ibhis addendum to procedure codes revised...

Version 1 January 23, 2014

Addendum to Guide to Procedure Codes for IBHIS

1

Modification

Date

Service Code

(Entered Directly

Into IBHIS)

Procedure Code (Submitted

through MSO)

Roll Up Code

(Medi-Cal)

Inactivate

Service CodeService Code Label/Descriptor

Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

NA 100:AT:HX NA N Acute General Hospital I 12A CP

NA 100:AT NA N Acute General Hospital - CGF I 12A CP

NA 100:AT:HT H2015:HE N Acute General Hospital - PDP I 12A CP

NA 101:HX NA N Acute Hosp Admin Day - PDP I 19 CP

NA 101:HE H0046:HE N Acute Hosp-Admin Day I 19 CP

90791 90791 H2015:HE N Assessment - Psych Diag Int I 42 1&3&4&5&6&8&9&18 DO CP FFS

NA 90791:HX NA N Assessment - Psych Diag Int (Non Medi-Cal) I 44 1&3&4&5&6&8&9&18 CP

9079159 90791:59 H2015:HE:59 N Assessment - Psych Diag Int Dup59 I 42 1&3&4&5&6&8&9&18 DO CP FFS

3/4/15 9079176 90791:76 H2015:HE:76 N Assessment - Psych Diag Int Dup76 I 42 1&3&4&5&6&8&9&18 DO CP

3/4/15 NA 90792:HX NA N Assessment - Psych Diag Int w/Med (Non Medi-Cal) I 44 1&3&4&5&6&8&9&18 CP

3/4/15 9079259 90792:59 H2015:HE:59 N Assessment - Psych Diag Int w/Med Dup59 I 42 1&3&4&5&6&8&9&18 DO CP FFS

3/4/15 90792 90792 H2015:HE N Assessment - Psych Diag Int w/Medical I 42 1&3 DO CP

3/4/15 9079276 90792:76 H2015:HE:76 N Assessment - Psych Diag Int w/Medical Dup76 I 42 1&3 DO CP

3/4/15 90792GT59 90792:GT:59 H2015:GT:59 N Assessment - Psych Diag Int w/MediTele59 I 42 1&3&4&5&6&8&9&18 DO CP

3/4/15 90792GT76 90792:GT:76 H2015:GT:76 N Assessment - Psych Diag Int w/MediTele76 I 42 1&3&4&5&6&8&9&18 DO CP

3/4/15 90792GT 90792:GT H2015:HE:GT N Assessment - Psych Diag Int w/MedTelePsy I 42 1&3&4&5&6&8&9&18 DO CP

90791GT 90791:GT H2015:HE:GT N Assessment - Psych Diag Int-TelePsy I 42 1&3&4&5&6&8&9&18 DO CP

90791GT59 90791:GT:59 H2015:GT:59 N Assessment - Psych Diag Int-TelePsy Dup59 I 42 1&3&4&5&6&8&9&18 DO CP

90791GT76 90791:GT:76 H2015:GT:76 N Assessment - Psych Diag Int-TelePsy Dup76 I 42 1&3&4&5&6&8&9&18 DO CP

5/31/15H0002 H0002 H2015:HE N Behavioral Health Screening I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H0002:HX NA N Behavioral Health Screening (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H000259 H0002:59 H2015:HE:59 N Behavioral Health Screening Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H000276 H0002:76 H2015:HE:76 N Behavioral Health Screening Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H0002SC H0002:SC H2015:HE:SC N Behavioral Health Screening Phone I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H0002SC59 H0002:SC:59 H2015:HE:SC:59 N Behavioral Health Screening Phone Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H0002SC76 H0002:SC:76 H2015:HE:SC:76 N Behavioral Health Screening Phone Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

3/4/15 M0064 M0064 H2010:HE Yes: 9/15/15 Brief Med Visit I 62 1&2&3&14 DO CP FFS

3/4/15 NA M0064:HX NA Yes: 9/15/15 Brief Med Visit (Non Medi-Cal) I 63 1&2&3&14 CP

3/4/15 M006459 M0064:59 H2010:HE:59 Yes: 9/15/15 Brief Med Visit Dup59 I 62 1&2&3&14 DO CP FFS

3/4/15 M006476 M0064:76 H2010:HE:76 Yes: 9/15/15 Brief Med Visit Dup76 I 62 1&2&3&14 DO CP

3/4/15 M0064GT M0064:GT H2010:HE:GT Yes: 9/15/15 Brief Med Visit TelePsy I 62 1&2&3&14 DO CP

3/4/15 M0064GT76 M0064:GT:76 H2010:HE:GT:76 Yes: 9/15/15 Brief Med Visit TelePsy Dup76 I 62 1&2&3&14 DO CP

NA G9007 NA N Case Conference Attendance I 421&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

NA G9007:SC NA N Case Conference Attendance Phone I 421&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

6000 6000 NA N Case Management Support I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO CP

5/31/1590887 90887 H2015:HE N Collateral I 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP FFS

NA 90887:HX NA Collateral (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/159088759 90887:59 H2015:HE:59 N Collateral Dup59 I 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP FFS

5/31/159088776 90887:76 H2015:HE:76 N Collateral Dup76 Dup76 I 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1590887SC 90887:SC H2015:HE:SC N Collateral Phone I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1590887SC59 90887:SC:59 H2015:HE:SC:59 N Collateral Phone Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1590887SC76 90887:SC:76 H2015:HE:SC:76 N Collateral Phone Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H2016 NA N Comprehensive Community Supp, per diem I 42A CP

May be used by

IBHIS Addendum to Procedure Codes Revised 05/31/2015

1



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

231 231 NA N COS - Community Client I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO CP

231SC 231:SC NA N COS - Community Client Phone I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO CP

231HK NA NA N COS - Community Client Specific Client I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO

231SCHK NA NA N COS - Community Client Specific Client Phone I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO

200 200 NA N COS - Mental Health Promotion I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO CP

200HK NA NA N COS - Mental Health Promotion Specific Client I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO

200SC 200:SC NA N COS - Promotion Phone I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO CP

200SCHK NA NA N COS - Promotion Specific Client Phone I1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&18DO

5/31/15H2011HE H2011:HE H2011:HE N Crisis Intervention I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H2011:HE:HX NA Crisis Intervention (Non Medi-Cal) I 781&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H2011HE76 H2011:HE:76 H2011:HE:76 N Crisis Intervention Dup76 I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2011SC H2011:SC H2011:HE:SC N Crisis Intervention Phone I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2011SC76 H2011:SC:76 H2011:HE:SC:76 N Crisis Intervention Phone Dup76 I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2011GT H2011:GT H2011:HE:GT N Crisis Intervention TelePsy I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2011GT76 H2011:GT:76 H2011:HE:GT:76 N Crisis Intervention TelePsy Dup76 I 77

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H0018 H0018:HE:HB N Crisis Residential I 43 CP

NA S9484:HE:TG S9484:HE:TG N Crisis Stabilization (ER) I 24 CP

NA S9484:HE:TG:59 S9484:HE:TG:59 N Crisis Stabilization (ER) Dup59 I 24 CP

NA S9484:HE S9484:HE:TG N Crisis Stabilization (Urgent Care) I 25 CP

NA S9484:HE:59 S9484:HE:TG:59 N Crisis Stabilization (Urgent Care) Dup59 I 25 CP

NA H2012:HE H2012:HE N Day Rehabilitation, Full Day I 98 CP

NA H2012:HQ H2012:HQ N Day Rehabilitation, Half Day I 92 CP

NA H2012:HE:TG H2012:HE:TG N Day Treatment Intensive, Full Day I 85 CP

NA H2012:HQ:TG H2012:HQ:TG N Day Treatment Intensive, Half Day I 82 CP

NA 99272 H2015:HE N E&M Consult Confirm Low I 42B 1&2&3&4 FFS

992725999272:59

H2015:HE:59 N E&M Consult Confirm Low Dup59 I 42B 1&2&3&4 FFS

NA 99274 H2015:HE N E&M Consult Confirm m-h I 42B 1&2&3&4 FFS

992745999274:59

H2015:HE:59 N E&M Consult Confirm m-h Dup59 I 42B 1&2&3&4 FFS

NA 99271 H2015:HE N E&M Consult Confirm minor I 42B 1&2&3&4 FFS

992715999271:59

H2015:HE:59 N E&M Consult Confirm minor Dup59 I 42B 1&2&3&4 FFS

NA 99263 H2015:HE N E&M Consult Follow - high I 42B 1&2&3&4 FFS

992635999263:59

H2015:HE:59 N E&M Consult Follow - high Dup59 I 42B 1&2&3&4 FFS

NA 99261 H2015:HE N E&M Consult Follow - low I 42B 1&2&3&4 FFS

992615999261:59

H2015:HE:59 N E&M Consult Follow - low Dup59 I 42B 1&2&3&4 FFS

NA 99262 H2015:HE N E&M Consult Follow – mod I 42B 1&2&3&4 FFS

992625999262:59

H2015:HE:59 N E&M Consult Follow – mod Dup59 I 42B 1&2&3&4 FFS

NA 99255 H2015:HE N E&M Consult New IP 110+ I 42B 1&2&3&4 FFS

992555999255:59

H2015:HE:59 N E&M Consult New IP 110+ Dup59 I 42B 1&2&3&4 FFS

NA 99252 H2015:HE N E&M Consult New IP 40-54 I 42B 1&2&3&4 FFS

992525999252:59

H2015:HE:59 N E&M Consult New IP 40-54 Dup59 I 42B 1&2&3&4 FFS

NA 99253 H2015:HE N E&M Consult New IP 55-79 I 42B 1&2&3&4 FFS

992535999253:59

H2015:HE:59 N E&M Consult New IP 55-79 Dup59 I 42B 1&2&3&4 FFS

NA 99251 H2015:HE N E&M Consult New IP min 20 I 42B 1&2&3&4 FFS

992515999251:59

H2015:HE:59 N E&M Consult New IP min 20 Dup59 I 42B 1&2&3&4 FFS

2



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

NA 99254 H2015:HE N E&M Consult New IP80-109 I 42B 1&2&3&4 FFS

992545999254:59

H2015:HE:59 N E&M Consult New IP80-109 Dup59 I 42B 1&2&3&4 FFS

NA 99241 H2015:HE N E&M Consult OP 20-29 min I 42B 1&2&3&4 FFS

992415999241:59

H2015:HE:59 N E&M Consult OP 20-29 min Dup59 I 42B 1&2&3&4 FFS

9924176 99241:76 H2015:HE:76 N E&M Consult OP 20-29 min Dup76 I 42B 1&2&3&4 FFS


992425999242:59



992435999243:59



992445999244:59


NA 99245 H2015:HE N E&M Consult OP 80+ min I 42B 1&2&3&4 FFS

992455999245:59

H2015:HE:59 N E&M Consult OP 80+ min Dup59 I 42B 1&2&3&4 FFS

NA 99333 H2015:HE N E&M Domicilary, Estab, Complication I 42B 1&2&3 FFS

993335999333:59

H2015:HE:59 N E&M Domicilary, Estab, Complication Dup59 I 42B 1&2&3 FFS

NA 99331 H2015:HE N E&M Domiciliary, Estab, Stable I 42B 1&2&3 FFS

993315999331:59

H2015:HE:59 N E&M Domiciliary, Estab, Stable Dup59 I 42B 1&2&3 FFS

NA 99332 H2015:HE N E&M Domiciliary, Estab,Tx need I 42B 1&2&3 FFS

993325999332:59

H2015:HE:59 N E&M Domiciliary, Estab,Tx need Dup59 I 42B 1&2&3 FFS

NA 99323 H2015:HE N E&M Domiciliary, New, High I 42B 1&2&3 FFS

993235999323:59

H2015:HE:59 N E&M Domiciliary, New, High Dup59 I 42B 1&2&3 FFS

NA 99321 H2015:HE N E&M Domiciliary, New, Low I 42B 1&2&3 FFS

993215999321:59

H2015:HE:59 N E&M Domiciliary, New, Low Dup59 I 42B 1&2&3 FFS

NA 99322 H2015:HE N E&M Domiciliary, New, Mod I 42B 1&2&3 FFS

993225999322:59

H2015:HE:59 N E&M Domiciliary, New, Mod Dup59 I 42B 1&2&3 FFS

99212 99212 H2010:HE N E&M Estab Client Low/Mod Sev I 62 1&2&3 DO CP FFS

9921259 99212:59 H2010:HE:59 N E&M Estab Client Low/Mod Sev Dup59 I 62 1&2&3 DO CP FFS

9921276 99212:76 H2010:HE:76 N E&M Estab Client Low/Mod Sev Dup76 I 62 1&2&3 DO CP

99213 99213 H2010:HE N E&M Estab Client Mod Sev I 62 1&2&3 DO CP FFS

9921359 99213:59 H2010:HE:59 N E&M Estab Client Mod Sev Dup59 I 62 1&2&3 DO CP FFS

9921376 99213:76 H2010:HE:76 N E&M Estab Client Mod Sev Dup76 I 62 1&2&3 DO CP

99214 99214 H2010:HE N E&M Estab Client Mod/High Sev I 62 1&2&3 DO CP FFS

9921459 99214:59 H2010:HE:59 N E&M Estab Client Mod/High Sev Dup59 I 62 1&2&3 DO CP FFS

9921476 99214:76 H2010:HE:76 N E&M Estab Client Mod/High Sev Dup76 I 62 1&2&3 DO CP

99215 99215 H2010:HE N E&M Estab Client Mod/High Sev/Complex I 62 1&2&3 DO CP FFS

9921559 99215:59 H2010:HE:59 N E&M Estab Client Mod/High Sev/Complex Dup59 I 62 1&2&3 DO CP FFS

9921576 99215:76 H2010:HE:76 N E&M Estab Client Mod/High Sev/Complex Dup76 I 62 1&2&3 DO CP

99350 99350 H2010:HE N E&M Estab Client Home High Sev I 62 1&2&3 DO CP FFS

NA 99350:HX NA E&M Estab Client Home HIgh Sev (Non Medi-Cal) I 63 1&2&3 CP

993505999350:59

H2010:HE:59 N E&M Estab Client Home High Sev Dup59 I 62 1&2&3 DO CP

993507699350:76

H2010:HE:76 N E&M Estab Client Home High Sev Dup76 I 62 1&2&3 DO CP

99350GT 99350:GT H2010:HE:GT N E&M Estab Client Home HIgh Sev TelePsy I 62 1&2&3 DO CP

99350GT59 99350:GT:59 H2010:HE:GT:59 N E&M Estab Client Home HIgh Sev TelePsy Dup59 I 62 1&2&3 DO CP

99350GT76 99350:GT:76 H2010:HE:GT:76 N E&M Estab Client Home HIgh Sev TelePsy Dup76 I 62 1&2&3 DO CP

3



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

99347 99347 H2010:HE N E&M Estab Client Home Low Sev I 62 1&2&3 DO CP

NA 99347:HX NA E&M Estab Client Home Low Sev (Non Medi-Cal) I 63 1&2&3 CP

993475999347:59

H2010:HE:59 N E&M Estab Client Home Low Sev Dup59 I 62 1&2&3 DO CP

993477699347:76

H2010:HE:76 N E&M Estab Client Home Low Sev Dup76 I 62 1&2&3 DO CP

99347GT 99347:GT H2010:HE:GT N E&M Estab Client Home Low Sev TelePsy I 62 1&2&3 DO CP

99347GT59 99347:GT:59 H2010:HE:GT:59 N E&M Estab Client Home Low Sev TelePsy Dup59 I 62 1&2&3 DO CP

99347GT76 99347:GT:76 H2010:HE:GT:76 N E&M Estab Client Home Low Sev TelePsy Dup76 I 62 1&2&3 DO CP

99348 99348 H2010:HE N E&M Estab Client Home Mod Sev I 62 1&2&3 DO CP

NA 99348:HX NA E&M Estab Client Home Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

993485999348:59

H2010:HE:59 N E&M Estab Client Home Mod Sev Dup59 I 62 1&2&3 DO CP

993487699348:76

H2010:HE:76 N E&M Estab Client Home Mod Sev Dup76 I 62 1&2&3 DO CP

99348GT 99348:GT H2010:HE:GT N E&M Estab Client Home Mod Sev TelePsy I 62 1&2&3 DO CP

99348GT59 99348:GT:59 H2010:HE:GT:59 N E&M Estab Client Home Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99348GT76 99348:GT:76 H2010:HE:GT:76 N E&M Estab Client Home Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

99349 99349 H2010:HE N E&M Estab Client Home Mod/High Sev I 62 1&2&3 DO CP

NA 99349:HX NA E&M Estab Client Home Mod/High Sev (Non Medi-Cal) I 63 1&2&3 CP

993495999349:59

H2010:HE:59 N E&M Estab Client Home Mod/High Sev Dup59 I 62 1&2&3 DO CP

993497699349:76

H2010:HE:76 N E&M Estab Client Home Mod/High Sev Dup76 I 62 1&2&3 DO CP

99349GT 99349:GT H2010:HE:GT N E&M Estab Client Home Mod/High Sev TelePsy I 62 1&2&3 DO CP

99349GT59 99349:GT:59 H2010:HE:GT:59 N E&M Estab Client Home Mod/High Sev TelePsy Dup59 I 62 1&2&3 DO CP

99349GT76 99349:GT:76 H2010:HE:GT:76 N E&M Estab Client Home Mod/High Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99212:HX NA E&M Estab Client Low/Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

99212GT 99212:GT H2010:HE:GT N E&M Estab Client Low/Mod Sev TelePsy I 62 1&2&3 DO CP

99212GT59 99212:GT:59 H2010:HE:GT:59 N E&M Estab Client Low/Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99212GT76 99212:GT:76 H2010:HE:GT:76 N E&M Estab Client Low/Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99213:HX NA E&M Estab Client Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

99213GT 99213:GT H2010:HE:GT N E&M Estab Client Mod Sev TelePsy I 62 1&2&3 DO CP

99213GT59 99213:GT:59 H2010:HE:GT:59 N E&M Estab Client Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99213GT76 99213:GT:76 H2010:HE:GT:76 N E&M Estab Client Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99214:HX NA E&M Estab Client Mod/High Sev (Non Medi-Cal) I 63 1&2&3 CP

99214GT 99214:GT H2010:HE:GT N E&M Estab Client Mod/High Sev TelePsy I 62 1&2&3 DO CP

99214GT59 99214:GT:59 H2010:HE:GT:59 N E&M Estab Client Mod/High Sev TelePsy Dup59 I 62 1&2&3 DO CP

99214GT76 99214:GT:76 H2010:HE:GT:76 N E&M Estab Client Mod/High Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99215:HX NAE&M Estab Client Mod/High Sev/Complex (Non Medi-

Cal)I 63 1&2&3 CP

99215GT 99215:GT H2010:HE:GT N E&M Estab Client Mod/High Sev/Complex TelePsy I 62 1&2&3 DO CP

99215GT59 99215:GT:59 H2010:HE:GT:59 N E&M Estab Client Mod/High Sev/Complex TelePsy Dup59 I 62 1&2&3 DO CP

99215GT76 99215:GT:76 H2010:HE:GT:76 N E&M Estab Client Mod/High Sev/Complex TelePsy Dup76 I 62 1&2&3 DO CP

NA 99275 H2015:HE N E&M IP Consult, Confirm, High I 42B 1&2&3&4 FFS

992755999275:59

H2015:HE:59 N E&M IP Consult, Confirm, High Dup59 I 42B 1&2&3&4 FFS

NA 99273 H2015:HE N E&M IP Consult, Confirm, Mod I 42B 1&2&3&4 FFS

992735999273:59

H2015:HE:59 N E&M IP Consult, Confirm, Mod Dup59 I 42B 1&2&3&4 FFS

NA 99239 H2015:HE N E&M IP, Discharge 30+ min I 42B 1&2&3 FFS

NA 99238 H2015:HE N E&M IP, Discharge under 30 min I 42B 1&2&3 FFS

NA 99223 H2015:HE N E&M IP, Initial, High I 42B 1&2&3 FFS

4



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

NA 99221 H2015:HE N E&M IP, Initial, Low I 42B 1&2&3 FFS

NA 99222 H2015:HE N E&M IP, Initial, Mod I 42B 1&2&3 FFS

NA 99232 H2015:HE N E&M IP, Subse, Inadequate Response I 42B 1&2&3 FFS

NA 99231 H2015:HE N E&M IP, Subsequent, Stable I 42B 1&2&3 FFS

NA 99233 H2015:HE N E&M IP, Subsequent, Unstable I 42B 1&2&3 FFS

99202 99202 H2010:HE N E&M New Client Low/Mod Sev I 62 1&2&3 DO CP FFS

9920259 99202:59 H2010:HE:59 N E&M New Client Low/Mod Sev Dup59 I 62 1&2&3 DO CP FFS

9920276 99202:76 H2010:HE:76 N E&M New Client Low/Mod Sev Dup76 I 62 1&2&3 DO CP

99201 99201 H2010:HE N E&M New Client Minor Sev I 62 1&2&3 DO CP FFS

9920159 99201:59 H2010:HE:59 N E&M New Client Minor Sev Dup59 I 62 1&2&3 DO CP FFS

9920176 99201:76 H2010:HE:76 N E&M New Client Minor Sev Dup76 I 62 1&2&3 DO CP

99203 99203 H2010:HE N E&M New Client Mod Sev I 62 1&2&3 DO CP FFS

9920359 99203:59 H2010:HE:59 N E&M New Client Mod Sev Dup59 I 62 1&2&3 DO CP FFS

9920376 99203:76 H2010:HE:76 N E&M New Client Mod Sev Dup76 I 62 1&2&3 DO CP

99204 99204 H2010:HE N E&M New Client Mod/High Sev I 62 1&2&3 DO CP FFS

9920459 99204:59 H2010:HE:59 N E&M New Client Mod/High Sev Dup59 I 62 1&2&3 DO CP FFS

9920476 99204:76 H2010:HE:76 N E&M New Client Mod/High Sev Dup76 I 62 1&2&3 DO CP

99205 99205 H2010:HE N E&M New Client Mod/High Sev/Complex I 62 1&2&3 DO CP FFS

9920559 99205:59 H2010:HE:59 N E&M New Client Mod/High Sev/Complex Dup59 I 62 1&2&3 DO CP FFS

9920576 99205:76 H2010:HE:76 N E&M New Client Mod/High Sev/Complex Dup76 I 62 1&2&3 DO CP

99344 99344 H2010:HE N E&M New Client Home High Sev I 62 1&2&3 DO CP FFS

NA 99344:HX NA E&M New Client Home High Sev (Non Medi-Cal) I 63 1&2&3 CP

993445999344:59

H2010:HE:59 N E&M New Client Home High Sev Dup59 I 62 1&2&3 DO CP

993447699344:76

H2010:HE:76 N E&M New Client Home High Sev Dup76 I 62 1&2&3 DO CP

99344GT 99344:GT H2010:HE:GT N E&M New Client Home High Sev TelePsy I 62 1&2&3 DO CP

99344GT76 99344:GT:76 H2010:HE:GT:76 N E&M New Client Home High Sev TelePsy Dup76 I 62 1&2&3 DO CP

99344GT59 99344:GT:59 H2010:HE:GT:59 N E&M New Client Home High Sev TelePsyDup59 I 62 1&2&3 DO CP

99341 99341 H2010:HE N E&M New Client Home Low Sev I 62 1&2&3 DO CP

NA 99341:HX NA E&M New Client Home Low Sev (Non Medi-Cal) I 63 1&2&3 CP

993415999341:59

H2010:HE:59 N E&M New Client Home Low Sev Dup59 I 62 1&2&3 DO CP

993417699341:76

H2010:HE:76 N E&M New Client Home Low Sev Dup76 I 62 1&2&3 DO CP

99341GT 99341:GT H2010:HE:GT N E&M New Client Home Low Sev TelePsy I 62 1&2&3 DO CP

99341GT59 99341:GT:59 H2010:HE:GT:59 N E&M New Client Home Low Sev TelePsy Dup59 I 62 1&2&3 DO CP

99341GT76 99341:GT:76 H2010:HE:GT:76 N E&M New Client Home Low Sev TelePsy Dup76 I 62 1&2&3 DO CP

99342 99342 H2010:HE N E&M New Client Home Mod Sev I 62 1&2&3 DO CP

NA 99342:HX NA E&M New Client Home Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

993425999342:59

H2010:HE:59 N E&M New Client Home Mod Sev Dup59 I 62 1&2&3 DO CP

993427699342:76

H2010:HE:76 N E&M New Client Home Mod Sev Dup76 I 62 1&2&3 DO CP

99342GT 99342:GT H2010:HE:GT N E&M New Client Home Mod Sev TelePsy I 62 1&2&3 DO CP

99342GT59 99342:GT:59 H2010:HE:GT:59 N E&M New Client Home Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99342GT76 99342:GT:76 H2010:HE:GT:76 N E&M New Client Home Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

99343 99343 H2010:HE N E&M New Client Home Mod/High Sev I 62 1&2&3 DO CP

NA 99343:HX NA N E&M New Client Home Mod/High Sev (Non Medi-Cal) I 63 1&2&3 CP

993435999343:59

H2010:HE:59 N E&M New Client Home Mod/High Sev Dup59 I 62 1&2&3 DO CP

5



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

993437699343:76

H2010:HE:76 N E&M New Client Home Mod/High Sev Dup76 I 62 1&2&3 DO CP

99343GT 99343:GT H2010:HE:GT N E&M New Client Home Mod/High Sev TelePsy I 62 1&2&3 DO CP

99343GT59 99343:GT:59 H2010:HE:GT:59 N E&M New Client Home Mod/High Sev TelePsy Dup59 I 62 1&2&3 DO CP

99343GT76 99343:GT:76 H2010:HE:GT:76 N E&M New Client Home Mod/High Sev TelePsyDup76 I 62 1&2&3 DO CP

99345 99345 H2010:HE N E&M New Client Home Unstable/Complex I 62 1&2&3 DO CP

NA 99345:HX NA NE&M New Client Home Unstable/Complex (Non Medi-

Cal)I 63 1&2&3 CP

993455999345:59

H2010:HE:59 N E&M New Client Home Unstable/Complex Dup59 I 62 1&2&3 DO CP

993457699345:76

H2010:HE:76 N E&M New Client Home Unstable/Complex Dup76 I 62 1&2&3 DO CP

99345GT 99345:GT H2010:HE:GT N E&M New Client Home Unstable/Complex TelePsy I 62 1&2&3 DO CP

99345GT59 99345:GT:59 H2010:HE:GT:59 NE&M New Client Home Unstable/Complex TelePsy

Dup59I 62 1&2&3 DO CP

99345GT76 99345:GT:76 H2010:HE:GT:76 NE&M New Client Home Unstable/Complex TelePsy

Dup76I 62 1&2&3 DO CP

NA 99202:HX NA N E&M New Client Low/Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

99202GT 99202:GT H2010:HE:GT N E&M New Client Low/Mod Sev TelePsy I 62 1&2&3 DO CP

99202GT59 99202:GT:59 H2010:HE:GT:59 N E&M New Client Low/Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99202GT76 99202:GT:76 H2010:HE:GT:76 N E&M New Client Low/Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99201:HX NA N E&M New Client Minor Sev (Non Medi-Cal) I 63 1&2&3 CP

99201GT 99201:GT H2010:HE:GT N E&M New Client Minor Sev TelePsy I 62 1&2&3 DO CP

99201GT59 99201:GT:59 H2010:HE:GT:59 N E&M New Client Minor Sev TelePsy Dup59 I 62 1&2&3 DO CP

99201GT76 99201GT:76 H2010:HE:GT:76 N E&M New Client Minor Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99203:HX NA N E&M New Client Mod Sev (Non Medi-Cal) I 63 1&2&3 CP

99203GT 99203:GT H2010:HE:GT N E&M New Client Mod Sev TelePsy I 62 1&2&3 DO CP

99203GT59 99203:GT:59 H2010:HE:GT:59 N E&M New Client Mod Sev TelePsy Dup59 I 62 1&2&3 DO CP

99203GT76 99203:GT:76 H2010:HE:GT:76 N E&M New Client Mod Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99204:HX NA N E&M New Client Mod/High Sev (Non Medi-Cal) I 63 1&2&3 CP

99204GT 99204:GT H2010:HE:GT N E&M New Client Mod/High Sev TelePsy I 62 1&2&3 DO CP

99204GT59 99204:GT:59 H2010:HE:GT:59 N E&M New Client Mod/High Sev TelePsy Dup59 I 62 1&2&3 DO CP

99204GT76 99204:GT:76 H2010:HE:GT:76 N E&M New Client Mod/High Sev TelePsy Dup76 I 62 1&2&3 DO CP

NA 99205:HX NA N E&M New Client Mod/High Sev/Complex (Non Medi-Cal) I 63 1&2&3 CP

99205GT 99205:GT H2010:HE:GT N E&M New Client Mod/High Sev/Complex TelePsy I 62 1&2&3 DO CP

99205GT59 99205:GT:59 H2010:HE:GT:59 N E&M New Client Mod/High Sev/Complex TelePsy Dup59 I 62 1&2&3 DO CP

99205GT76 99205:GT:76 H2010:HE:GT:76 N E&M New Client Mod/High Sev/Complex TelePsy Dup76 I 62 1&2&3 DO CP

NA 99301 H2015:HE N E&M Nurs Fac, Assess, 30-39 min I 42B 1&2&3 FFS

993015999301:59

H2015:HE:59 N E&M Nurs Fac, Assess, 30-39 min Dup59 I 42B 1&2&3 FFS

NA 99302 H2015:HE N E&M Nurs Fac, Assess, 40-49 min I 42B 1&2&3 FFS

993025999302:59

H2015:HE:59 N E&M Nurs Fac, Assess, 40-49 min Dup59 I 42B 1&2&3 FFS

NA 99303 H2015:HE N E&M Nurs Fac, Assess, 50+ min I 42B 1&2&3 FFS

993035999303:59

H2015:HE:59 N E&M Nurs Fac, Assess, 50+ min Dup59 I 42B 1&2&3 FFS

NA 99315 H2015:HE N E&M Nurs Fac, Disch under 30 min I 42B 1&2&3 FFS

993155999315:59

H2015:HE:59 N E&M Nurs Fac, Disch under 30 min Dup59 I 42B 1&2&3 FFS

NA 99316 H2015:HE N E&M Nurs Fac, Discharge 30+ min I 42B 1&2&3 FFS

993165999316:59

H2015:HE:59 N E&M Nurs Fac, Discharge 30+ min Dup59 I 42B 1&2&3 FFS

NA 99311 H2015:HE N E&M Nurs Fac, Subsequent, 15-24 min I 42B 1&2&3 FFS

993115999311:59

H2015:HE:59 N E&M Nurs Fac, Subsequent, 15-24 min Dup59 I 42B 1&2&3 FFS

NA 99312 H2015:HE N E&M Nurs Fac, Subsequent, 25-34 min I 42B 1&2&3 FFS

6



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

993125999312:59

H2015:HE:59 N E&M Nurs Fac, Subsequent, 25-34 min Dup59 I 42B 1&2&3 FFS

NA 99313 H2015:HE N E&M Nurs Fac, Subsequent, 35+ min I 42B 1&2&3 FFS

993135999313:59

H2015:HE:59 N E&M Nurs Fac, Subsequent, 35+ min Dup59 I 42B 1&2&3 FFS

NA 90871 H2010:HE N ECT, multiple seizure/day I 62 1&2&3 FFS

NA 90871:59 H2010:HE:76 N ECT, multiple seizure/day Dup59 I 62 1&2&3 FFS

NA 90870 H2010:HE N ECT, single seizure I 62 1&2&3 FFS

NA 90870:59 H2010:HE:59 N ECT, single seizure Dup59 I 62 1&2&3 FFS

5/31/15H2025 H2025 H2017:HE N Employment Maintenance I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H2025:HX NA N Employment Maintenance (NonMedi-Cal) I 421&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H202559 H2025:59 H2017:HE:59 N Employment Maintenance Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H202576 H2025:76 H2017:HE:76 N Employment Maintenance Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2025SC H2025:SC H2017:HE:SC N Employment Maintenance Phone I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2025SC59 H2025:SC:59 H2017:HE:SC:59 N Employment Maintenance Phone Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2025SC76 H2025:SC:76 H2017:HE:SC:76 N Employment Maintenance Phone Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA 90847:HX NA N Family Therapy (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

90847 90847 H2015:HE N Family Therapy with Client I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

9084759 90847:59 H2015:HE:59 N Family Therapy with Client Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

9084776 90847:76 H2015:HE:76 N Family Therapy with Client Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

99996 NA NA N Financial Placeholder I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

NA 100:HZ NA N Forensic Inpatient Unit I 50 CP

5/31/1590887HEHQ 90887:HE:HQ H2015:HE N Group Collateral G 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

3/5/15 NA 90887:HE:HQ:HX NA N Group Collateral (Non Medi-Cal) G 101&2&3&4&5&6&7&8&9&10&11

&12&14&15&18

5/31/1590887HEHQ5 90887:HE:HQ:59 H2015:HE:59 N Group Collateral Dup59 G 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1590887HEHQ7 90887:HE:HQ:76 H2015:HE:76 N Group Collateral Dup76 G 10

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

H2010HEHQ H2010:HE:HQ H2010:HE N Group Medication G 62 1&2&3&7&8&9&10&14&15 DO CP

NA H2010:HE:HQ:HX NA N Group Medication (Non Medi-Cal) I 63 1&2&3&7&8&9&10&14&15 CP

H2010HEHQ5 H2010:HE:HQ5 H2010:HE:59 N Group Medication Dup59 G 62 1&2&3&7&8&9&10&14&15 DO CP

H2010HEHQ7 H2010:HE:HQ7 H2010:HE:76 N Group Medication Dup76 G 62 1&2&3&7&8&9&10&14&15 DO CP

5/31/1599997 NA NA N Group Placeholder G

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/15H2015HEHQ H2015:HE:HQ H2015:HE N Group Rehab G 52

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H2015:HE:HQ:HX NA N Group Rehab (Non Medi-Cal) G 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H2015HEHQ5 H2015:HE:HQ:59 H2017:HE:59 N Group Rehab Dup59 G 52

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2015HEHQ7 H2015:HE:HQ:76 H2017:HE:76 N Group Rehab Dup76 G 52

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

90853 90853 H2015:HE N Group Therapy G 52 1&2&3&4&5&6&7&8&18 DO CP FFS

90849 90849 H2015:HE N Group Therapy - Multi Family G 52 1&2&3&4&5&6&7&8&18 DO CP FFS

NA 90849:HX NA N Group Therapy - Multi Family (Non Medi-Cal) G 44 1&2&3&4&5&6&7&8&18 CP

9084959 90849:59 H2015:HE:59 N Group Therapy - Multi Family Dup59 G 52 1&2&3&4&5&6&7&8&18 DO CP FFS

9084976 90849:76 H2015:HE:76 N Group Therapy - Multi Family Dup76 G 52 1&2&3&4&5&6&7&8&18 DO CP

NA 90853:HX NA N Group Therapy (Non Medi-Cal) G 44 1&2&3&4&5&6&7&8&18 CP

9085359 90853:59 H2015:HE:59 N Group Therapy Dup59 G 52 1&2&3&4&5&6&7&8&18 DO CP FFS

9085376 90853:76 H2015:HE:76 N Group Therapy Dup76 G 52 1&2&3&4&5&6&7&8&18 DO CP

5/31/15NA T1017:HK T1017:HK N ICC I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

NA T1017:HK:HX T1017:HK:HX N ICC (Non Medi-Cal) I 51&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15NA T1017:HK:76 T1017:HK:76 N ICC Dup76 I 07

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

7



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

5/31/15NA T1017:HK:SC T1017:HK:SC N ICC Phone I 07

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA T1017:HK:SC:76 T1017:HK:SC:76 N ICC Phone Dup76 I 07

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA T1017:HK:GT T1017:HK:GT N ICC TelePsy I 07

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA T1017:HK:GT:76 T1017:HK:GT:76 N ICC TelePsy Dup76 I 07

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2015:HK H2015:HK N IHBS I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

NA H2015:HK:HX NA N IHBS (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15NA H2015:HK:76 H2015:HK:76 N IHBS Dup76 I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2015:HK:SC H2015:HK:SC N IHBS Phone I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2015:HK:SC:76 H2015:HK:SC:76 N IHBS Phone Dup76 I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2015:HK:GT H2015:HK:GT N IHBS TelePsy I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2015:HK:GT:76 H2015:HK:GT:76 N IHBS TelePsy Dup76 I 57

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

NA 183 NA N IMD Pass Day I 39 CP

NA 100:HE:GZ NA N IMD w/o Patch, 60 Beds & Over I 35 CP

NA 100:HK NA N IMD with Patch I 36 CP

NA 100:HE:TG NA N IMD with Patch Subacute Forensic History I 36 CP

NA 100:TG NA N IMD with Patch, Indigent MIO I 38 CP

NA 100:HB:HZ NA N IMD with Patch, Reg MIO I 37 CP

NA 100:HE NA N IMD without Patch I 35 CP

NA 100:HB:TG NA N IMDw/Patch Indigent Subacute Forens Hist I 39 CP

5/31/1599999 NA NA N Individual Placeholder I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

96372 96372 H2010:HE N Injection - Intramuscular I 62 1&2&3&7&8&9&10&14&15 DO CP FFS

9637259 96372:59 H2010:HE:59 N Injection - Intramuscular Dup59 I 62 1&2&3&7&8&9&10&14&15 DO CP

9637276 96372:76 H2010:HE:76 N Injection - Intramuscular Dup76 I 62 1&2&3&7&8&9&10&14&15 DO CP

99998 NA NA N Intake Placeholder I 001&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

NA 134 NA N Life Support I CP

5/31/1517 NA NA N MAA Discounted Mental Health Outreach I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1514 NA NA N MAA Discounted MH Service Contract Admin I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/154 NA NA N MAA Medi-Cal Eligibility Intake I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/154HK NA NA N MAA Medi-Cal Eligibility Intake Clt Spec I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/151 NA NA N MAA Medi-Cal Outreach I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/151HK NA NA N MAA Medi-Cal Outreach Clt Specific I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1531HK NA NA N MAA Non SPMP Case Managmnt Clt Specific I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1531 NA NA N MAA Non SPMP Case Managmnt Non-Open Case I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1535 NA NA N MAA Non SPMP Program Plan and Developmnt I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1511HK NA NA N MAA Refer in Crisis for Client Specific I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1511 NA NA N MAA Refer in Crisis for Non-Open Cases I

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

21 NA NA N MAA SPMP Case Managmnt of Non-Open Case I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

21HK NA NA N MAA SPMP Case Managmnt of Non-Open Clt Specific I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

27 NA NA N MAA SPMP MAA Related Training I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

24 NA NA N MAA SPMP Program Planning and Development I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

H2010HE H2010:HE H2010:HE N Medication Support I 62 1&2&3&7&8&9&10&14&15 DO CP

NA H2010:HE:HX NA Medication Support (Non Medi-Cal) I 63 1&2&3&7&8&9&10&14&15 CP

H2010HE59 H2010HE:59 H2010:HE:59 N Medication Support Dup59 I 62 1&2&3&7&8&9&10&14&15 DO CP

H2010HE76 H2010HE:76 H2010:HE:76 N Medication Support Dup76 I 62 1&2&3&7&8&9&10&14&15 DO CP

8



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

H2010SC H2010:SC H2010:HE:SC N Medication Support Phone I 62 1&2&3&7&8&9&10&14&15 DO CP

H2010SC76 H2010:SC:76 H2010:HE:SC:76 N Medication Support Phone Dup76 I 62 1&2&3&7&8&9&10&14&15 DO CP

H2010GT H2010:GT H2010:HE:GT N Medication Support TelePsy I 62 1&2&3&7&8&9&10&14&15 DO CP

H2010GT76 H2010:GT:76 H2010:HE:GT:76 N Medication Support TelePsy Dup76 I 62 1&2&3&7&8&9&10&14&15 DO CP

NA 100:GZ NA N MH Rehabilitation Center I 90 CP

5/31/159088959 90889:59 H2017:HE:59 N

No Contact – Report Writing Duplicate (Procedural

Service)I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/159088976 90889:76 H2017:HE:76 N

No Contact – Report Writing Duplicate (Repeat

Procedure) Duplicate (Repeat Procedure)I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1500000

NA NAN Non-Billable I 00

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

00004 NA NA N Non-Billable to Medi-Cal CI I 781&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

5/31/1500001

NA NAN Non-Billable to Medi-Cal MHS I 44

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

00003NA NA

N Non-Billable to Medi-Cal MSS I 63 1&2&3&7&8&9&10&14&15 DO

5/31/1500005 NA NA N Non-Billable to Medi-Cal TBS I 59

1&2&3&4&5&6&7&8&9&10&11

&12&14&15&16&17&18DO

5/31/1500002

NA NAN Non-Billable to Medi-Cal TCM I 5

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&16&17&18DO

H0033 H0033 H0034:HE N Oral Medication Administration I 62 1&2&3&7&8&9&10&14&15 DO CP

H003359 H0033:59 H0034:HE:59 N Oral Medication Administration Dup59 I 62 1&2&3&7&8&9&10&14&15 DO CP

H003376 H0033:76 H0033:HE:76 N Oral Medication Administration Dup76 I 62 1&2&3&7&8&9&10&14&15 DO CP

6057 NA NA N PG Administration I DO

6067 NA NA N PG Investigation I DO

5/31/15H0032 H0032 H0032 N Plan Development I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP FFS

NA H0032:HX NA Plan Development (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H003259 H0032:59 H0032:59 N Plan Development Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP FFS

5/31/15H003276 H0032:76 H0032:76 N Plan Development Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H0032SC H0032:SC H0032:SC N Plan Development Phone I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H0032SC76 H0032:SC:76 H0032:SC:76 N Plan Development Phone Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA 101:HA H0045:HE:HC N Psych Hosp 21 – Admin Day I 19 CP

NA 100:HC H2015:HE:HC N Psych Hosp 65 or over I 15 CP

NA 101:HC H0046:HE:HC N Psych Hosp 65+ Admin Day I 19 CP

NA 101 NA N Psych Hosp Admin Day - PDP I 19 CP

NA 100:HX NA N Psych Hosp Foren/IMD w/o Patch, Indigent I 12 CP

NA 100:HA H2015:HE:HA N Psych Hosp, 21 or under I 14 CP

NA 100:HB NA N Psych Hosp, 22-64/SNF Acute Intensive I 15 CP

NA 101:HB NA N Psych Hosp, Ages 22-64 - Admin Day I 19 CP

NA 100:SC NA N Psych Hospital - PDP I 15 CP

96105 96105 H2015:HE N Psych Test Aphasia-QHCP, Admin by Computer I 34 1&4 DO CP

9610559 96105:59 H2015:HE:59 N Psych Test Aphasia-QHCP, Admin by Computer Dup59 I 34 1&4 DO CP

9610576 96105:76 H2015:HE:76 N Psych Test Aphasia-QHCP, Admin by Computer Dup76 I 34 1&4 DO CP

NA 96105:HX NAPsych Test Asses Aphasia-QHCP,Cmptr Admn (Non Medi-

Cal)I 44 1&4 CP

96103 96103 H2015:HE N Psych Test by computer I 34 1&4 DO CP

NA 96103:HX NA Psych Test by computer (Non Medi-Cal) I 44 1&4 CP

9610359 96103:59 H2015:HE:59 N Psych Test by computer Dup59 I 34 1&4 DO CP

9610376 96103:76 H2015:HE:76 N Psych Test by computer Dup76 I 34 1&4 DO CP

NA 96101:HX NA Psych Test by MD or PhD (Non Medi-Cal) I 44 1&4 CP

96101 96101 H2015:HE N Psych Test by psych or psychol I 34 1&4 DO CP FFS

9610159 96101:59 H2015:HE:59 N Psych Test by psych or psychol Dup59 I 34 1&4 DO CP FFS

9



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

9610176 96101:76 H2015:HE:76 N Psych Test by psych or psychol Dup76 I 34 1&4 DO CP

96102 96102 H2015:HE N Psych Test by technician I 34 1&4 DO CP

NA 96102:HX NA Psych Test by technician (Non Medi-Cal) I 44 1&4 CP

9610259 96102:59 H2015:HE:59 N Psych Test by technician Dup59 I 34 1&4 DO CP

9610276 96102:76 H2015:HE:76 N Psych Test by technician Dup76 I 34 1&4 DO CP

NA 96110:HX NA Psych Test Develmental, Limited (Non Medi-Cal) I 44 1&4 CP

96111 96111 H2015:HE N Psych Test Developmental, Extended I 34 1&4 DO CP

NA 96111:HX NA Psych Test Developmental, Extended (Non Medi-Cal) I 44 1&4 CP

9611159 96111:59 H2015:HE:59 N Psych Test Developmental, Extended Dup59 I 34 1&4 DO CP

9611176 96111:76 H2015:HE:76 N Psych Test Developmental, Extended Dup76 I 34 1&4 DO CP

96110 96110 H2015:HE N Psych Test Developmental, Limited I 34 1&4 DO CP

9611059 96110:59 H2015:HE:59 N Psych Test Developmental, Limited Dup59 I 34 1&4 DO CP

9611076 96110:76 H2015:HE:76 N Psych Test Developmental, Limited Dup76 I 34 1&4 DO CP

96116 96116 H2015:HE N Psych Test Neurobehavioral Status I 34 1&4 DO CP

NA 96116:HX NA Psych Test Neurobehavioral Status (Non Medi-Cal) I 44 1&4 CP

9611659 96116:59 H2015:HE:59 N Psych Test Neurobehavioral Status Dup59 I 34 1&4 DO CP

9611676 96116:76 H2015:HE:76 N Psych Test Neurobehavioral Status Dup76 I 34 1&4 DO CP

96118 96118 H2015:HE N Psych Test Neuropsych Licensed Psych/MD I 34 1&4 DO CP FFS

NA 96118:HX NAPsych Test Neuropsych Licensed Psych/MD (Non Medi-

Cal)I 44 1&4 CP

9611859 96118:59 H2015:HE:59 N Psych Test Neuropsych Licensed Psych/MD Dup59 I 34 1&4 DO CP FFS

9611876 96118:76 H2015:HE:76 N Psych Test Neuropsych Licensed Psych/MD Dup76 I 34 1&4 DO CP

96119 96119 H2015:HE N Psych Test Neuropsych-QHCP I 34 1&4 DO CP

NA 96119:HX NA Psych Test Neuropsych-QHCP (Non Medi-Cal) I 44 1&4 CP

96120 96120 H2015:HE N Psych Test Neuropsych-QHCP, Admin by Computer I 34 1&4 DO CP

NA 96120:HX NAPsych Test Neuropsych-QHCP, Admin by Computer (Non

Medi-Cal)I 44 1&4 CP

NA 96125:HX NAPsych Test Standardized Cog Perfrmnce Test (Non Medi-

Cal)I 44 1&4 CP

96125 96125 H2015:HE N Psych Test Standardized Cognitive Performance I 34 1&4 DO CP

NA H2013 H2013:HE N Psychiatric Health Fac I 20 CP

H0046 H0046 H2015:HE N Psychotherapy 0-15 Min FF I 42 1&2&3&4&5&6&7&8&18 DO CP

NA H0046:HX NA Psychotherapy 0-15 Min FF (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

H004659 H0046:59 H2015:HE:59 N Psychotherapy 0-15 Min FF Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP

H004676 H0046:76 H2015:HE:76 N Psychotherapy 0-15 Min FF Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

90832 9032 H2015:HE N Psychotherapy 16-37 Min FF I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

NA 90832:HX NA Psychotherapy 16-37 Min FF (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

9083259 90832:59 H2015:HE:59 N Psychotherapy 16-37 Min FF Dup59 I 57 1&2&3&4&5&6&7&8&18 DO CP FFS

9083276 90832:76 H2015:HE:76 N Psychotherapy 16-37 Min FF Dup76 I 07 1&2&3&4&5&6&7&8&18 DO CP

90832GT 90832:GT H2015:GT N Psychotherapy 16-37 Min FF TelePsy I 42 1&2&3&4&5&6&7&8&18 DO CP

90832GT59 90832:GT:59 H2015:GT:59 N Psychotherapy 16-37 Min FF TelePsy Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP


90834 90834 H2015:HE N Psychotherapy 38-52 Min FF I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

NA 90834:HX NA Psychotherapy 38-52 Min FF (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

9083459 90834:59 H2015:HE:59 N Psychotherapy 38-52 Min FF Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

9083476 90834:76 H2015:HE:76 N Psychotherapy 38-52 Min FF Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

90834GT 90834:GT H2015:GT N Psychotherapy 38-52 Min FF TelePsy I 42 1&2&3&4&5&6&7&8&18 DO CP

10



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)



90837 90837 H2015:HE N Psychotherapy 53+ Min FF I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

NA 90837:HX NA Psychotherapy 53+ Min FF (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

9083759 90837:59 H2015:HE:59 N Psychotherapy 53+ Min FF Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

9083776 90837:76 H2015:HE:76 N Psychotherapy 53+ Min FF Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

90837GT 90837:GT H2015:GT N Psychotherapy 53+ Min FF TelePsy I 42 1&2&3&4&5&6&7&8&18 DO CP

90837GT59 90837:GT:59 H2015:GT:59 N Psychotherapy 53+ Min FF TelePsy Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP

90837GT76 90837:GT:76 H2015:GT:76 N Psychotherapy 53+ Min FF TelePsy Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

90839 90839 H2015:HE N Psychotherapy for Crisis I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

NA 90839:HX NA Psychotherapy for Crisis (Non Medi-Cal) I 44 1&2&3&4&5&6&7&8&18 CP

9083959 90839:59 H2015:HE:59 N Psychotherapy for Crisis Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP FFS

9083976 90839:76 H2015:HE:76 N Psychotherapy for Crisis Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

90839GT 90839:GT H2015:GT N Psychotherapy for Crisis TelePsy I 42 1&2&3&4&5&6&7&8&18 DO CP

90839GT59 90839:GT:59 H2015:GT:59 N Psychotherapy for Crisis TelePsy Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP

90839GT76 90839:GT:76 H2015:GT:76 N Psychotherapy for Crisis TelePsy Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

H0046SC H0046:SC H2015:HE:SC N Psychotherapy Phone I 42 1&2&3&4&5&6&7&8&18 DO CP

H0046SC59 H0046:SC:59 H2015:HE:SC:59 N Psychotherapy Phone Dup59 I 42 1&2&3&4&5&6&7&8&18 DO CP

H0046SC76 H0046:SC:76 H2015:HE:SC:76 N Psychotherapy Phone Dup76 I 42 1&2&3&4&5&6&7&8&18 DO CP

QA1 NA NA N QA Case Review I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA6 NA NA N QA Develop Protocols I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA5 NA NA N QA Medication Monitoring I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA7 NA NA N QA Overview of Service Providers I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA4 NA NA N QA Personnl Time ReState & Fed QA Audt I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA2 NA NA N QA Quality Improvement Meeting I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

QA3 NA NA N QA Training Time Medi-Cal & QA Reqrmnt I1&2&3&4&5&6&7&8&9&10&11

&12&14&15&18DO

5/31/1590885 90885 H0032:HE N Record Review I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/159088559 90885:59 H0032:HE:59 N Record Review Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA 90885:HX NA Record Review (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/159088576 90885:76 H0032:HE:76 N Record Review Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2015 H2015 H2017:HE N Rehab I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA H2015:HX NA Rehab (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15H201559 H2015:59 H2017:HE:59 N Rehab Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H201576 H2015:76 H2017:HE:76 N Rehab Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2015SC H2015:SC H2017:HE:SC N Rehab Phone I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2015SC59 H2015:SC:59 H2017:HE:SC:59 N Rehab Phone Dup59 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15H2015SC76 H2015:SC:76 H2017:HE:SC:76 N Rehab Phone Dup76 I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/1590889 90889 H2017:HE N Report Writing I 42

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

NA 90889:HX NA Report Writing (Non Medi-Cal) I 441&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

NA 183HB NA N Residential Pass Day I 60A CP

NA H0019:HX NA N Semi-Supervised Living I 80 CP

NA H2030:HX NA N Socialization Day Service I 41 CP

NA 100 NA N State Hospital I 1 CP

5/31/15T1017HEHS T1017:HE:HS T1017:HE N Targeted Case Management I 4

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

11



Modification

Date

Service Code

(Entered Directly

Into IBHIS)


through MSO)

Roll Up Code

(Medi-Cal)

Inactivate


Type Of

Service

(Individual

or Group)

Mode/SFC

CodeDiscipline(s)

Directly

Operated

(DO)

Contract

Providers

(CP)

Fee For

Service

Providers

(FFS)

NA T1017:HE:HS:HX NA Targeted Case Management (Non Medi-Cal) I 51&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15T1017HEHS7 T1017:HE:HS:76 T1017:HE:76 N Targeted Case Management Dup76 I 4

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15T1017SC T1017:SC T1017:HE:SC N Targeted Case Management Phone I 4

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15T1017SC76 T1017:SC:76 T1017:HE:SC:76 N Targeted Case Management Phone Dup76 I 4

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18DO CP

5/31/15NA H2019:HE H2019:HE N TBS I 58

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

NA H2019:HE:HX NA TBS (Non Medi-Cal) I 591&2&3&4&5&6&7&8&9&10&11

&12&14&15&18CP

5/31/15NA H2019:HE:76 H2019:HE:76 N TBS Dup76 I 58

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2019:SC H2019:HE:SC N TBS Phone I 58

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

5/31/15NA H2019:SC:76 H2019:HE:SC:76 N TBS Phone Dup76 I 58

1&2&3&4&5&6&7&8&9&10&11

&12&13&14&15&18CP

NA H0019:HE H0019:HE:HB N Trans Res – Long Term I 70 CP

NA H0019:HC NA N Trans Res - Trans - Non Medi-Cal I 60 CP

NA H0019 H0019:HE:HB N Trans Res - Transitional I 65 CP

H2014 H2014 NA N Vocational Day Service I 31 DO CP

12

ibhis addendum to procedure codes revised...

Documents