Oregon Problem Gambling Services

Procedure Codes and Rates for FY2016-17

Effective July 1, 2016
Code

Description

PGS Payment
Amount

Service Criteria

H0001

Gambling Assessment

$139.70

T1023

Behavioral Health Screening per

15 min

$23.86

H0004

Gambling Treatment counseling

and therapy, per 15 min
Gambling Treatment counseling,
group per 15 min
Family Psychotherapy (without the
patient present), per service
Family Psychotherapy (conjoint
psychotherapy) with the patient
present, per service

$23.86

Service provided by qualified counselor per OAR 309-019-0100. If assessment

takes longer than 1 hour, service provider can encounter remaining time as H0004.
Screening to determine the appropriateness of consideration of an individual for
participation in A&D 81 services. This service deferens from a gambling
assessment in that the activity may be delivered over the telephone and requires not
only the evaluation of a client's treatment needs, but also an evaluation of available
treatment options. Service can be provided 30 days prior to enrollment and
encountered for, as long as service notes per occurrence are documented and
included in individual record.
Service provided by qualified counselor per OAR 309-019-0100

$9.90

Service provided by qualified counselor per OAR 309-019-0100

$92.69

Service provided by LMP, LPC, LMFT, LCSW, Psychologist or QMHP.

$115.49

Service provided by LMP, LPC, LMFT, LCSW, Psychologist or QMHP.

Family psychotherapy is covered when there is a need to observe the clients
interaction with family members and/or where there is a need to assess the
capabilities of and assist the family members in aiding in the management of the
client. Individual and family therapy codes can be encountered on the same date of
service if there are two separate counseling sessions- one with the client and one
with the family member and patient present. Providers should not encounter an
individual therapy code with the family therapy code if only one session of therapy
is rendered.
Service provided by LMP, LPC, LMFT, LCSW, Psychologist or QMHP

H0005
90846
90847

90849
90801 or
90791

Multiple-family group
psychotherapy, per service
Psychiatric Diagnostic Interview

$37.38

$131.44

Service provided by MD, Psychiatric Mental Health Nurse Practitioner, LPC,

LMFT, LCSW, Psychologist or QMHP.

90792

Psychiatric Diagnostic Interview,

with medication services
Psychotherapy, 30 minutes with
patient and/or family member

$140.94

Psychological Testing with

interpretation and report, per hour
Medication Management
Psychotherapy (Formerly known
as Medication Management), per
30 minutes

$91.19

H2027

Individual counseling continuing

care, per 15 min

$23.86

G2100

Continuing Care Group Services,

per 15 min for gambler and/or
family member

$9.90

H0038

Peer Delivered Services, per 15

min

$16.00

90832

96101
90862 or
90863 or
90832
GMED

$66.53

$70.47
65.72

Service provided by MD or Psychiatric Mental Health Nurse Practitioner, LPC,

LMFT, LCSW, Psychologist or QMHP.
Service provided by LMP, LPC, LMFT, LCSW, Psychologist or QMHP. Individual
psychotherapy, insight oriented, behavioral modifying and/or supportive.
Individual must be diagnosed with a gambling disorder and mental health disorder
(dual diagnosed). Client must not have existing health insurance coverage. Goal is
to get patient enrolled in Oregon Health Plan or connected to other health insurance
options.
QHHP who is licensed Psychologist or a Psychology Intern supervised by a
Licensed Psychologist
Services provided by MD or Psychiatric Mental Health Nurse Practitioner. Scope of
services includes prescribing medication, is the initial evaluation of the patients
needs for medication, and ongoing medication monitoring/evaluation related to the
patients use of medication.
Service provided by a LMP, LPC, LMFT, LCSW, Psychologist, or QMHP with
patient and/or family member. Effective January 1, 2016.
This activity may be delivered to clients who have received AD81 services for up to
one year following discharge. The function is of maintaining recovery and continued
wellness and to prevent relapse.
Services provided to clients who have completed problem gambling treatment
within the past 12 months and are to be utilized to facilitate continued recovery or to
avert a potential relapse. Services can be provided within an existing therapy or
psycho-educational group being provided to current clients or to a group of previous
clients meeting on a regular basis for aftercare.
"Peer Delivered Services" means an array of agency or community-based services
and support provided by peers, and peer support specialists, to individuals or family
members with similar lived experience, that are designed to support the needs of
individuals and families as applicable by current policy. "Peer Support Specialist"
means a person providing peer delivered services to an individual or family member
with similar life experiences, under the supervision of a qualified Clinical
Supervisor. A Peer Support Specialist must complete an AMH approved training
program and be: a self-identified person currently or formerly receiving mental
health services; or a self-identified person in recovery from a substance use or
gambling disorder, who meets the abstinence requirements for recovering staff in
substance use disorders or gambling treatment programs; or a family member of an

H0038G

Peer Delivered Services- Group,

per 15 min

$5.28

H2010

Comprehensive medication
services, per 15 min
Psychiatric health facility service,
per diem

$23.86

H2013

$350.23

99368

Team conference/consultation
with Interdisciplinary team, per 30
minutes or more

22.00

G2013

Residential gambling treatment

service, per diem Marion County
Bridgeway Residential Program
Only

$175.00
$200.00

T1016

Case management, per 15 min

$22.25

T1016P

Case management, per 15 min

$16.00

G2030

Financial counseling, per hour

$89.00

individual who is a current or former recipient of addictions or mental health

services.
This could can also be encountered for as an aftercare service (effective July 1,
2016).
Peer Delivered Services provided by Peer Support Specialist per definition provided
under H0038 in a group setting.
This could can also be encountered for as an aftercare service (effective July 1,
2016).
Services delivered by a licensed registered nurse or QMHP related to the dispensing,
administration and management of medications.
Services provided in a licensed mental health residential facility and intensively
staffed 24-hours under a physician approved treatment plan for which treatment
includes an appropriate mix and intensity of assessment, medication management,
individual and group therapies and skills development to reduce or eliminate the
acute symptoms of the disorder and restore the client's ability to function in a home
or the community to the best possible level.
Medical team conference with interdisciplinary team of non-physician\health care
professionals without client or family present. Can only be encountered for problem
gambling treatment staff (s) that is present. Must consult on individual client for at
least 30 minutes to encounter for service.
Services provided in a licensed residential alcohol and drug treatment facility
designated as a residential gambling treatment program and intensively staffed 24hour for which treatment includes an appropriate mix and intensity of assessment,
medication management, individual and group therapies and skills development to
reduce or eliminate the acute symptoms of the disorder and restore the client's ability
to function in a home or the community to the best possible level.
Services provided for coordinating access to and provision of services from multiple
agencies, establishing service linkages, advocating for treatment needs, and
providing assistance in obtaining entitlements based on mental or emotional
disability,
Peer Support Specialist services provided for coordinating access to and provision of
services from multiple agencies, establishing service linkages, advocating for
treatment and recovery needs, and providing assistance in obtaining entitlements
based on mental or emotional disability.
Pressure relief counseling or other forms of counseling provided to individuals

T1013

Sign language/oral interpreter

service, per 15 min

$9.60

99203

Evaluation and management

physical health visit, new patient,
30 minutes maximum length

82.56

99213

Evaluation and management

physical health visit, established
patient, 15 minutes maximum
length

$55.53

G5000

Individual counseling, other

technologies, per 15 min

$23.86

enrolled in A&D 81 services or their family members for the purpose of financial
restitution of gambling debt.
Sign language/oral interpreter services necessary to ensure the provision of services
for individuals with hearing impairments or in the primary language of non-English
speaking individuals. Such interpreters shall be linguistically appropriate and be
capable of communicating in English and the primary language of the individual and
be able to translate clinical information effectively.
Payment for interpreter services is only allowed when provided in conjunction with
another service such as assessment, individual/family therapy, or group therapy, etc.
whenever feasible, individuals should receive services from staff, who are able to
provide sign and/or oral interpretive services. In this case, interpreter services cannot
be billed in addition to the therapeutic service.
Evaluation and management of a new patient that requires a detailed history, detailed
examination and medical decision making of low complexity. Service provided by
Nurse Practitioner, Naturopathic or other qualified medical professional.
Counseling and/or consultation of care with other qualified health care professionals
or agencies are provided consistent with the nature of the problems and the patients
and/or family needs. Service should be provided when physical health conditions
are impeding with gambling treatment. Must be face-to-face. Maximum of 2 visits
per patient. Client must not have existing health insurance coverage. Goal is to get
patient enrolled in Oregon Health Plan or connected to other health insurance
options.
Evaluation and management of an established patient that requires an expanded
problem focused history, expanded problem focused examination and medical
decision making of low complexity. Service provided by Nurse Practitioner,
Naturopathic or other qualified medical professional. Counseling and/or consultation
of care with other qualified health care professionals or agencies are provided
consistent with the nature of the problems and the patients and/or family needs.
Service should be provided when physical health conditions are impeding with
gambling treatment. Must be face-to-face. Maximum of 3 visits per patient. Client
must not have existing health insurance coverage. Goal is to get patient enrolled in
Oregon Health Plan or connected to other health insurance options.
Services provided by qualified counselor per current policy standards. Must meet
current requirements for confidentiality with patient informed consent.

G4000

Individual counseling, telephone,

per 15 min

G30

Mileage

50A*
50B*

50C*

50D*

50E*
50F*

$23.86

Services provided by qualified counselor per current policy standards. Must meet
current requirements for confidentiality with patient informed consent.

Current US Limited to: 1. Service provider's travel to and from primary site providing AD81
GSA rate services and ancillary AD81 service site; 2. Mileage charges by program or case
consultants; 3. Service providers travel bringing clients to the treatment site. 4.
Service providers transportation costs to bring clients to and from the residential
treatment site. 5. Client transportation costs
Strategic Outreach Planning, per
$23.86
Time spent with development of a Strategic Outreach/Referral Pathways Plan.
15 min
Limited to maximum of 10% of A&D 81 allocations unless preauthorized by OHA
Problem Gambling Services Manager.
Referral Agreement Development,
$23.86
Time spent with allied agencies to develop and follow up on formal referral
per 15 min
agreements. Limited to 8 hours per allied agency, unless preauthorized by OHA
Problem Gambling Services Manager. Includes time spent preparing for meetings
and development of presentation, process and paperwork.
Presentations to Allied
$23.86
Time spent delivering presentations to professionals in health/medicine/social
Professionals, per 15 min
services/legal/financial with the express intent to follow up with individual contacts
in order to establish relationship, develop screening and referral agreements and
protocols, etc. Limited to 8 hours per allied agency, unless preauthorized by OHA
Problem Gambling Services Manager. Includes time spent preparing for meeting
and developing presentations.
Presentations to Targeted High
$23.86
Time spent delivering presentations to targeted high risk clients groups, including
Risk Client Groups, per 15 min
but not limited to: Incarcerated individuals A/D clients (OP/Residential) MH clients
(OP/Residential) CAF clients. These presentations shall be focused on signs and
symptoms of disordered gambling, treatment options and how to access treatment.
Code can be used to provide individual or group consultation/education with
potential family member client(s) for the purpose of explaining importance of
treatment and what can be expected, in hopes that family member will enroll.
Includes time spent preparing and developing presentations.
Treatment Advertising
Actual Cost Treatment Ads (yellow pages, web-based ads, radio, TV, newspaper). Limited to
maximum of 20% of AD81 allocations unless preauthorized by OHA Problem
Gambling Services Manager.
Exhibiting at Professional
$23.86
Exhibiting at a conference or meeting of professionals that we know from
Conferences, per 15 min
experience are likely to have problem gamblers in their practices and are in a
position to potentially refer (i.e., physicians, nurses, social services, corrections,

legal, financial). This is in contrast to a conference for service organizations (i.e.

Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4 hours) per exhibit,
unless preauthorized by OHA Problem Gambling Manager.
50G*
Other as Pre-authorized
As AuthorizedOther as pre-authorized by OHA Problem Gambling Manager.
FLEX
Non-traditional Services or
Actual Cost Examples include wraparound (barrier removal) type services (travel vouchers for
Activities
clients, childcare expenses, etc)., and workforce development needs of service
provider.
50AP*
Strategic Outreach Planning, per
$16.00
Peer Support Specialist time spent with clinician staff participating in strategic
15 min
outreach plan development. Limited to maximum of 10% of A&D 81 allocations
unless preauthorized by OHA Problem Gambling Manager.
50CP*
Presentations to allied
$16.00
Peer Support Specialist time spent delivering presentations to professionals in
professionals, per 15 min
health/medicine/social services/legal/financial with the express intent to follow up
with individual contacts in order to establish relationship, develop screening and
referral agreements and protocols, etc. Limited to 8 hours per allied agency, unless
preauthorized by OHA Problem Gambling Services Manager.
50DP*
Presentations to targeted high risk
$16.00
Peer Support Specialist time spent delivering presentations to targeted high risk
client groups, per 15 min
clients groups, including but not limited to: Incarcerated individuals A/D clients
(OP/Residential) MH clients (OP/Residential) CAF clients. These presentations shall
be focused on signs and symptoms of disordered gambling, treatment options and
how to access treatment. Limited to 8 hours per allied agency, unless preauthorized
by OHA Problem Gambling Services Manager.
50FP*
Exhibiting at Professional
$16.00
Peer Support Specialist time spend exhibiting at a conference or meeting of
Conferences, per 15 min
professionals with the intention of educating potential gambling treatment referral
sources about problem gambling, recovery, treatment, screening tools, and available
problem gambling help in Oregon. This is in contrast to a conference for service
organizations (i.e. Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4
hours) per exhibit, unless preauthorized by OHA Problem Gambling Manager.
*50A-50G codes, known as Referral Pathways Codes, have the primary purpose of getting problem gamblers and/or family members enrolled in
services, geared specifically towards increasing the number of clients receiving treatment. It is targeted, generally involves repeated contacts and
the development of a relationship with the provider. The provider is generally another professional and the goal is to increase the number of clients
they assess and refer to your program.
For Referral Pathways documentation requirement, please keep on file a copy of strategic outreach plan, referral agreements, documentation of
meetings, outline of presentations, copy of ads, flight schedules of media, exhibitor confirmation letter, etc.
*** Providers must bill at rates, based upon the cost of services determined through a cost allocation, not in excess of their usual and customary
charge to the general public ** (OAR 309-016-0105 and OAR 309-016-0420)

Note: Language in red font is updated or new language for fiscal year 2016-17.