Substance Use Disorder Billing Guide
Washington Apple Health (Medicaid)Substance UseDisorderBilling Guide(Fee-for-Service)August 1, 2020
DisclaimerEvery effort has been made to ensure this guide’s accuracy. If an actual orapparent conflict between this document and an HCA rule arises, the HCA rulesapply.Billing guides are updated on a regular basis. Due to the nature of contentchange on the internet, we do not fix broken links in past guides. If you find abroken link, please check the most recent version of the guide. If this is the mostrecent guide, please notify us at askmedicaid@hca.wa.gov.About this guide*This publication takes effect August 1, 2020, and supersedes earlier billingguides to this program.The Health Care Authority is committed to providing equal access to our services.If you need an accommodation or require documents in another format, pleasecall 1-800-562-3022. People who have hearing or speech disabilities, please call711 for relay services.Washington Apple Health means the public health insuranceprograms for eligible Washington residents. Washington AppleHealth is the name used in Washington State for Medicaid, thechildren’s health insurance program (CHIP), and state-onlyfunded health care programs. Washington Apple Health isadministered by the Washington State Health Care Authority.Refer also to HCA’s ProviderOne billing and resource guide for valuableinformation to help you conduct business with the Health Care Authority.How can I get HCA Apple Health provider documents?To access provider alerts, go to HCA’s provider alerts webpage.To access provider documents, go to HCA’s provider billing guides and feeschedules webpage.Where can I download HCA forms?To download an HCA form, see HCA’s Forms & Publications webpage. Type onlythe form number into the Search box (Example: 13-835).*This publication is a billing instruction.CPT codes and descriptions only are copyright 2019 American Medical Association.2 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Copyright disclosureCurrent Procedural Terminology (CPT) copyright 2019 American MedicalAssociation (AMA). All rights reserved. CPT is a registered trademark of the AMA.Fee schedules, relative value units, conversion factors and/or related componentsare not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practicemedicine or dispense medical services. The AMA assumes no liability for datacontained or not contained herein.What has changed?SubjectChangeReason for ChangeEntire GuideGeneralhousekeeping fixesand complete formatrevision throughoutguideTo improve usability andcomply with accessibilitystandardsWho should NOT use thisbilling guide?Replaced BeaconHealth Options withBehavioral HealthAdministrativeServicesOrganization (BHASO)To correct guideWho can receivesubstance use disorder(SUD) treatment servicesunder fee-for-service?Added criteria forfee-for-servicesubstance usedisorder servicesTo clarify billinginstructionsCoverage LimitationsReplaced “3 hours”with “11 units” perclient, per day forGroup TherapyTo clarify billinginstructionsReplaced “4 hours”with “16 units” perclient, per day forPeer SupportservicesAdded limitations forFamily TherapyservicesCPT codes and descriptions only are copyright 2019 American Medical Association.3 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Table of ContentsResources Available . 6Definitions . 7Substance Use Disorder Treatment . 11Who should use this billing guide? . 11Institution for Mental Diseases (IMD) . 11Who should NOT use this billing guide? . 11Client Eligibility . 12Who can receive substance use disorder (SUD) treatment services under feefor-service? . 12How do I verify a client’s eligibility? . 13Are clients enrolled in an HCA-contracted managed care organization (MCO)eligible? . 14Managed care enrollment . 15Apple Health – Changes for January 1, 2020 . 16Clients who are not enrolled in an HCA-contracted managed care plan forphysical health services . 17Integrated managed care (IMC) . 17Integrated managed care regions . 18Integrated Apple Health Foster Care (AHFC) . 19Fee-for-service Apple Health Foster Care . 19Coverage Table . 20Telemedicine and Coronavirus (COVID-19) . 24Coverage Limitations . 25Billing for case management or intensive case management . 30Peer Support Services . 30What certification is required for peer support providers? . 31Inpatient and withdrawal management SUD facilities: Medication for OpioidUse Disorder . 32Withdrawal management and stabilization . 33What is secure withdrawal management and stabilization?. 34Who is eligible for secure withdrawal management and stabilization? . 34Who is eligible to provide and bill for secure withdrawal management andstabilization services? . 35What authorization is required? . 35How do I bill for secure withdrawal management and stabilization services?. 35CPT codes and descriptions only are copyright 2019 American Medical Association.4 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Billing . 39What are the general billing requirements? . 39What are the recordkeeping requirements specific to substance use disorder(SUD) treatment providers? . 40What if a client has Medicare coverage? . 40Where can I find substance use disorder fee schedules? . 41How do I bill claims electronically? . 41Place of service . 41Outpatient service codes . 41CPT codes and descriptions only are copyright 2019 American Medical Association.5 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Resources AvailableTopicContact InformationBecoming a provider or submittinga change of address or ownershipSee the HCA’s Billers and ProviderswebpageFinding out about payments,denials, claims processing, or HCAmanaged care organizationsSee the HCA’s Billers and ProviderswebpageElectronic billingSee the HCA’s Billers and ProviderswebpageFinding HCA documents (e.g.,Washington Apple Health billingguides and fee schedules)See the HCA’s Billers and ProviderswebpageTransfer board or devicesSee the HCA’s Billers and ProviderswebpagePrivate insurance or third-partyliability, other than HCA managedcareSee the HCA’s Billers and ProviderswebpageQuestions regarding policy orpayment ratesThe Division of Behavioral Health andRecoveryPO Box 45330Olympia, WA 98504-5330360-725-1500orWashington State Health CareAuthorityMedical Assistance Customer ServiceCenter (MACSC)Contact MACSC1-800-562-3022CPT codes and descriptions only are copyright 2019 American Medical Association.6 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
DefinitionsThis section defines terms and abbreviations, including acronyms, used in thisbilling guide. Refer to Chapter 182-500 WAC for a complete list of definitions forWashington Apple HealthHCA-designee – Any entity expressly designated by the HCA to act on its behalf.American Indian/Alaska Native (AI/AN) – A person having origins in any of theoriginal peoples of North America, or people who self-identify as AI/AN whenthey: Apply or re-certify for Medicaid Submit a change in Healthplanfinder or through the HCA Medicaid CustomerService Center.Approved treatment facility - A treatment facility, either public or private, forprofit or nonprofit, approved by the HCA according to 246-341 WAC and RCW71.05.American Society of Addiction Medicine (ASAM) - A professional medicalsociety dedicated to increasing access and improving the quality of addictiontreatment.ASAM Criteria - A clinical tool used to systematically evaluate the severity anddiagnosis of a person’s need for treatment along six dimensions, and then use afixed combination rule to determine which level of care a substance-using personwill respond to with the greatest success. ASAM also includes recommendationsregarding substance use disorder (SUD) treatment services.Assessment - The set of activities conducted on behalf of a new patient, for thepurpose of determining eligibility, evaluating treatment needs, and makingnecessary referrals and completing forms. The assessment includes all practiceslisted in applicable sections of Chapter 246-341 WAC* or its successor. For thepurpose of determining eligibility for Chemical Dependency DispositionAlternative (CDDA), the set of activities will include completion of all of thefollowing: The Adolescent Drug Abuse Diagnosis (ADAD) The Kiddie version of the Schedule of Affective Disorders and Schizophrenia(K-SADS) American Society of Addiction Medicine (ASAM) questionnaire forms*The Department of Health (DOH) is currently creating Chapter 246-341 WAC.This change resulted from Second Engrossed Substitute House Bill 1388 (effectiveJuly 1, 2018), which transferred authority for behavioral health agency licensingand certification from the Department of Social and Health Services to DOH. Theemergency (temporary) rules for this chapter can be found on the DOH website.CPT codes and descriptions only are copyright 2019 American Medical Association.7 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Case management services – Services provided by a certified Substance UseDisorder Professional (SUDP), a Substance Use Disorder Trainee (SUDPT), or aperson under the clinical supervision of a SUDP to assist individuals in gainingaccess to needed medical, social, educational, and other services.Client - A person receiving substance use disorder treatment services from aDOH-certified agency.Core provider agreement – An agreement between the HCA and eligibleproviders. The HCA reimburses enrolled eligible providers for covered medicalservices, equipment, and supplies they provide to eligible clients.Fee-for-service (FFS) - See WAC 182-500-0035.Group therapy - Planned therapeutic or counseling activity conducted by one ormore certified SUDPs or SUDPTs to a group of two to 16 people. Acupuncturemay be included as a group therapy activity if all of the following are met: A SUDP or SUDPT is present during the activity The provision of these services is written into the master treatment plan forthe client The services are documented in the client case file in the progress notesIndividual therapy - A planned therapeutic or counseling activity provided to aneligible client by a certified Substance Use Disorder Professional (SUDP) or aSubstance Use Disorder Trainee (SUDPT) under the supervision of a SUDP.Individual therapy includes treatment provided to a family group consisting of aprimary client and one or more significant others, or treatment provided to acouple who are partnered. Individual therapy may be provided to a family groupwithout the primary client present or to a client without the family present.Institution for mental diseases (IMD) - A hospital, nursing facility, or otherinstitution of more than sixteen beds that is primarily engaged in providingdiagnosis, treatment or care of people with mental diseases, including medicalattention, nursing care and related services. An IMD may include inpatientchemical dependency facilities of more than sixteen beds which provideresidential treatment for alcohol and substance abuse. See WAC 182-500-0050.Maximum allowable - The maximum dollar amount a provider may bereimbursed by the HCA for specific services, supplies, or equipment.CPT codes and descriptions only are copyright 2019 American Medical Association.8 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Opioid treatment programs (OTP) - Opioid treatment program services includedispensing opioid treatment medication, along with a comprehensive range ofmedical and rehabilitative services, when clinically necessary, to an individual toalleviate the adverse medical, psychological, or physical effects incident to opioiduse disorder as described in Chapter 246-341 WAC.*OTPs provide bundled services. Services are consistent with all state and federalrequirements and good treatment practices. Bundled services must include, as aminimum, all of the following services: Physical evaluation upon admission Urinalysis testing** Medical examination within 14 days of admission and annually thereafter Initial treatment plan and treatment plan review quarterly, and semi -annuallyafter the first two years of continuous treatment Vocational rehabilitation services as needed (may be by referral) Dose preparation and dose dispensing (Methadone, buprenorphine, andother treatment drugs) Detoxification if and when needed Patient case management Individual and/or group counseling One session of family planning; 30 minutes of counseling and education permonth for pregnant enrollees HIV screening, counseling, and testing referral Courtesy dosingNote: No additional fee is reimbursed for different types ofmedication used.Residential services - A complete range of services and supports performed in alive-in setting as authorized by HCA.Pregnant and postpartum women (PPW) assessment - Assessment providedto an eligible woman who is pregnant or postpartum. The postpartum periodcovers the 60 days after delivery and any remainder of the month in which the60th day falls.*Urinalysis tests (UAs) are part of the bundled service daily rate. For moreinformation, see the Drug Testing for Substance Use Disorder section of the HCA’sPhysician-Related Services/Health Care Professional Services Billing Guide.CPT codes and descriptions only are copyright 2019 American Medical Association.9 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Provider Entry Portal (PEP) - The PEP allows registration and data submission,as defined by the Behavioral Health Data System Data Guide, by non-tribalproviders for American Indian/Alaska Native (AI/AN) Medicaid clients notenrolled in managed care.ProviderOne -The HCA’s primary provider payment processing system.ProviderOne Client ID - A system-assigned number that uniquely identifies asingle client within the ProviderOne system; the number consists of nine numericcharacters followed by “WA.”Secure withdrawal management and stabilization - Care and treatment of aperson while the person recovers from the transitory effects of acute or chronicintoxication or withdrawal from alcohol or other drugs. The designated crisisresponder (DCR) will determine if a person is “gravely disabled or presenting alikelihood of serious harm to self or others due to a substance use disorder.”Treatment provided is for people who meet Involuntary Treatment Act (ITA)criteria due to a substance use disorder (Chapter 71.05 RCW).Substance use disorder - A problematic pattern of substance abuse leading toclinically significant impairment or distress, ranging in severity from mild,moderate, or severe.Substance Use Disorder Professional (SUDP) – An individual who has met therequirements of WAC 246-811-030 and is certified to provide SUD servicesaccording to RCW 18.205.030.Substance Use Disorder Professional Trainee (SUDPT) – An individual workingtoward the education and experience requirements for certification as asubstance use disorder professional, and who has been credentialed as a SUDPT.Substance use disorder treatment – Behavioral health services provided to aneligible client designed to mitigate or reverse the effects of substance usedisorder and restore normal physical and psychological functioning. Substanceuse disorder treatment is characterized by a combination of drug and alcoholeducation sessions, individual therapy, group therapy, and related activitiesprovided to clients and their families.Urinalysis - Analysis of a client’s urine sample for the presence of alcohol orcontrolled substances by a licensed laboratory or a provider who is exemptedfrom licensure by the Department of Health.Withdrawal management - Care and treatment of a person while the personrecovers from the transitory effects of acute or chronic intoxication or withdrawalfrom alcohol or other drugs. Acute – Inpatient program that is medically monitored by nurses with on-callphysicians available 24/7 for consultation. They have “standing orders” andavailable medications to help with withdrawal symptoms. Sub-Acute – Residential program that is clinically managed with limitedmedical coverage by staff and counselors who monitor patients. Generally,any treatment medications are self-administered.CPT codes and descriptions only are copyright 2019 American Medical Association.10 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE
Substance Use Disorder TreatmentWho should use this billing guide? Department of Health (DOH)-certified substance use disorder (SUD) providersregistered in the Provider Entry Portal (PEP) (see the Contractor and providerresources webpage for information about registering through PEP) Provid
7 SUBSTANCE USE DISORDER (SUD) BILLING GUIDE Definitions This section defines terms and abbreviations, including acronyms, used in this billing guide. Refer to Chapter 182-500 WAC for a complete list of definitions for Washington Apple Health HCA-designee – Any entity expressly designated by the HCA to act on its behalf.
2. Assessment and Diagnosis in Substance Use Disorder 3. Epidemiology of Substance Use 4. Acute Effects of Alcohol, Opioid and Cannabis Use 5. Health Hazards of Long Term Alcohol, Opioid and Cannabis Use 6. Treatment Principles and Issues in Manage-ment of Substance Use Disorder - An Overview 7. Pharmacotherapy of Substance Use Disorder 8.
F41.1 Generalized anxiety disorder F40.1 Social phobia F41.2 Mixed anxiety and depressive disorder F33 Recurrent depressive disorder F43.1 Post-traumatic stress disorder F60.31 Borderline personality disorder F43.2 Adjustment disorder F41.0 Panic disorder F90 Hyperkinetic (attention deficit) disorder F42 Obsessive-compulsive disorder
9417 Depersonalization disorder SOMATOFORM DISORDERS 9421 Somatization disorder 9422 Pain disorder 9423 Undifferentiated somatoform disorder 9424 Conversion disorder 9425 Hypochondriasis MOOD DISORDERS 9431 Cyclothymic disorder 9432 Bipolar disorder 9433 Dysthymic disorder 9434 Major depres
5. The batch will close and so will the OPIE Billing application. 6. To return to OPIE Billing, create a new batch. Get Started in Billing - Set up Global Settings in Billing Admin Rights in OPIE are required to access Billing Settings. 1. Log into OPIE Billing, go to the top left part of the Window to the menus: File, Windows, Help and click .
Adolescent Substance Use Disorder Treatment Zachary W. Adams, Ph.D., HSPP. . Identify drivers of substance use problems and implement evidence- . NIDA Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. www.drugabuse.gov. NIDA for Teens.
Consolidated Billing 3 Medicare Part B 3. SNF Billing Requirements 4. Billing Tips 5 Special Billing Situations 6 Readmission Within 30 Days 6 Benefits Exhaust 7 No Payment Billing 8 Expedited Review Results. 9 Noncovered Days 10 Other SNF Billing Situations 10. Resources 12. The American Hospital Association (the " AHA
Module 6: Approaches to Addressing Substance Use Disorder with Patients Identified by the PDMP 1. Learn how to integrate the PDMP with other screening tools to help identify those who may require substance use disorder . Substance misuse by patients is commonly encountered by healthcare providers in a variety of settings. However, evidence .
kesehatan mata menggunakan media permainan ular tangga. Tindakan preventif yang dilakukan adalah dalam bentuk pemeriksaan kesehatan mata pada masyarakat. Kegiatan diharapkan dapat mencangkup masyarakat lebih luas. Oleh karena itu, even Car Free Day dipilih sebagai lokasi kegiatan. Gambar 1. Lokasi Pendidikan dan Penyuluhan Kesehatan Mata di Car Free Day Cilembang . April 2020 [JURNAL .
