PART I - Department of Behavioral Health and Developmental ...

Family Outpatient Services: Family CounselingTransactionCodeCode Detail Code Mod1Mod2Mod3Mod4Rate Code Detail Code Mod1Mod2Mod3Mod4RatePractitioner Level 2, In-Clinic H0004 HS U2 U6 $38.97 Practitioner Level 2, Out-of-Clinic H0004 HSU2U7 $46.76Family – BHcounseling/therapy (w/oclient present)Practitioner Level 3, In-Clinic H0004 HSPractitioner Level 4, In-Clinic H0004 HSU3U4U6 $30.01 Practitioner Level 3, Out-of-Clinic H0004 HSU6 $20.30 Practitioner Level 4, Out-of-Clinic H0004 HSU3U4U7 $36.68U7 $24.36Practitioner Level 5, In-Clinic H0004 HSU5U6 $15.13 Practitioner Level 5, Out-of-Clinic H0004 HSU5U7 $18.15Practitioner Level 2, In-Clinic H0004 HR U2 U6 $38.97 Practitioner Level 2, Out-of-Clinic H0004 HRU2U7 $46.76Family – BHcounseling/therapy (withclient present)Practitioner Level 3, In-Clinic H0004 HRPractitioner Level 4, In-Clinic H0004 HRU3U4U6 $30.01 Practitioner Level 3, Out-of-Clinic H0004 HRU6 $20.30 Practitioner Level 4, Out-of-Clinic H0004 HRU3U4U7 $36.68U7 $24.36Practitioner Level 5, In-Clinic H0004 HR U5 U6 $15.13 Practitioner Level 5, Out-of-Clinic H0004 HRU5U7 $18.15Family Psychotherapyw/o thepatient present(appropriatelicense required)Practitioner Level 2, In-Clinic 90846Practitioner Level 3, In-Clinic 90846Practitioner Level 4, In-Clinic 90846U2U3U4U6 $38.97 Practitioner Level 2, Out-of-Clinic 90846U6 $30.01 Practitioner Level 3, Out-of-Clinic 90846U6 $20.30 Practitioner Level 4, Out-of-Clinic 90846U2U3U4U7 $46.76U7 $36.68U7 $24.36Practitioner Level 5, In-Clinic 90846U5U6 $15.13 Practitioner Level 5, Out-of-Clinic 90846U5U7 $18.15ConjointFamily Psychotherapyw/ thepatient present(appropriatelicense required)Practitioner Level 2, In-Clinic 90847Practitioner Level 3, In-Clinic 90847Practitioner Level 4, In-Clinic 90847U2U3U4U6 $38.97 Practitioner Level 2, Out-of-Clinic 90847U6 $30.01 Practitioner Level 3, Out-of-Clinic 90847U6 $20.30 Practitioner Level 4, Out-of-Clinic 90847U2U3U4U7 $46.76U7 $36.68U7 $24.36FY2013 Provider Manual for Community Behavioral Health Providers Page 69