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 Womens 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 Womens Specialty Services.

FY2008

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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- 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. H0004- Behavioral health counseling and therapy, per 15 minutes. Refer to code descriptions 90804-90815, 90826 Psychotherapy (individual). H2035- An hour of outpatient alcohol/other drug treatment services. H2036- Per diem outpatient alcohol/other drug treatment services. H0050 - 15 minutes of outpatient alcohol/other drug treatment services (brief intervention) Series/Line (depends on other payers)

Individual Outpatient

H0004, 90804 90815, 90826, H2035, H2036, H0050

0900, 0914, 0915, 0916, 0919

Institutional or Professional (depends on other payers)

Group Outpatient

H0005, 90846, 90847, 90849 90853, 90857, H2027, H2035, H2036

0900, 0914, 0915, 0916, 0919

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 - 15 minute units 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 Professional (depends on other payers)

Outpatient (Combination) H0015

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 Intensive Outpatient Services Chemical Dependency.

Series/Line (depends on other payers)

Institutional or Professional (depends on other payers)

Pharmacologic Support H0020 Methadone

N/A

H0020- Alcohol and/or drug services; Methadone administration and/or service (provision of the drug by a licensed program).

Encounter

Line

Professional

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Service Description
Subacute Detoxification

HCPCS or CPT Codes

H0010 , H0012, 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- 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 Residential treatment chemical dependency.

Residential Treatment

H0018, H0019

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 Residential treatment chemical dependency. 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. T1012 - Alcohol and/or drug services; Recovery Support and Skills Development. Activities to develop client community integration and recovery support. H0038 - Peer services, per 15 minutes

Day

Series

Institutional or Professional (depends on other payers)

Early Intervention

H0022

Encounter

Line

Professional

Recovery Support Services

T1012, H0038

N/A

T1012: Encounter H0038: 15 minutes

Line

Professional

FY2009

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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 - Lodging, per diem, not otherwise specified. H0006- services provided to link clients to other essential medical, educational, social and/or other services. 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. Non-emergency transportation services.

Reporting Units
Day Encounter

Reporting Technique
Series Line

Claim Format (ASC X12N 837)

Institutional or Professional (depends on other payers) Professional

Laboratory Tests

H0003, H0048, 80100, 80101

N/A

Encounter

Line

Professional

Transportation

T2001 - T2005, S0215, A0100, A0110 90801, 90802

N/A

Refer to code descriptions Encounter

Line

Professional

Psychiatric Evaluation

N/A

90801- Diagnostic interview examination. 90802- Diagnostic interview examination using play equipment, physical devices, language interpreter or other mechanisms of communication. T1009 - Care of the children of the individual receiving alcohol and/or substance abuse services.

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, direct observation. (Use for Buprenorphine or Suboxone administration and/or service provision of the drug). 97810 - Accupuncture, 1 or more needles, initial 15 minutes. 97811 - Accupuncture, 1 or more needles, each additional 15 minutes. 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

N/A

Encounter

Line

Professional

Physician Evaluation

99203-99205

N/A

Encounter

Line

Professional

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Medication Review 90862 N/A 90602 - Review of current mdications. Encounter (face- Line to-face) Professional

FY2009

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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. 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 via telemedicine..

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

HJ

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

HS

H9

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Coverage
State Plan Block, PA2

State Plan Block, PA2

State Plan Block, PA2

State Plan Block, PA2

State Plan Block, PA2

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Coverage
Additional b3, Block, PA2

Additional b3, Block, PA2

State Plan Block, PA2

State Plan, Block, PA2

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Coverage
Block, PA2 Block, PA2

Block, PA2, State Plan under methadone

Block, PA2

Block, PA2

Block, PA2

Block, PA2, Mediciad Savings Block, PA2

Block, PA2, State Plan under methadone

FY2009

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SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Revenue Codes

Block, PA2

FY2009

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