attachment e substance abuse encounter rpting hcpcs and revenue codes chart fy10 287030 7 (1)

FY2008 of 5 (09.05.07)

Overview for Fiscal Year 2011

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.

SUBSTANCE ABUSE ENCOUNTER REPORTING:HCPCS and Revenue Codes

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 Women’s 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.).

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 Women’s Specialty Services.

SUBSTANCE ABUSE ENCOUNTER REPORTINGHCPCS and Revenue Codes

FY2009 of 5 (10.21.08)

Service Description Reporting Code Description Coverage

Assessment H0001 N/A Line Professional

Individual Outpatient

Group Outpatient

H0015 0906 Day

H0020 N/A Encounter Line Professional

HCPCS or CPT Codes

Revenue Codes

Reporting Units

Reporting Technique

Claim Format (ASC X12N 837)

H0001- Individual face-to-face alcohol and/or drug assessment at the licensed provider level for the pupose of identifying functional and treatment needs and to formulate the basis for the Individualized Treatment Plan.

Encounter (1 hour minimum)

State Plan Block, PA2

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

0900, 0914, 0915, 0916, 0919

H0004- Behavioral health counseling and therapy, per 15 minutes. 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)

Refer to code descriptions

Series/Line (depends on other payers)

Institutional or Professional (depends on other payers)


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

0900, 0914, 0915, 0916, 0919

H0005- Alcohol and/or drug services; group counseling by a clinician. Family or group therapy90846, 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.





Outpatient (Combination)

H0015- Alcohol and/or drug services; intensive outpatient (from 9 to 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.




Pharmacologic Support – Methadone

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



FY2009 of 5 (10.21.08)


Subacute Detoxification 1002 Series

Residential Treatment H0018, H0019 1002 Day Series

Early Intervention H0022 N/A Encounter Line Professional

T1012, H0038 N/A Line Professional

HCPCS or CPT Codes

Revenue Codes

Reporting Units

Reporting Technique


H0010 , H0012, H0014

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.

Day (refer to code descriptions)


Additional b3, Block, PA2

H0018- Alcohol and/or drug services; short-term residential (non-hospital residential treatment program). H0019- Alcohol and/or drug services; long-term residential (non-medical, non-acute care in residential treatment program where stay is typically longer than 30 days).1002 – Residential treatment – chemical dependency.


Additional b3, Block, PA2

H0022 - Alcohol and/or drug services; Intervention Service (Early Intervention). Any planned intervention that may assist a person to abstain for AOD use.


Recovery Support Services

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

T1012: Encounter H0038: 15 minutes

State Plan, Block, PA2


FY2009 of 5 (10.21.08)

Codes For Reporting


S9976 N/A Day Series Block, PA2

Case Management H0006 N/A Encounter Line Professional Block, PA2

Laboratory Tests N/A Encounter Line Professional

Transportation N/A Non-emergency transportation services. Line Professional Block, PA2

Psychiatric Evaluation 90801, 90802 N/A Encounter Line Professional Block, PA2

Child Sitting Services T1009 N/A Encounter Line Professional Block, PA2

H0033 N/A Encounter Line Professional

Accupuncture 97810-97811 N/A Encounter Line Professional Block, PA2

Physician Evaluation 99203-99205 N/A Encounter Line Professional

HCPCS or CPT Codes

Revenue Codes

Reporting Units

Reporting Technique


Residential Room and Board

S9976 - Lodging, per diem, not otherwise specified. Institutional or Professional (depends on other payers)

H0006- services provided to link clients to other essential medical, educational, social and/or other services.

H0003, H0048, 80100, 80101

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.

Block, PA2, State Plan under methadone

T2001 - T2005, S0215, A0100, A0110


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.

Pharmacologic Support – Buprenorphine or Suboxone

H0033 -Oral medication administration, direct observation. (Use for Buprenorphine or Suboxone administration and/or service - provision of the drug).

Block, PA2, Mediciad Savings

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).

Block, PA2, State Plan under methadone


FY2009 of 5 (10.21.08)

Medication Review 90862 N/A Line Professional Block, PA290602 - Review of current mdications. Encounter (face-to-face)


FY2009 of 5 (10.21.08)

Modifiers for Substance Abuse HCPCS Codes

Modifier Description

GT

HA

HB

HC

HD

HG

HH

HJ

HQ

HR

HS

H9

Telemedicine the use of an electronic media to link beneficiaries with healthprofessionals in different locations. The examination of the beneficiary is performed via a real-timeinteractive audio and video telecommunications system. The beneficiary must be able to see and interactwith the off-site practitioner at the time services are provided via telemedicine..

Child- Adolescent Program (services designed for persons under the age of 18).

Adult Program- Non-Geriatric (services designed for persons age 18-64).

Geriatric Program (services designed for adults age 65 and older).

Women's Specialty Services Pregnant/Parenting Women Program: (services provided in a program that treats pregnant women or women with dependent children).

Opioid Addiction Treatment Program (program specifically designed to provide opioid-treatment services (including but not limited to the provision of methadone).

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.

Group Setting (services provided to more than one client in a single treatment event, such that the clients have no particular relationship).

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).

attachment e substance abuse encounter rpting hcpcs and revenue codes chart fy10 287030 7 (1)

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