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Service Code
| Defined Service |
| County (SCA) Reimbursement |
| Unit |
| 01 |
| Early Intervention Individual |
| $65.00 |
| per hour (in conjunction with 19, limited to 8 hours per FY) |
| 02 |
| Psychiatric Evaluation (performed by Psychiatrist) |
| $225.00 |
| per evaluation (New rate Effective 7/1/2022) |
| 03 |
| Urine Drug Screen (UDS) |
| $22.00 |
| per screen |
| 04 |
| Individual Therapy Session |
| $90.00 |
| per hour (*not to exceed 2 hours per day) (New rate Effective 7/1/2022) |
| 05 |
| Family Therapy Session |
| $82.00 |
| per hour (*not to exceed 2 hours per day) |
| 06 |
| Outpatient Group Session |
| $39.00 |
| per hour (*not to exceed 2 hours per day)/Minimum 4 participants |
| 07 |
| Physical Examination |
| $102.00 |
| per hour |
| 08 |
| Medication Check |
| $32.00 |
| per visit |
| 09 |
| Methadone Maintenance |
| $486.17 |
| per Monthly Bundled Rate |
| 10 |
| Collateral |
| $82.00 |
| per hour (*not to exceed 2 hours per day) |
| 11 |
| Intensive Outpatient Group |
| $37.00 |
| per hour (*not to exceed 3 hours per day)/Minimum 4 participants |
| 15 |
| Case Consultation |
| $82.00 |
| per hour (*not to exceed 4 per year) |
| 19 |
| Early Intervention Group |
| $31.00 |
| per hour (in conjunction with 01, limited to 8 hours per FY)/Minimum 4 participants |
| 21 |
| Vivitrol Medication Dose |
| $1,007.93 |
| per dose (*not to exceed 1 per 28 days) |
| 22 |
| Vivitrol Medication Administration |
| $150.00 |
| per administration (*not to exceed 1 per 28 days) |
| 23 |
| Psychiatric Evaluation (performed by CRNP) |
| $145.00 |
| per evaluation (New rate Effective 7/1/2022) |
| 24 |
| Oral Buprenorphine/Naloxone Prescription |
| $5.10 |
| per 2mg pill |
| 25 |
| Oral Buprenorphine/Naloxone Prescription |
| $9.14 |
| per 8mg film |
| 26 |
| Oral Buprenorphine Prescription |
| $7.50 |
| per 8mg pill |
| 27 |
| Buprenorphine Intake |
| $225.00 |
| per intake |
| 28 |
| Medication Assisted Treatment Intake Bloodwork |
| $110.00 |
| per bloodwork |
| 852A |
| Partial Hospital |
| $108.00 |
| per day |
** When invoicing (01, 04, 05, 06, 10, 11, 19) for SCA eligible individuals, ≥ 45 minutes, invoice 1 unit; 44-22 minutes, invoice 0.5 unit; SCA will not make payment for ≤21 minute session
** When invoicing Early Intervention services (01, 19) limited to 8 hours total during fiscal year, may not be used for treatment required as a result of 1st or 2nd offense DUI
** When invoicing (09) for SCA eligible individuals, ≥ 15 days on MMT program, invoice 1 unit; ≤ 14 days on MMT program, invoice 0.5 unit
** When invoicing (21, 24, 25, 26) invoicing should be for the cost of the medication but should not exceed reimbursement identified above.