |
| 31(339)(349)(351), |
Usually,
the presenting problem(s) are self-limited or minor. |
| 99252 |
|
|
Initial
Inpatient Consultation for a new or established patient, which requires these
three components: |
40 min. |
57.40 |
All |
| 8
(80)(81) |
* an expanded problem focused history, |
| 9(93)(94)(95),
10(100) |
* an expanded problem focused examination; and |
| 11 (111)(122)(123) |
* straightforward medical decision making. |
| 31(339)(349)(351) |
Usually,
the presenting problem(s) are of low severity. |
| 99253 |
|
|
Initial
Inpatient Consultation for a new or established patient, which requires these
three components: |
55 min. |
78.57 |
All |
| 8
(80)(81) |
* a detailed history, |
| 9(93)(94)(95),
10(100) |
* a detailed examination; and |
| 11 (111)(122)(123) |
* decision making of low complexity. |
| 31(339)(349)(351), |
Usually,
the presenting problem(s) are of moderate severity. |
| 99254 |
|
|
Initial Inpatient Consultation
for a new or established patient, which requires these three components: |
80 min. |
113.13 |
All |
| 8
(80)(81) |
* a comprehensive history, |
| 9(93)(94)(95),
10(100) |
* a comprehensive examination; and |
| 11 (111)(122)(123) |
* medical decision making of high complexity. |
| 31(339)(349)(351), |
Usually,
the presenting problem(s) are of moderate to high severity. |
| 99255 |
|
|
Initial
Inpatient Consultation for a new or established patient, which requires these
three components: |
110 min. |
155.96 |
All |
| 11 (111)(122)(123) |
* a comprehensive history, |
| 9(93)(94)(95),
10(100) |
* a comprehensive examination; and |
| 8
(80)(81) |
* medical decision making of moderate complexity. |
| 31(339)(349)(351), |
Usually,
the presenting problem(s) are of high severity. |
| 90862 |
|
|
Pharmacologic management, including
prescription, use, and review of medication with no more than minimal medical
psychotherapy |
By Contact |
49.00 |
All |
| 11(111)(122)(123) |
| 9(93)(94)(95),
10(100) |
| 8
(80)(81) |
| 31(351)(349)(339) |
| 90772 |
|
8 (80)(81) |
Therapeutic, propylatic or diagnostic injection
(specify substance or drug); subcutaneous or intramuscular |
By Contact |
14.15 |
All |
| 9(93)(94)(95),
10(100) |
| 31(339)(349)(351) |
| |
| 11
(111)(122)(123) |
| J0515 |
|
|
Injection, Benztropine Mesylate, per 1 mg. |
By
Contact |
3.69 |
All |
| 11(111)(112) |
| 9(93)(94)(95),
10(100) |
| 8(80)(81) |
| 31(349)(351)(339) |
| J2680 |
|
9(93)(94)(95), 10(100) |
Fluphenazine Decanoate up to 25 mg |
By
Contact |
8.92 |
All |
| |
| 11 (111)(122)(123) |
| 8(80)(81) |
| 31(349)(351)(339) |
| J1631 |
|
9(93)(94)(95), 10(100) |
Haloperidol Decanoate 50 mg |
By
Contact |
8.64 |
All |
| |
| 11 (111)(122)(123) |
| 8(80)(81) |
| 31(339)(349)(351) |
| J2794 |
|
|
Risperidone, Long Acting |
By
Contact |
4.83 |
All |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(349)(351)(339) |
| 8(80)(81) |
| J3490 |
|
|
Unclassified Drugs |
By
Contact |
Manually
Priced |
All |
| 9(93)(94)(95),
10(100) |
| 11 (111)(122)(123) |
| 31(349)(351)(339) |
| 8(80)(81) |
|
Specialized Community Based Mental Health Services |
| H0036 |
HA |
11 (111)(122)(123) |
CPST - Child |
15 Min. |
$30.00 |
0-24 |
| H0036 |
HB |
11
(111)(122)(123) |
CPST - Adult |
15 Min. |
$28.75 |
16-99 |
| H0036 |
HK |
11
(111)(122)(123) |
CPST – EBP Strength Based |
15 Min |
$31.25 |
0-99 |
| H0036 |
HJ |
11
(111)(122)(123) |
CPST – EBP Employment Support |
15 Min. |
$31.25 |
16-99 |
| H0036 |
HH |
11
(111)(122)(123) |
CPST – EBP Integrated Dual
Diagnosis |
15 Min. |
$32.50 |
0-99 |
| H2017 |
|
11
(111)(122)(123) |
PR - Individual |
15 Min. |
$11.75 |
0-99 |
| H2017 |
Tj |
11
(111)(122)(123) |
PR – Child Group |
15 Min. |
$8.75 |
0-24 |
| H2017 |
HQ |
11
(111)(122)(123) |
PR - Adult Group |
15 Min. |
$4.37 |
16-99 |
| H0038 |
|
11
(111)(122)(123) |
PS - Individual |
15 Min. |
$11.75 |
14-99 |
| H0038 |
HQ |
11
(111)(122)(123) |
PS - Group |
15 Min. |
$4.37 |
14-99 |
| H2011 |
|
11 (111)(122)(123) |
Crisis Intervention - Emergent - Attendant |
15 Min. |
$18.75 |
0-99 |
| H2015 |
|
11
(111)(122)(123) |
Crisis Stabilization - Ongoing -
Attendant |
15 min. |
$5.63 |
0-99 |
| H2011 |
HK |
11
(111)(122)(123) |
Crisis Intervention - Emergent -
Bachelors |
15 Min. |
$30.00 |
0-99 |
| H2015 |
HK |
11
(111)(122)(123) |
Crisis Stabilization - Ongoing -
Bachelors |
15 Min. |
$11.75 |
0-99 |
| H2011 |
HO |
11
(111)(122)(123) |
Crisis Intervention - Emergent -
LMHP |
15 Min. |
$37.50 |
0-99 |
| T1017 |
|
11 (111)(122)(123) |
TCM – Mental Health |
15 Min. |
$25.00 |
0-99 |
| |
| 96110 |
|
8
(80)(81) |
Early Intervention Mental Health Assessment -
Limited (includes standardized assessments such as the ASQ-SE, ITSEA, CBCL,
with interpretation and report) |
Per contact |
$65.00 |
0-8 |
| |
| 9(93)(94)(95),
10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| H0031 |
|
8
(80)(81) |
Early
Intervention Mental health assessment – Extended (standardized assessment
with interpretation and report including clinical observation for more then 3
hrs.) |
Per Contact |
$135.00 |
0-8 |
| |
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| H0032 |
|
8
(80)(81) |
Early Intervention Mental Health service plan
development by an LMHP in conjunction with the family and significant others
and with other systems of care such as early education, child care, child
welfare. |
15 min. |
$17.50 |
0-8 |
| |
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
| T1019 |
HE |
11 (111)(122) |
1915 (B)(3) Attendant Care |
15 min. |
$6.00 |
0-99 |
| 99361 |
|
8
(80)(81) |
1915 (B)(3) Case Conference |
15 min. |
$10.00 |
0-99 |
| |
| 10(100) |
| 11 (111)(112)(115)(116)(122)(123) |
| 31(339)(349)(351) |
|
HCBS SED Waiver Services |
| S5110 |
|
11 (123) |
Parent Support and Training –
Ind. |
15 min. |
$10.00 |
0-22 |
| S5110 |
Tj |
11 (123) |
Parent Support and Training -
Group |
15 min. |
$3.00 |
0-22 |
| T2038 |
|
11 (123) |
Independent Living / Skills
Building |
Hour |
$40.00 |
0-22 |
| S5150 |
|
11 (123) |
Short Term Respite Care |
15 min. |
$6.00 |
0-22 |
| H2021 |
|
11 (123) |
Wrap Around Facilitation |
15 min. |
$20.00 |
0-22 |
| S9485 |
|
11 (123) |
Professional Resource Family
Care (Crisis Stabilization) |
day |
$138.00 |
0-22 |
| T1019 |
HK |
11 (123) |
Attendant Care |
15 min. |
$6.00 |
0-22 |
