Medica Behavioral Health â MN CAC Code List ... - Ubhonline.com
Medica Behavioral Health â MN CAC Code List ... - Ubhonline.com
Medica Behavioral Health â MN CAC Code List ... - Ubhonline.com
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<strong>Medica</strong> <strong>Behavioral</strong> <strong>Health</strong> – <strong>MN</strong> <strong>CAC</strong> <strong>Code</strong> <strong>List</strong><br />
Optum<strong>Health</strong> <strong>Behavioral</strong> Solutions<br />
01/01/2013<br />
<strong>Code</strong>s that do not require prior authorization for <strong>Medica</strong> members - provided the member has an<br />
available benefit for these services.<br />
CPT <strong>Code</strong>s that Do Not require Authorization<br />
= Add-on <strong>Code</strong> (<strong>List</strong> this code separately in addition to the code for primary procedure).<br />
Blue = New Psychiatric CPT codes which can ONLY be submitted by a provider with<br />
prescriptive authority (MD’s & Nurses)<br />
Procedure <strong>Code</strong><br />
Description<br />
90785<br />
Interactive <strong>com</strong>plexity<br />
90791 Psychiatric diagnostic evaluation<br />
90792 Psychiatric diagnostic evaluation with medical services<br />
90832 Psychotherapy, 30 minutes with patient and/or family member<br />
90833<br />
Psychotherapy, 30 minutes with patient and/or family member when<br />
performed with an evaluation and management service<br />
90834 Psychotherapy, 45 minutes with patient and/or family member<br />
90836<br />
Psychotherapy, 45 minutes with patient and/or family member when<br />
performed with an evaluation and management service<br />
Psychotherapy, 60 minutes with patient and/or family member<br />
90837 No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
Psychotherapy, 60 minutes with patient and/or family member when<br />
90838<br />
performed with an evaluation and management service<br />
No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
90839 Psychotherapy for crisis; first 60 minutes<br />
90840<br />
Psychotherapy for crisis; each additional 30 minutes<br />
90846 Family psychotherapy (without the patient present)<br />
90847 Family psychotherapy (conjoint psychotherapy)(with patient present)<br />
90849 Multiple-family group psychotherapy<br />
90853 Group psychotherapy (other than of a multiple-family group)<br />
Electroconvulsive therapy (includes necessary monitoring)<br />
90870 No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
Interpretation or explanation of results of psychiatric examination or<br />
procedure to family or other responsible persons<br />
90887<br />
No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
90901 Biofeedback training by any modality<br />
96101-96103 Psychological testing
No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
96116 Neurobehavioral status exam<br />
96118-96120 Neuropsychological testing<br />
96150-96155 <strong>Health</strong> and behavior assessment and intervention<br />
99201-99205 Office or other outpatient visit – New Patient<br />
99211-99215 Office or other outpatient visit – Established Patient<br />
99221-99223 Initial hospital care – New or Established Patient<br />
99231-99233 Subsequent hospital care – New or Established Patient<br />
99236<br />
Observation or inpatient hospital care (admitted and discharged on the same<br />
date of service0<br />
99238-99239 Hospital discharge day management<br />
99241-99245 Office or other outpatient consultation – New or Established Patient<br />
99251-99255 Inpatient consultation – New or Established Patient<br />
99281-99285 Emergency department visit<br />
99304-99306 Initial nursing facility care - New or Established Patient<br />
99308-99310 Subsequent nursing facility care - New or Established Patient<br />
99318<br />
Evaluation and management of a patient involving an annual nursing facility<br />
assessment<br />
99324-99328 Domiciliary or rest home visit – New Patient<br />
99334-99337 Domiciliary or rest home visit – Established Patient<br />
99341-99343 Home visit – New Patient<br />
99347-99349 Home visit – Established Patient<br />
99408-99409<br />
Alcohol and/or substance abused structured screening and brief intervention<br />
services<br />
99441-99443 Telephonic services<br />
H0031<br />
H2011<br />
S9484<br />
S9485<br />
Crisis Response Services – Billing <strong>Code</strong>s<br />
Only if contracted as Mobile Crisis Assessment or Response<br />
Only if contracted as Mobile Crisis Intervention<br />
Crisis intervention mental health services, per hour<br />
No authorization needed for 5 digit group numbers. Please call for benefits<br />
to determine authorization requirements for 6 digit group numbers.<br />
Crisis intervention mental health services, per diem<br />
In addition to services listed above….Minnesota State Public Program<br />
services which Do Not require prior authorization for contracted providers:<br />
(Products include: PMAP, <strong>MN</strong>Care, GAMC, MSHO, SNB, branded as <strong>Medica</strong><br />
ChoiceCare, <strong>Medica</strong> MinnesotaCare, Dual Solution and AccessAbility Solution)<br />
State Public Program Crisis Response Services – Billing <strong>Code</strong>s<br />
H0031, H0031 HN H2011, H2011 HN<br />
S9484, S9484 HM, S9484 HN, S9484 HQ, S9484 HQ HM, S9484 UA, S9484 UA HN
ARMHS/Peer Specialist Services – Billing <strong>Code</strong>s<br />
90882, 90882 HM,<br />
H0038, H0038 U5,<br />
H0034, H0034 HQ<br />
90882 UD, 90882 UD HM<br />
H0038 HQ<br />
H0046 HK<br />
H2017, H2017 HM,<br />
H2017 HQ, H2017 UD,<br />
H2017 UD HM<br />
CTSS Services – Billing <strong>Code</strong>s<br />
H0004 UA H0046 UA H2015 UA<br />
H2012 UA<br />
H2012 UA HK<br />
H2012 UA HK U6<br />
H2014 UA,<br />
H2014 UA HR,<br />
H2014 UA HQ<br />
H2019 UA,<br />
H2019 UA HM,<br />
H2019 UA HE<br />
Targeted Case Management (TCM) Services – Billing <strong>Code</strong>s<br />
Adolescent: T2023 HE HA, T2023 HE HA TF, T2023 HE HA TG<br />
Adult:<br />
T2023 HE, T2023 HE TF, T2023 HE TG
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