Dmas Approved Codes & Rates Approved By Centers For Medicare And .
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructurePage 1 of 13DMAS APPROVED CODES & RATESAPPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AUGUST 25, 2017Community Based CareBilling CodeService NameService DescriptionASAM LevelUnit Lengths Annual Limit(per fiscal year)Rates per UnitAuthorizationRequiredNotesMedicaid/FAMIS/GAP CoverageMedicaid/FAMIS FFS member billMagellanH0006Substance Use Case Management(licensed by DBHDS)Targeted Substance Use CaseManagement Services-provided byDBHDS licensed case managementprovider.N/A1 unit 1 month 243.00*NoNot reimbursable with any otherMedicaid/FAMIS MCO member billMedicaid covered case managementMCOservice.Non-covered for GAP. GAP Memberscovered by GAP Case ManagementT1012S9445Peer support services - individualEffective 7/1/17Peer support services - groupEffective 7/1/17H0015orIntensive outpatientrev 0906with H0015Self help/Peer Services. Peer providedservices to initiate clinical serviceutilization and self-determinationstrategies - individualSelf help/Peer Services. Peer providedservices to initiate clinical serviceutilization and self-determinationstrategies - group settingStructured program delivering 9-19hours per week, before/afterwork/school, in evening and/orweekends to meet complex needs ofpeople with addition and co-occuringconditions.Note: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Medicaid/FAMIS FFS/GAP member billMagellanN/A1 unit 15 minutes 6.50YesMay be provided in any ASAM LevelMedicaid/FAMIS MCO member billMCON/A1 unit 15 minutes 2.70YesMay be provided in any ASAM LevelMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMISMCO member bill MCO3 hours per day minimum of clinicalprogramming and minimum of 9hours per week adult / minimum of 6hours per week adolescent2.11 unit 1 day 250.00*Virginia Department of Medical Assistance ServicesYes, URGENT:Additional Services that can beReview withinbilled:72 hours, PA Level 1WM or 2WM for MATretroactiveInduction Physician Visits (CPT or E&MCodes) Drug Screens/Labs MedicationsMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructureS0201 orrev 0913 with Partial HospitalizationS0201*SpecialNote:20 or more hours of clinicallyintensive programming per week witha planned format of individualizedand family therapies.2.51 unit 1 day 500.00*Page 2 of 135 Hours per day minimum of clinicalprogramming and minimum of 20service hours per week.Medicaid/FAMIS FFS member billMagellanYes, URGENT: Additional Services that can beReview within billed:Medicaid/FAMIS MCO member bill72 hours, PA Level 1WM or 2WM for MATMCOretroactive Induction Physician Visits (CPT or E&MEffective 10/1/17: Covered for GAP billCodes)Magellan Drug Screens/Labs MedicationsThe rates for Substance Use Case Management, Substance Use Care Coordination, Opioid Treatment Programs (OTPs), Office Based Opioid Treatment (OBOT) services, Partial Hospitalization Programs and Intensive Outpatient Programs are designed to build aninfrastructure for quality care. DMAS will work with Managed Care Organizations to develop accountability using financial incentives. Full payment will require providers to meet structural requirements, report quality and outcome metrics, and have a significantportion of payments at risk. Within 3 years, providers must meet thresholds for process and outcome measures. Managed Care Organizations will also be encouraged in the next 3-5 years to develop risk-based alternative payment models such as bundledpayments and medical homes.Opioid Treatment Programs (OTP) / Office Based Opioid Treatment (OBOT)Billing CodeH0014Service NameMedication Assisted Treatment (MAT)day one induction - PhysicianService DescriptionASAM LevelAlcohol and/or drug services;ambulatory detoxification; All nonfacility withdrawal managementinductionsOTP/OBOTMAT - Evaluation and managementPhysician/Nurse Practitioner Evaluation99211-99215visit - Follow up and maintenanceand management visitsservicesNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.OTP/OBOTUnit Lengths Annual Limit(per fiscal year)Per encounter. Limit of 3induction encounters percalendar year per provider.CPT valuesRates per UnitAuthorizationRequired 140.00NoNotesCoverageMedicaid/FAMIS FFS/GAP member billMagellanUsed on OTP/OBOT setting only.Medicaid/FAMIS MCO member billMCOCPT rates as of July 1, 2017:Age 21 15.57 to 111.43Age 20 13.66 to 97.80Virginia Department of Medical Assistance ServicesNoIf a member fails 3 buprenorphineMAT inductions in a calendar year inan OBOT setting, the member shouldbe referred to an OTP for assessmentfor Methadone program.Medicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructurePage 3 of 13Medicaid/FAMIS FFS/GAP member billMagellanG9012Substance Use Care CoordinationOBOT and OTP Substance Use Carecoordination to manage MATtreatmentN/A1 unit 1 month 243.00*NoMedicaid/FAMIS MCO member billUsed in OBOT and OTP setting only.MCONot reimbursable with any otherMedicaid covered case managementMust be billed with moderate to severeservice.Opioid Use Disorder as primary diagnosisfor non-pregnant members. Pregnantmembers any opioid use.Medicaid/FAMIS FFS/GAP member billMagellanH0020H0004H0005Medication AdministrationOpioid treatment services - IndividualOpioid treatment services - GroupMedication adminstration by RN / LPNOTPPer encounter 8.00NoUsed in OTP setting onlyMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellanOpioid Treatment - individualcounselingOTP/OBOTOpioid Treatment - group counselingand family therapyOTP/OBOT1 unit 15 minutes1 unit 15 minutes 24.00 7.25NoNoUsed in OBOT and OTP setting onlyUsed in OTP/OBOT setting only10 individuals maximum per groupMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMAS82075Alchohol BreathalyzerToxicology/LabCPT valuesCPT rates as of 7/1/14: 5.52NoMedicaid/FAMIS MCO member billMCO8030580307Presumptive drug class screening, anydrug classG0480-G0483 Definitive drug classesToxicology/LabToxicology/LabNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.OTP/OBOT1WM-2WMOTP/OBOT1WM-2WMCPT valuesCPT valuesCPT rates as of 4/1/17:80305- 14.96, 80306- 19.95, 80307 79.81CPT rates as of 4/1/17:G0480- 79.74, G0481- 122.99,G0482- 166.03, G0483- 215.23Virginia Department of Medical Assistance ServicesNoUse these codes for urine drugscreening and alcohol mouth swabtestMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMASNoMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement 102586580930009300593010J0570RPR TestHepatitis B and C / HIV TestsPregnancy TestTB TestEKGProbuphine (buprenorphine implant)74.2 mgToxicology/LabCPT valuesToxicology/LabCPT valuesToxicology/LabCPT valuesToxicology/LabCPT valuesToxicology/LabMedication administration byproviderNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.CPT valuesOTP1WM-2WM andother settingsCommunitybased settingsASAM Levels2.1 to 3.71 unit 6 monthsCPT rates as of 7/1/14:86592 - 4.18, 86593 - 4.82, 86780 16.02CPT rates as of 7/1/14:Hep B and C: 86704 - 13.93, 86803 16.49, 86702 - 9.20, 86703- 11.48HIV: 86701 - 10.27CPT rate as of 7/1/14: 7.30CPT rate as of 7/1/17: 6.88CPT rate as of 7/1/17:93000 - Age 21 14.35,Age 20 14.3593005 Age 21 7.18, Age 20 7.1893010- Age 21 7.18, Age 20 7.18Rate as of 10/1/17 1261.30Virginia Department of Medical Assistance ServicesNoPage 4 of 13Required upon initiating treatmentwith methadone by federalregulations.Medicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCONoNoNoVirginia Department of HealthMedicaid/FAMIS FFS/GAP member billencourages at least annual screening DMASof all individuals with substance usedisorder for HIV, Hepatitis B and CMedicaid/FAMIS MCO member billMCOStrongly recommend pregnancy testbefore initiating treatment.Medicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billVirginia Department of HealthDMASencourages at least annual screeningof all individuals with substance useMedicaid/FAMIS MCO member billdisorder for tuberculosisMCOMedicaid/FAMIS FFS/GAP member billDMASNoMedicaid/FAMIS MCO member billMCOYesUsed as part of a comprehensivesubstance use disorder treatmentprogram to include counseling andpsychosoical support. See serviceauthorization criteria on ARTSwebsite.Medicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement tion administration byproviderMedication administration in clinicQ3014 – GT Telehealth originating site facility fee*SpecialNote:S0109 Methadone oral 5 mg 0.26/5mgJ0571 Buprenorphine, oral, 1 mg 1.00/unitJ0572 Buprenorphine/naloxone oral 3 mg 4.34/unitJ0573 Buprenorphine/naloxone oral 3 mg but 6 mg 7.76/ unitJ0574 Buprenorphine/naloxone oral 6 mg but 10 mg 7.76/unitJ0575 Buprenorphine/naloxone oral 10 mg 15.52/unitJ2315 Naltrexone Injection, depotform, 1 mg 3.24/unit (rate changeeffective 4/1/17).OTP/OBOT1WM-2WM andother settingsCommunitybased settingsASAM Levels2.1 to 3.71WM-2WMPer Visit 20.00Page 5 of 13No SA required.MD visits, counseling, casemanagement and medical servicesallowed concurrently.No*The Naltrexone injection does notrequire service authorizationregardless if dispensed by physicianor pharmacy.Medicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMISMCO member bill MCOOBOTs may dispense buprenorphineproducts on-site only during theinduction phase and then shallprescribe buprenorphine productsafter the induction phase.NoThe rates for Substance Use Case Management, Substance Use Care Coordination, Opioid Treatment Programs (OTPs), Office Based Opioid Treatment (OBOT) services, Partial Hospitalization Programs and Intensive Outpatient Programs are designed to build aninfrastructure for quality care. DMAS will work with Managed Care Organizations to develop accountability using financial incentives. Full payment will require providers to meet structural requirements, report quality and outcome metrics, and have a significantportion of payments at risk. Within 3 years, providers must meet thresholds for process and outcome measures. Managed Care Organizations will also be encouraged in the next 3-5 years to develop risk-based alternative payment models such as bundledpayments and medical homes.Medication Assisted Treatment (MAT) - Outpatient Settings - non OTP/OBOT SettingsBilling Code99201-99205Service NameEvaluation and management servicesnew patientService DescriptionASAM LevelUnit Lengths Annual Limit(per fiscal year)Evaluation and Management servicesnew patient1WM-2WMCPT valuesNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Rates per UnitCPT rates as of 7/1/17:Age 21 33.87 to 159.22Age 20 29.72 to 139.75Virginia Department of Medical Assistance /FAMIS FFS/GAP member billMagellanNoMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement Structure99211-9921582075Evaluation and management servicesestablished patientEvaluation and Management servicesestablished patientAlchohol BreathalyzerToxicology/Lab1WM-2WMCPT valuesCPT valuesPage 6 of 13Medicaid/FAMIS FFS/GAP member billMagellanCPT rates as of 7/1/17:Age 21 15.57 to 111.43Age 20 13.66 to 97.80NoCPT rates as of 7/1/14: 5.52NoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCO8030580307Presumptive drug class screening, anydrug classG0480-G0483 Definitive drug 25RPR TestHepatitis B and C / HIV TestsPregnancy cology/LabToxicology/LabNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.OTP/OBOT1WM-2WMOTP/OBOT1WM-2WMCPT valuesCPT valuesCPT valuesCPT valuesCPT valuesCPT rates as of 4/1/17: 80305- 14.96,80306- 19.95, 80307- 79.81CPT rates as of 1/1/16: G0480 79.74, G0481- 122.99, G0482 166.03, G0483- 215.23CPT rates as of 7/1/14: 86592 - 4.18,86593 - 4.82, 86780 - 16.02CPT rates as of 7/1/14: Hep B and C:86704 - 13.93, 86803 - 16.49 86702- 9.20, 86703- 11.48 HIV: 86701 10.27,CPT rate as of 7/1/14: 7.30Virginia Department of Medical Assistance ServicesNoUse these codes for urine drugscreening and alcohol mouth swabtestMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMASNoMedicaid/FAMIS MCO member billMCONoNoNoRequired upon initiating treatmentwith methadone by federalregulations.Medicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCOVirginia Department of Healthencourages at least annual screening Medicaid/FAMIS FFS/GAP member billof all individuals with substance use DMASdisorder for HIV, Hepatitis B and CMedicaid/FAMIS MCO member billMCOStrongly recommend pregnancy testbefore initiating treatment.Medicaid/FAMIS FFS/GAP member billDMASMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement Structure86580930009300593010TB TestEKGToxicology/LabToxicology/Lab90832Add GT if Psychotherapy, 30 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)90833Add GT ifneeded (w/E&M)Psychotherapy, 30 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementservice90834Add GT if Psychotherapy, 45 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)90836Add GT ifneeded (w/E&M)CPT valuesCPT values1 and 1WM1 and 1WMVaries based on MD facetime with patientCPT rate as of 7/1/17:93000 - Age 21 14.35,Age 20 14.3593005 Age 21 7.18, Age 20 7.1893010- Age 21 7.18, Age 20 7.18NoMedicaid/FAMIS FFS/GAP member billVirginia Department of HealthDMASencourages at least annual screeningof all individuals with substance useMedicaid/FAMIS MCO member billdisorder for tuberculosisMCOMedicaid/FAMIS FFS/GAP member billDMASNoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellanCPT OP rate as of 7/1/17: 53.53NoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellanCPT OP rate as of 7/1/17: 55.62NoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellan1 and 1WMN/ACPT OP rate as of 7/1/17: 71.07NoMedicaid/FAMIS MCO member billMCOPsychotherapy, 45 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementservice1 and 1WM90837Add GT if Psychotherapy, 60 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)1 and 1WMNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Varies based on MD facetime with patientCPT rate as of 7/1/17: 6.88Page 7 of 13N/AN/ACPT OP rate as of 7/1/17: 70.27CPT OP rate as of 7/1/17: 106.75NoList separately in addition to thecode for the primary procedureMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellanNoMedicaid/FAMIS MCO member billMCOVirginia Department of Medical Assistance Serviceslast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement Structure90838Add GT ifneeded (w/E&M)Psychotherapy, 60 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementservice1 and 1WM90846Add GT ifneededFamily psychotherapy (without patientpresent)Outpatient service1 and 1WM90847Add GT ifneededFamily psychotherapy (with patientpresent)Outpatient serviceN/A45 minutes to 1 hourCPT OP rate as of 7/1/17: 92.70CPT OP rate as of 7/1/17: 86.12NoPage 8 of 13List separately in addition to thecode for the primary procedureMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMASNoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billDMAS1 and 1WM45 minutes to 1 hourCPT OP rate as of 7/1/17: 89.41NoMedicaid/FAMIS MCO member billMCO90853Add GT ifneededGroup psychotherapy (other than multiOutpatient servicefamily)90863Add GT ifneededPharmacologic management, includingprescription and review of medication,when performed with psychotherapyservicesOutpatient serviceQ3014 – useTelehealth originating site facility feeGTNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.1 and 1WMPer enounterCPT OP rate as of 7/1/17: 21.53No1 and 1WMUse in conjunction with90832, 90834, 90837CPT OP rate as of 1/1/13 48.93No1WM-2WMPer Visit 20.00NoMedicaid/FAMIS FFS/GAP member billUse 90853 in conjunction with 90785Magellanfor the specified patient when grouppsychotherapy includes interactiveMedicaid/FAMIS MCO member billcomplexity.MCOMedicaid/FAMIS FFS/GAP member billPharmacologic managementincluding prescription and review of Magellanmedication, when performed withMedicaid/FAMIS MCO member billpsychotherapy services.MCOMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOVirginia Department of Medical Assistance Serviceslast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructureResidential and Inpatient TreatmentBilling CodeH2034Service NameClinically managed low intensityresidential servicesService DescriptionAlcohol and/or drug abuse halfwayhouse services, per diem. Supportiveliving environment with 24-hour staffand integration with clinical services;at least 5 hours of low-intensitytreatment per week.ASAM Level3.1Unit Lengths Annual Limit(per fiscal year)1 unit 1 dayRates per UnitAuthorizationRequiredPage 9 of 13NotesCoverage 175Yes – ASAMAssessment byIndependentThird PartyRequiredURGENT:reviewed within72 hoursMedicaid/FAMIS FFS member billDaily rate includes all services.MagellanAdditional services consist ofOutpatient, Intensive Outpatient,Medicaid/FAMIS MCO member billPartial Hospitalization Program, andMCOall Medication Assisted Treatment inwhich can be billed separately.Effective 10/1/17: covered for GAP - billMagellanMax 393.50Yes – ASAMAssessment byIndependentThird PartyRequiredURGENT:reviewed within72 hoursPer Diem covers all TherapeuticProgramming.Additional Services that can bebilled: Physician Visits ( E&M Codes) Drug Screens/Labs MedicationsAlcohol and /or drug services; subacute detoxification (residentialaddiction program inpatient). AdultsonlyH0010Rev 1002Use modifierTGClinically managed population-specifichigh intensity residential servicesClinically managed therapeuticrehabilitative facility for adults withcognitive impairment includingdevelopmental delay. Staffed bycredentialed addiction professionals,physicians/physician extenders, andcredentialed MH professionals.3.31 unit 1 dayMedicaid FFS member bill MagellanMedicaid MCO member bill MCOEffective 10/1/17: covered for GAP billMagellanNon-covered for FAMISNon-covered for FAMIS MOMSClinically directed withdrawalmanagement may be provided (ASAMLevel 3.2WM)Note: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Virginia Department of Medical Assistance Serviceslast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructureH0010Rev 1002Adult - usemodifier HBClinically managed high-intensityresidential services (Adult)Clinically managed medium-intensityresidential servicesAdolescent (Adolescent)use modifierHAAlcohol and /or drug services; subacute detoxification (residentialaddiction program inpatient).Clinically managed therapeuticcommunity or residential treatmentfacility providing high intensityservices for adults or mediumintensity services for adolescents.Staffed by licensed/credentialedclinical staff including addictioncounselors, LCSWs, LPCs,physicians/physician extenders, andcredentialed MH professionals.Page 10 of 13Medicaid FFS member bill Magellan3.51 unit 1 dayYes – ASAMAssessment by*Psychiatric Units & FreestandingIndependentPsychiatric Hospitals psychiatric perThird Partydiem rateRequired Residential Treatment Services URGENT:max. 393.50reviewed within72 hoursPer Diem covers all TherapeuticProgramming.Additional Services that can bebilled: Physician Visits ( E&M Codes) Drug Screens/Labs MedicationsMedicaid MCO member bill MCOEffective 10/1/17: covered for GAP billMagellan Non-covered for FAMIS Non-covered for FAMIS MOMS*MCOs may elect to cover for FAMIS andFAMIS MOMSClinically directed withdrawalmanagement may be provided (ASAMLevel 3.2WM)Alcohol and/or other drug treatmentprogram, per diem.Planned and structured regimen of 24H2036hour professionally directedRev 1002Medically monitored intensive inpatient evaluation, observation, medicalservices (Adult)monitoring and addiction treatment inAdult - usean inpatient setting consisting ofmodifier HBMedically monitored high intensityfreestanding facility or a specialty unitinpatient services (Adolescent)in a general or psychiatric hospital orAdolescent other licensed health care facility.use modifierHAMedically Monitored InpatientWithdrawal Management (ASAMLevel 3.7 WM) may also be provided.Note: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Medicaid FFS member bill Magellan3.71 unit 1 dayYes – ASAMAssessment by*Psychiatric Units & FreestandingIndependentPsychiatric Hospitals psychiatric perThird Partydiem rateRequired Residential Treatment Services URGENT:max. 393.50reviewed within72 hoursVirginia Department of Medical Assistance ServicesPer Diem covers all TherapeuticProgramming.Additional Services that can bebilled: Physician Visits ( E&M Codes) Drug Screens/Labs MedicationsMedicaid MCO member bill MCOEffective 10/1/17: covered for GAP billMagellan Non-covered for FAMIS Non-covered for FAMIS MOMS*MCOs may elect to cover for FAMIS andFAMIS MOMSlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructureH0011Rev 1002Medically managed intensive inpatientservicesAlcohol and/or drug services; acutedetoxification.Medically Managed IntensiveInpatient Services consist of 24 hournursing care and daily physician carefor severe, unstable problems indimensions 1, 2 or 3. Counselingavailable.4.01 unit 1 dayASAM LevelUnit Lengths Annual Limit(per fiscal year)Psychiatric Per Diem or DRGYesURGENT –TelephonicApprovalWithin 24 hours(1 calendar day)Medically Managed InpatientWithdrawal Management (ASAMLevel 4WM) may also be provided.Outpatient TreatmentBilling CodeService NameService DescriptionRates per UnitAuthorizationRequired90791Add GT ifneededPsychiatric diagnostic evaluationOutpatient service11 unit per rolling 12months for same providerCPT OP rate as of 7/1/17: 110.04No90792Add GT ifneededPsychiatric diagnostic evaluation withmedical serviceOutpatient service11 unit per rolling 12months for same providerCPT OP rate as of 7/1/17: 123.50No90785Add GT ifneededInteractive complexity service add-oncode to office visitsOutpatient serviceNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.1CPT OP rate as of 7/1/17: 11.66Virginia Department of Medical Assistance ServicesNoPage 11 of 13Medicaid/FAMIS FFS member billRate structure (psychiatric per diemMagellanvs. DRG payment) determinedbetween provider and MedicaidMedicaid/FAMIS MCO member billMCO for Managed Care enrolledMCOmembers / Provider and DMAS forfee-for-service members.Non-covered for GAPNotesCoverageMedicaid/FAMIS FFS/GAP member billUse 90785 in conjunction with 90791Magellanor 90792 when the diagnosticevaluation includes interactiveMedicaid/FAMIS MCO member billcomplexity services.MCOMedicaid/FAMIS FFS/GAP member billUse 90785 in conjunction with 90791Magellanor 90792 when the diagnosticevaluation includes interactiveMedicaid/FAMIS MCO member billcomplexity services.MCOList separately in addition to thecode for primary procedure.Medicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement StructurePage 12 of 13Medicaid/FAMIS FFS/GAP member &Magellan Credentialed Provider billMagellan99408Alcohol and/or substance (other thantobacco) abuse structured screening: 15 Outpatient service- 30 minutesCPT OP rate as of 7/1/17: ages 21 25.82 20 23.731NoMedicaid/FAMIS FFS member & DMASProvider bill DMASMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member &Magellan Credentialed Provider billMagellan99409Alcohol and/or substance (other thantobacco) abuse structured screening:greater than 30 minutesOutpatient serviceCPT OP rate as of 7/1/17: ages 21 50.34 20 46.261NoMedicaid/FAMIS FFS member & DMASProvider bill DMASMedicaid/FAMIS MCO member billMCO90832Add GT if Psychotherapy, 30 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)90833Add GT ifneeded (w/E&M)Psychotherapy, 30 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementservice90834Add GT if Psychotherapy, 45 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)90836Add GT ifneeded (w/E&M)Psychotherapy, 45 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementserviceNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.Medicaid/FAMIS FFS/GAP member billMagellan1CPT unit valuesCPT OP rate as of 7/1/17: 53.53NoMedicaid/FAMIS MCO member billMCO1CPT unit valuesCPT OP rate as of 7/1/17: 55.62NoList separately in addition to thecode for primary procedure.Medicaid/FAMISFFS/GAP member billMagellanMedicaid/FAMISMCO member bill MCOMedicaid/FAMIS FFS/GAP member billMagellan1CPT unit valuesCPT OP rate as of 7/1/17: 71.07NoMedicaid/FAMIS MCO member billMCO1CPT unit valuesCPT OP rate as of 7/1/17: 70.27Virginia Department of Medical Assistance ServicesNoList separately in addition to thecode for primary procedure.Medicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCOlast update 10/6/2017
Addiction and Recovery Treatment Services (ARTS)Reimbursement Structure90837Add GT if Psychotherapy, 60 minutes with patientOutpatient serviceneeded (w/o and/or family memberE&M)90838Add GT ifneeded (w/E&M)Psychotherapy, 60 minutes with patientand/or family member when performedOutpatient servicewith an evaluation and managementserviceFamily psychotherapy (without patientpresent)Outpatient service90847Add GT ifneededFamily psychotherapy (with patientpresent)Outpatient service908631CPT unit valuesCPT OP rate as of 7/1/17: 106.75NoMedicaid/FAMIS MCO member billMCO1CPT unit valuesCPT OP rate as of 7/1/17: 92.70NoList separately in addition to thecode for primary procedure.Medicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS MCO member billMCO1CPT unit valuesCPT OP rate as of 7/1/17: 86.12NoMedicaid/FAMIS MCO member billMCOMedicaid/FAMIS FFS/GAP member billMagellan1CPT unit valuesCPT OP rate as of 7/1/17: 89.41NoMedicaid/FAMIS MCO member billMCOGroup psychotherapy (other than multiOutpatient servicefamily)Pharmacologic management:prescription and review of medication,when performed with psychotherapyservicesMedicaid/FAMIS FFS/GAP member billMagellanMedicaid/FAMIS FFS/GAP member billMagellan90846Add GT ifneeded90853Add GT ifneededPage 13 of 13Outpatient serviceNote: Labs should only be billed if performed in-house.If patient or specimen sent to independent laboratory, the laboratory should bill.11WM-2WMCPT unit valuesUse in conjunction with90832, 90834, 90837CPT OP rate as of 7/1/17: 21.53CPT OP rate as of 1/1/13 48.93Virginia Department of Medical Assistance ServicesNoMedicaid/FAMIS FFS/GAP member billUse 90853 in conjunction with 90785Magellanfor the specified patient when grouppsychotherapy includes interactiveMedicaid/FAMIS MCO member billcomplexity.MCONoPharmacologic managementMedicaid/FAMIS FFS/GAP member billincluding prescription and review of Magellanmedication, when performed withpsychotherapy services.Medicaid/FAMIS MCO member billMCOlast update 10/6/2017
Virginia Department of Medical Assistance Services last update 10/6/2017. Addiction and Recovery Treatment Services (ARTS) Reimbursement Structure Page 2 of 13 S0201 or rev 0913 with . G0480-G0483 Definitive drug classes Toxicology/Lab OTP/OBOT 1WM-2WM CPT values CPT rates as of 4/1/17: G0480- 79.74, G0481- 122.99, G0482- 166.03, G0483- 215.23 No
PSI AP Physics 1 Name_ Multiple Choice 1. Two&sound&sources&S 1∧&S p;Hz&and250&Hz.&Whenwe& esult&is:& (A) great&&&&&(C)&The&same&&&&&
Argilla Almond&David Arrivederci&ragazzi Malle&L. Artemis&Fowl ColferD. Ascoltail&mio&cuore Pitzorno&B. ASSASSINATION Sgardoli&G. Auschwitzero&il&numero&220545 AveyD. di&mare Salgari&E. Avventurain&Egitto Pederiali&G. Avventure&di&storie AA.&VV. Baby&sitter&blues Murail&Marie]Aude Bambini&di&farina FineAnna
The program, which was designed to push sales of Goodyear Aquatred tires, was targeted at sales associates and managers at 900 company-owned stores and service centers, which were divided into two equal groups of nearly identical performance. For every 12 tires they sold, one group received cash rewards and the other received
College"Physics" Student"Solutions"Manual" Chapter"6" " 50" " 728 rev s 728 rpm 1 min 60 s 2 rad 1 rev 76.2 rad s 1 rev 2 rad , π ω π " 6.2 CENTRIPETAL ACCELERATION 18." Verify&that ntrifuge&is&about 0.50&km/s,∧&Earth&in&its& orbit is&about p;linear&speed&of&a .
theJazz&Band”∧&answer& musical&questions.&Click&on&Band .
6" syl 4" syl 12" swgl @ 45 & 5' o.c. 12" swchl 6" swl r1-1 ma-d1-6a 4" syl 4" syl 2' 2' r3-5r r4-7 r&d 14.7' 13' cw open w11-15 w16-9p ma-d1-7d 12' 2' w4-3 moonwalks abb r&d r&d r&d r&d r&d r&d ret ret r&d r&d r&d r&d r&d 12' 24' r&d ma-d1-7a ma-d1-7b ret r&d r&d r5-1 r3-2 r&d r&r(b.o.) r6-1r r3-2 m4-5 m1-1 (i-195) m1-1 (i-495) m6-2l om1-1 .
s& . o Look at the poem’s first and last lines (first and last lines may give readers important . it is important to read poems four times. Remind them that the first time they read is for enjoyment; rereads allow them to dive deeper into poems .
ASTM D 4255 In-Plane Shear Strength / Modulus (Rail Shear) ASTM D 4442 Moisture Content Measurement ASTM D 4585 Controlled Condenstaion Conditioning ASTM D 5229 Moisture Absorption ASTM D 5379 Shear Properties (V-Notch) ASTM D 5420 Gardner Drop Impact Test ASTM D 5467 Skin Compression by Beam Flexure ASTM D 5628 Drop Impact Test ASTM D 570 Water Absorption ASTM D 5766 Tensile Strength, Open .
