Oppositional Defiant Disorder, Intensive Outpatient ... - Ubhonline.com
Oppositional Defiant Disorder, Intensive Outpatient ... - Ubhonline.com
Oppositional Defiant Disorder, Intensive Outpatient ... - Ubhonline.com
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Limited to specific CPT and HCPCS codes?<br />
x YES □ NO<br />
H0015<br />
S9480<br />
<strong>Intensive</strong> outpatient (treatment program that<br />
operates at least 3 hours/day and at least 3<br />
days/week and is based on an individualized<br />
treatment plan), including assessment,<br />
counseling; crisis intervention, and activity<br />
therapy.<br />
<strong>Intensive</strong> outpatient psychiatric services, per<br />
diem<br />
Limited to specific diagnosis codes?<br />
x YES □ NO<br />
313.81 <strong>Oppositional</strong> <strong>Defiant</strong> <strong>Disorder</strong><br />
Limited to place of service (POS)?<br />
x YES □ NO<br />
<strong>Intensive</strong> <strong>Outpatient</strong> Program<br />
Limited to specific provider type?<br />
□ YES x NO<br />
Limited to specific revenue codes?<br />
□ YES x NO<br />
HISTORY<br />
Revision Date Name Revision Notes<br />
12/2/12 L. Urban Version 2-Final<br />
The enrollee's specific benefit documents supersede these guidelines and are used to make coverage determinations.<br />
These Coverage Determination Guidelines are believed to be current as of the date noted.<br />
<strong>Intensive</strong> <strong>Outpatient</strong> Treatment of <strong>Oppositional</strong> <strong>Defiant</strong> <strong>Disorder</strong> (ODD) Page 14 of 14<br />
Coverage Determination Guideline<br />
Confidential and Proprietary, © Optum 2012<br />
Optum is a brand used by United Behavioral Health and its affiliates
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