SUBSTANCE ABUSE HCPCS CODES
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
LIST (A) THESE CODES CANNOT BE BILLED ON THE SAME CLAIM WITH THE CODES FROM LIST (B)
H0010 Alcohol and/or drug (Inpatient)sub-acute 303-305.93 H0011 Alcohol and/or drug (Inpatient)acute 303-305.93 H0012 Alcohol and/or drug (Outpatient)sub-acute 303-305.93 H0013 Alcohol and/or drug (Outpatient)acute 303-305.93 H0015 Alcohol and/or drug, intensivev outpatient including assessment,etc 303-305.93 H0017* Alcohol and/or drug Residential without room and board 303-305.93
H0043 Supported housing, per diem 303-305.93
S9475
Ambulatory setting substance abuse treatment or detoxification services,
per diem 303-305.93
Note
*H0017 is moving to EAPG 312 on 7-1-15 as well as the valid primary diagnosis.
MENTAL HEALTH HCPCS CODES
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
LIST (B)
THESE CODES CANNOT BE BILLED ON THE SAME CLAIM WITH THE CODES FROM LIST (A)
H0017*
Behavioral health; residential (hospital residential treatment program),
without room and board, per diem (effective 7-1-15) 290-302.9306.3-319 H0018
Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem
290-302.9 306.3-319 H0035 Mental health partial hospitalization, treatment, less than 24 hours
290-302.9 306.3-319 H0037 Community psychiatric supportive treatment program, per diem
290-302.9 306.3-319 H2029 Sexual offender treatment service, per diem
290-302.9 306.3-319 S0201 Partial hospitalization services, less than 24 hours, per diem 290-302.9306.3-319 S9485 Crisis intervention mental health services, per diem
290-302.9 306.3-319
LIST OF CPT/ HCPCS CODES THAT CAN HAVE BOTH BEHAVIORAL HEATLH AND SUBSTANCE ABUSE DIAGNOSIS CODES AND CAN BE BILLED ON THE SAME CLAIM WITH LIST (A) AND (B)
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
90791 Psychiatric Diagnostic Evaluation
303-305.93 290-302.9 306.3-319 90792 Psychiatric Diagnostic Eval W/Medical Services
303-305.93 290-302.9 306.3-319 90832 Psychotherapy Patient &/ Family 30 Minutes
303-305.93 290-302.9 306.3-319 90833 Psychotherapy Pt&/Family W/E&M Srvcs 30 Min
303-305.93 290-302.9 306.3-319 90834 Psychotherapy Patient &/ Family 45 Minutes
303-305.93 290-302.9 306.3-319 90836 Psychotherapy Pt&/Family W/E&M Srvcs 45 Min
303-305.93 290-302.9 306.3-319 90837 Psychotherapy Patient &/ Family 60 Minutes
303-305.93 290-302.9 306.3-319 90838 Psychotherapy Pt&/Family W/E&M Srvcs 60 Min
303-305.93 290-302.9 306.3-319 90839 Psychotherapy For Crisis Initial 60 Minutes
303-305.93 290-302.9 306.3-319 90845 Psychoanalysis 303-305.93 290-302.9 306.3-319 90846 Family Psychotherapy W/O Patient Present
303-305.93 290-302.9 306.3-319 90847 Family Psychotherapy W/Patient Present
303-305.93 290-302.9 306.3-319 90849 Multiple Family Group Psychotherapy
303-305.93 290-302.9 306.3-319 90853 Group Psychotherapy 303-305.93 290-302.9 306.3-319 90863 Pharmacologic Management W/Psychotherapy
303-305.93 290-302.9 306.3-319
LIST OF CPT/ HCPCS CODES THAT CAN HAVE BOTH BEHAVIORAL HEATLH AND SUBSTANCE ABUSE DIAGNOSIS CODES AND CAN BE BILLED ON THE SAME CLAIM WITH LIST (A) AND (B)
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
90865 Narcosynthesis Psyc Dx&Ther Purposes
303-305.93 290-302.9 306.3-319 90880 Hypnotherapy 303-305.93 290-302.9 306.3-319 90887 Interpj/Explnaj Results Psychiatric Exam Family
303-305.93 290-302.9 306.3-319 90899 Unlisted Psychiatric Service/Procedure
303-305.93 290-302.9 306.3-319 96020 Test Select & Admn Functl Brain Map Phys/Qhp
303-305.93 290-302.9 306.3-319 96101 Psychological Testing Pr Hr With Patient
303-305.93 290-302.9 306.3-319 96102 Psychological Testing Admn By Tech Pr Hr
303-305.93 290-302.9 306.3-319 96103 Psychological Testing Computer W/Prof I&R
303-305.93 290-302.9 306.3-319 96105 Assessment Aphasia W/Interp & Report Per Hour
303-305.93 290-302.9 306.3-319 96110 Developmental Screen W/Scoring & Doc Std Instrm
303-305.93 290-302.9 306.3-319 96111 Developmental Testing W/Interp & Report
303-305.93 290-302.9 306.3-319 96116 Nubhvl Status Xm Pr Hr W/Pt Interpj&Prepj
303-305.93 290-302.9 306.3-319 96118 Nuropsyc Testing Pr Hr W/Pt & Interpj Time
303-305.93 290-302.9 306.3-319 96119 Neuropsyc Tstg W/Prof I&R Admn By Tech Pr Hr
303-305.93 290-302.9 306.3-319 96120 Neuropsycholog Testing Computer W/Prof I&R
303-305.93 290-302.9 306.3-319
LIST OF CPT/ HCPCS CODES THAT CAN HAVE BOTH BEHAVIORAL HEATLH AND SUBSTANCE ABUSE DIAGNOSIS CODES AND CAN BE BILLED ON THE SAME CLAIM WITH LIST (A) AND (B)
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
96125 Standardized Cognitive Performance Testing
303-305.93 290-302.9 306.3-319 99408 Alcohol/Substance Screen & Interven 15-30 Min
303-305.93 290-302.9 306.3-319 99409 Alcohol/Substance Screen & Intervention >30 Min
303-305.93 290-302.9 306.3-319
G0176
Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
303-305.93 290-302.9 306.3-319 G0177
Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)
303-305.93 290-302.9 306.3-319 G0396
Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
303-305.93 290-302.9 306.3-319 G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
303-305.93 290-302.9 306.3-319 G0410
Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes
303-305.93 290-302.9 306.3-319 G0411 Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes
303-305.93 290-302.9 306.3-319 G0442 Annual alcohol misuse screening, 15 minutes
303-305.93 290-302.9 306.3-319 G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
303-305.93 290-302.9 306.3-319 G0444 Annual depression screening, 15 minutes
303-305.93 290-302.9 306.3-319
G0445
High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
303-305.93 290-302.9 306.3-319 H0001 Alcohol and/or drug assessment
303-305.93 290-302.9 306.3-319 LIST OF CPT/ HCPCS CODES THAT CAN HAVE BOTH BEHAVIORAL HEATLH
H0002
Behavioral health screening to determine eligibility for admission to treatment program
303-305.93 290-302.9 306.3-319 H0004 Behavioral health counseling and therapy, per 15 minutes
303-305.93 290-302.9 306.3-319 H0005 Alcohol and/or drug services; group counseling by a clinician
303-305.93 290-302.9 306.3-319 H0006 Alcohol and/or drug services; case management
303-305.93 290-302.9 306.3-319 H0007 Alcohol and/or drug services; crisis intervention (outpatient)
303-305.93 290-302.9 306.3-319 H0014 Alcohol and/or drug services; ambulatory detoxification
303-305.93 290-302.9 306.3-319 H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)
303-305.93 290-302.9 306.3-319 H0031 Mental health assessment, by non-physician
303-305.93 290-302.9 306.3-319 H0032 Mental health service plan development by non-physician
303-305.93 290-302.9 306.3-319 H0033 Oral medication administration, direct observation
303-305.93 290-302.9 306.3-319 H0034 Medication training and support, per 15 minutes
303-305.93 290-302.9 306.3-319 H0049 Alcohol and/or drug screening
303-305.93 290-302.9 306.3-319 H0050 Alcohol and/or drug services, brief intervention, per 15 minutes
303-305.93 290-302.9 306.3-319 H2001 Rehabilitation program, per 1/2 day
303-305.93 290-302.9 306.3-319 H2011 Crisis intervention service, per 15 minutes
303-305.93 290-302.9 306.3-319 LIST OF CPT/ HCPCS CODES THAT CAN HAVE BOTH BEHAVIORAL HEATLH
AND SUBSTANCE ABUSE DIAGNOSIS CODES AND CAN BE BILLED ON THE SAME CLAIM WITH LIST (A) AND (B)
VALID PRIMARY DIAGNOSIS CODES FOR EAPG CLAIMS
H2027 Psychoeducational service, per 15 minutes
303-305.93 290-302.9 306.3-319 H2028 Sexual offender treatment service, per 15 minutes
303-305.93 290-302.9 306.3-319 H2032 Activity therapy, per 15 minutes
303-305.93 290-302.9 306.3-319 H2033 Multisystemic therapy for juveniles, per 15 minutes
303-305.93 290-302.9 306.3-319 H2035 Alcohol and/or other drug treatment program, per hour
303-305.93 290-302.9 306.3-319 H2036 Alcohol and/or other drug treatment program, per diem
303-305.93 290-302.9 306.3-319 M0064
Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
303-305.93 290-302.9 306.3-319 S9480 Intensive outpatient psychiatric services, per diem
303-305.93 290-302.9 306.3-319 S9482 Family stabilization services, per 15 minutes
303-305.93 290-302.9 306.3-319 S9484 Crisis intervention mental health services, per hour
303-305.93 290-302.9 306.3-319 T1006 Alcohol and/or substance abuse services, family/couple counseling
303-305.93 290-302.9 306.3-319 T1007
Alcohol and/or substance abuse services, treatment plan development and/or modification
303-305.93 290-302.9 306.3-319 T1023
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
303-305.93 290-302.9 306.3-319
