CCBHC Measures Technical Manual-2019.pdf

Nevada CCBHC Measures Technical Manual

October 2019 | Edition 0.6

Substance Abuse Prevention and Treatment Agency

Nevada Division of Public and Behavioral Health

Department of Health and Human Services

Steve Sisolak Governor

State of Nevada

Richard Whitley, MS Director

Department of Health and Human Services

Lisa Sherych, MBA Administrator

Division of Public and Behavioral Health

Ihsan Azzam, PhD, MD Chief Medical Officer

Division of Public and Behavioral Health

Nevada CCBHC Measures Technical Manual 1

Acknowledgements

Report Prepared by:

James Kuzhippala, MPH

CCBHC Epidemiologist Consultant

Editing, Review, and Comments:

Joseph Turner Management Analyst III Rate Analysis and Development Unit Nevada Division of Health Care Financing and Policy

Sarah Dearborn Social Services Program Specialist III Nevada Division of Health Care Financing and Policy Nevada Department of Health and Human Services

Brook Adie, LSW, MS Health Bureau Chief Behavioral Health Wellness and Prevention

Stephanie Woodard, Psy. D.

DHHS Senior Advisor on Behavioral Health

Nevada Department of Health and Human Services

Dennis Humphrey Program Manager

CCBHC Planning Grant

Betty Hammond, MSW, CRC, NIC

Quality Assurance Specialist III

Mark Disselkoen, LCSW, LADC Senior Project Manager

Center for the Application of Substance Abuse Technologies University of Nevada, Reno

Martha Framsted

Public Information Officer

For Additional Information Contact:

James Kuzhippala, MPH CCBHC Epidemiologist Consultant Substance Abuse Prevention and Treatment Agency Nevada Division of Public and Behavioral Health

4126 Technology Way, 2nd Floor Carson City, Nevada 89706 jkuzhippala@tmcc.edu

Recommended Citation Substance Abuse Prevention and Treatment Agency. Division of Public and Behavioral Health. Nevada CCBHC

Measures Technical Manual. Carson City, Nevada e0.6. October 2019.

Nevada CCBHC Measures Technical Manual 2

Table of Contents

ACKNOWLEDGEMENTS

PURPOSE

DATASET DEFINITIONS

CCBHC ALLOWABLE SERVICES GRID

FQHC-CCBHC ALLOWABLE SERVICES GRID

MEASURE TECHNICAL SPECIFICATIONS

I-EVAL-A

I-EVAL-B

BMI-SF

WCC-BH

TSC

ASC

SRA-BH-C

SRA-A

CDF-BH

DEP-REM-12

HOU

PEC

Y/FEC

FUM

FUA

PCR-BH

SSD

SAA-BH

FUH-BH

ADD-BH

AMM-BH

IET-BH

ELECTRONIC HEALTH RECORD VARIABLES

ELECTRONIC HEALTH RECORD SPECIFICATIONS

DEFINITIONS

Nevada CCBHC Measures Technical Manual 3

Purpose

This manual provides the specifications for and general information related to quality measures and other metrics developed to be used at the provider level by Certified Community Behavioral Health Clinics (CCBHCs).

Data and quality measure reporting have multiple objectives. Collection and reporting of this information offer providers, states, and other stakeholders a better method for assessing the manner in which care is accessed and provided. The information can be used for internal quality improvement (QI) processes to determine the degree of progress achieved or to determine where new or additional improvement is needed. The data can be used for accountability, to grantors or regulatory entities, for example. Some quality measures can be used as part of incentive programs, such as the quality bonus payments (QBPs) that are part of the Section 223 behavioral health demonstration Prospective Payment System (PPS) methodology. The data and measures reported also may be used to evaluate programs, such as the national evaluation of the CCBHC Demonstration Program.

This manual includes specifications for quality measures derived from multiple sources. In most cases, the original measures were designed for reporting at the state or health plan level. Each measure has been re-specified to enable reporting at the CCBHC level. This manual includes the most current version of the measure specifications.

Nevada CCBHC Measures Technical Manual 4

Dataset Definitions

Electronic Health Records

• Submit quarterly by CCBHCs.

• Information collected within this dataset reflects services provided to patients within each CCBHC.

Data is utilized to calculate individual CCBHC measures. CCBHCs are advised to review the “Electronic Health Record Variables” section of this report for proper formatting and allowable variables and values.

Eligibility

• Submit quarterly by Nevada Medicaid.

• Information collected within this dataset reflects if a patient is eligible for Medicaid, Medicare, or both. In addition, this identifies the number of months a patient is eligible.

Medicaid Claims

• Information collected with this dataset reflects all claims every Nevada CCBHC patient has received. This dataset is utilized to identify services received within CCBHCs as well as facilities and providers outside.

Pharmacy Data

• Information collected within this dataset reflects every prescription Nevada CCBHC patients has received. In addition, this dataset includes the route, dose, and number of days supplied.

Nevada CCBHC Measures Technical Manual 5

CCBHC Allowable Services Grid CPT or HCPCS Code* DESCRIPTION

Crisis Intervention Services to include: 24 Hour Crisis Response with Crisis Intervention, Crisis Stabilization, and 24 hour Mobile Crisis Services

Crisis Intervention

H2011

H2011 GT/HT

Crisis Intervention

H2011, 90839/90840, 90846/90847/ 90849

Intensive Family Intervention Services can be utilized with a combination of services: Crisis Intervention Services (H2011), Psychotherapy for Crisis (90839 and 90840), and Family Psychotherapy with or w/out the patient (90846, 90847 and 90849).

H0007 Alcohol and/or drug services; crisis intervention (outpatient)

99218 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making that is straightforward or of low complexity.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.

99219 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.

99220 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.

Est. Patient 99211- 99215, New Patient 99201-99205

Ambulatory Withdrawal Management is an outpatient detoxification that requires medication monitoring to either assist a recipient to detox by using medications or to assist in titrating down from medications. This requires a higher level of safety protocols to be put in place for monitoring and safety of the recipient. These codes would be best utilized through office visit codes (established 99211- 99215 and new patient 99201-99205).

Psychotherapy for Crisis/Crisis Stabilization

90839 Psychotherapy for Crisis, first 60 mins

90840 Psychotherapy for Crisis, each additional 30 mins

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24-Hour Mobile Crisis

H2011

H2011 GT/HT

Crisis Intervention Service

Behavioral Health Screening, Assessment, and Diagnosis including Assessment of Risk

Behavioral Health Screening

H0002 Behavioral Health Screening to determine eligibility for admission to treatment program (1 unit per assessment at least 30 minutes)

H0049 Alcohol/drug screening (1 unit per screening)

96110 Developmental Screening

99408 Alcohol and/or Substance Abuse Screening

99409 Alcohol and/or Substance Abuse Screening

Interactive Complexity & Psychiatric Diagnostic Procedures

90785 Interactive Complexity

90791 Psychiatric Diagnostic Evaluation

90792 Psychiatric Diagnostic Evaluation with Medical Services

Evaluation & Management-Physician, NP's, PA's.

90833 Psychotherapy, 30 mins, with pt and/or family member when performed with an E/M service.

90836 Psychotherapy, 45 mins, with pt and/or family member when performed with an E/M service.

90838 Psychotherapy, 60 mins, with pt and/or family member when performed with an E/M service.

99201 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. 10 mins face-to-face.

99202 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 20 mins face-to-face.

99203 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. 30 mins face-to-face.

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99204 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. 45 mins face-to-face.

99205 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. 60 mins face-to-face.

99211 Office or other outpatient visit for the E/M of an ESTABLISHED patient, that may not require the presence of a physician or other qualified healthcare professional. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services.

99212 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are self limited or minor. Typically, 10 minutes face-to-face.

99213 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are low to moderate severity. Typically, 15 minutes face-to-face.

99214 Office/outpatient visit est

99215 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are of moderate to high severity. Typically, 40 minutes face-to-face.

99217 Observation care discharge day management

Psychological Assessment

96101- 96103 Psychological Testing

96111 Developmental Testing

96118-96120 Neuropsychological Testing

96150-96151 Health and Behavior Assessment

Nevada CCBHC Measures Technical Manual 8

Behavioral Health Assessment

H0031 Mental Health Assessment by Non-physician

H0001 Alcohol and/or Drug Assessment (1 unit per assessment at least 30 minutes)

96116 Neurobehavioral Status Exam

Patient-Centered Treatment Planning or Similar Processes Including Risk Assessment and Crisis Planning

96101-96103, 96111, 96118-96120, 96150- 96151

Treatment Planning is combined with behavioral health and/or psychological screens and assessments to determine the needed services for a recipient.

H2011

H2011 GT/HT

Crisis Intervention Service

H0007 Risk Assessment (Suicidality); Alcohol and/or drug services; crisis intervention (outpatient)

Outpatient Mental Health and Substance Abuse Treatment

90832 Psychotherapy, 30 mins, with pt and/or family member

90834 Psychotherapy, 45 mins, with pt and/or family member

90837 Psychotherapy, 60 mins, with pt and/or family member

90846 Family Psychotherapy (without the patient present)

90847 Family Psychotherapy (conjoint therapy) (with patient present)

90849 Multiple-Family Group Psychotherapy

90853 Group Psychotherapy (other than of a multiple-family group)

90875, 90876, 90901 Biofeedback Training

90911 Biofeedback peri/uro/rectal

H0004 Behavioral Health Counseling; in home or community setting

H0004 HQ Behavioral Health Counseling; in home or community setting; groups

H0035 Mental Health; Partial Hospitalization, treatment less than 24 hours (1 unit equals 60 minutes)

S9480 Intensive Outpatient Psychiatric Services, per diem

H0005 Alcohol and/or Drug Services; group counseling by a clinician (1 unit per group at least 30 minutes)

H0015 Alcohol and/or Drug Services; intensive outpatient program (3 hours per day at least 3 days per week) (1 unit equals 1 day/visit)

Nevada CCBHC Measures Technical Manual 9

H0020 Alcohol and/or Drug Services; methadone administration and/or service (provision of the drug by a licensed program)

H0047 Alcohol and/or Drug Services; (State defined: individual counseling by a clinician). (1 unit per session at least 30 minutes)

96152-96155 Health and Behavior Intervention

Medication Management

H0034 Medication Training and Support; per 15 minutes

H0034 TD Medication Training and Support; per 15 minutes; Registered Nurse QMHA

96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular

Medication Assisted Treatment

Targeted Case Management

T1016 Case Management for Non-SMI, Non-SED (Level I-II LOCUS/CASII)

T1017 Targeted Case Management-Non-SED

T1017 Targeted Case Management-SED

T1017 Targeted Case Management-Non-SMI

T1017 Targeted Case Management-SMI

81000 Urinalysis nonauto w/scope

81001 Urinalysis auto w/scope

81002 Urinalysis nonauto w/o scope

81003 Urinalysis auto w/o scope

81015 Microscopic exam of urine

81025 Urine pregnancy test

82948 Reagent strip/blood glucose

82962 Glucose blood test

83026 Hemoglobin

83036 HgA1c

84702 Chorionic gonadotropin test

84703 Chorionic gonadotropin assay

Nevada CCBHC Measures Technical Manual 10

86308 Heterophile antibody screen

86331 Immunodiffusion ouchterlony

86580 Tb intradermal test

86702 Hiv-2 antibody

87340 Hepatitis B surface AG IA

87341 Hepatitis B surface AG IA

87800 Detect agnt mult dna direc

87880 Strep A assay w/optic

90471 Immunization admin

90472 Immunization admin each add

90473 Immune admin oral/nasal

90474 Immune admin oral/nasal addl

90690 Typhoid vaccine oral

90691 Typhoid vaccine im

90740 HepB vacc 3 dose immunsup im

90747 HepB vacc 4 dose immunsup im

90748 HIB-HEPB vaccine im

94010 Breathing capacity test

94060 Evaluation of wheezing

94150 Vital capacity test

94640 Airway inhalation treatment

99420 Health risk assessment test

99174 Amblyopia screening; Screening for amblyopia may be separately reimbursed along with an EPSDT screen.

99381 New patient, infant (age under 1 year)

99382 New patient, early childhood (age 1-4)

99383 New patient, late childhood (age 5-11)

Nevada CCBHC Measures Technical Manual 11

99384 New patient, adolescent (age 12-17)

99385 New patient, adult (age 18-20)

99391 Established patient, infant (under 1 year)

99392 Established patient, early childhood (age 1-4)

99393 Established patient, late childhood (age 5-11)

99394 Established patient, adolescent (age 12-17)

99395 Established patient, adult (age 18-20)

G0101 Cervical or vaginal cancer screening; pelvic and clinical breast exam

G0102 Prostate cancer; digital rectal exam

G0438 Annual Wellness Visit, including a personalized prevention plan of service, initial visit (21 & over)

G0439 Annual Wellness Visit, including a personalized prevention plan of service, subsequent visit (21 & over)

90460 Immunization Administration through 18 years of age; first vaccine/toxoid component (Bill at the usual and customary charge)

90471 Vaccine Administration – Single

90472 Vaccine Administration – Each Additional Unit

90476-90748 Vaccines (Bill the appropriate vaccine code at a zero dollar amount.) Providers must use Vaccines for Children (VFC) vaccines for children 18 and under.

90476 Vaccine for adenovirus oral admin, type 4

90477 Vaccine for adenovirus oral admin, type 7

96110 Developmental Screening

96127 Brief emotional/behavioral assessment (e.g., Depression inventory, ADHD) with scoring and documentation per standardized instrument

99188 Application of fluoride varnish by physician or other qualified health care professional

99401 Family Planning Service

96161 Caregiver Health Risk Assessment, administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument.

80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service.

Nevada CCBHC Measures Technical Manual 12

80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by instrument assisted direct optical observation (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service.

80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay, [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service.

G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.

G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.

G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)

G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomer’s), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.

80047-80076 Organ or Disease-oriented panel (bill the appropriate code)

36415 Routine Venipuncture

86631 Chlamydia antibody

86632 Chlamydia iGm

87110 Chlamydia culture any source

87270 Chlamydia antigen detection by immuflourescent technique

87320 Chlamydia antigen detection by enzyme immunoassay technique

Nevada CCBHC Measures Technical Manual 13

87490 Neisseria gonorrhea, direct probe technique

87491 Neisseria gonorrhea, amplified probe technique

87492 Neisseria gonorrhea, quantification

87801 Infectious agent detection by DNA or RNA, direct probe technique

87810 Chlamydia antigen detection by immunoassay with direct optical observation

87590 Neisseria gonorrhea, direct probe technique

87591 Neisseria gonorrhea, amplified probe technique

87592 Neisseria gonorrhea, quantification

87801 Infectious agent detection by DNA or RNA, direct probe technique

87850 Neisseria gonorrhea antigen detection by immunoassay with direct optical observation

86689 HIV antibody confirmatory test e.g. Western Blot

86701 HIV-1 antibody OR HIV-2 antibody

86703 HIV-1 & HIV-2 antibody

86592 Syphilis test, qualitative e.g. VDRL, RPR

86593 Syphilis test, quantitative e.g. VDRL, RPR

87623 Human Papillamavirus (HPV), low-risk types

87624 Human Papillamavirus (HPV), high-risk types

87625 Human Papillamavirus (HPV), types 16 and 18 only, includes type 45, if performed

80061 Cardiovascular disease screening - lipid panel

82465 Cardiovascular disease screening - cholesterol, serum or whole blood, total

83718 Cardiovascular disease screening - lipoprotein, direct measurement; high density cholesterol (hdl)

84478 Cardiovascular disease screening - triglycerides

82947 Diabetes screening tests - glucose; quantitative, blood (except reagent strip)

82950 Diabetes screening tests - glucose; post glucose dose

82951 Diabetes screening tests - glucose; tolerance test, three specimens

G0432 HIV screening; infectious agent antigen detection by immunoassay technique

Nevada CCBHC Measures Technical Manual 14

G0433 HIV screening; infectious agent antigen detection by enzyme-linked immunosorbent assay

G0435 HIV screening; infectious agent antigen detection by rapid antibody test

Psychiatric Rehabilitation Services

H2012 Behavioral Health Day Treatment (* Under an approved Model of Specialty 308)

H2014 Basic Skills Training

H2014 HQ Basic Skills Training Group

H2017 Psychosocial Rehabilitation - PSR could be utilized to assist with development of a wellness recovery action plan (WRAP) for coping with crisis scenarios.

H2017 HQ Psychosocial Rehabilitation Group - PSR could be utilized to assist with development of a wellness recovery action plan (WRAP) for coping with crisis scenarios.

97165 Occupational Therapy Evaluation Low Complex 30 min

97166 Occupational Therapy Evaluation Moderate Complex 45 min

97167 Occupational Therapy Evaluation High Complex 60 min

97168 Occupational Therapy Re-evaluation Plan Care 30 min

97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises

97112 Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation

97150 Therapeutic procedures(s), group (a group is 2 to 4 individuals.)

97530 Therapeutic activities, direct (one-to-one) patient contact by the provider (use of dynamic activities to improve the functional performance), each 15 minutes

97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), each 15 minutes

97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-to-one) contact by the provider, each 15 minutes

97535 Self care/home management training (e.g., ADLs) direct (one-to-one) contact by the provider, each 15 minutes

97542 Wheelchair management/propulsion training, each 15 minutes

98961 Education and training for patient self-management by a Qualified, non physician health care professional using standardized curriculum, face-to-face with the patient (could include caregiver/family), each 30 min; individual

98962 Education and training for patient self-management by a Qualified, non physician health care professional using standardized curriculum, face-to-face with the patient (could include caregiver/family), each 30 min; 5-8 patients

Behavior Change Intervention & Counseling Risk Factors

99401 Preventive med counseling

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99406 Smoking and tobacco cessation counseling

99407 Smoking and tobacco cessation counseling

99490 Chronic disease self-management (disease intervention, self monitoring)

G0108 Diabetes self-management; outpatient self-management training services, individual, per 30 minutes

G0109 Diabetes self-management; outpatient self-management training services, group session, per 30 minutes

H0038 Self-Help/Peer Service; per 15 minutes

H0038 Self-Help/Peer Service; per 15 minutes; Use modifier HQ when requesting/billing for a group setting

Place of Service: Providing services in the community and in non-traditional settings

Q3014 Telehealth Originating site facility fee

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FQHC-CCBHC Allowable Services Grid

The services highlighted in yellow are services that CCBHCs and FQHCs can both provide. In order to prevent duplicative billing for FQHCs that are dually certified as a CCBHC, please refer to the FQHC MSM Chapter 2900 and the CCBHC MSM Chapter 2700.

CPT or HCPCS Code* DESCRIPTION

Crisis Intervention Services to include: 24 Hour Crisis Response with Crisis Intervention, Crisis Stabilization, and 24 hour Mobile Crisis Services

Crisis Intervention

H2011

H2011 GT/HT

Crisis Intervention

H2011, 90839/90840, 90846/90847/ 90849

Intensive Family Intervention Services can be utilized with a combination of services: Crisis Intervention Services (H2011), Psychotherapy for Crisis (90839 and 90840), and Family Psychotherapy with or w/out the patient (90846, 90847 and 90849).

H0007 Alcohol and/or drug services; crisis intervention (outpatient)

99218 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making that is straightforward or of low complexity.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.

99219 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.

99220 Initial Observation Care, per day, for the E/M of a patient which requires these 3 key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's or family's needs. Usually, the problem(s) requiring admission to "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.

Est. Patient 99211- 99215, New Patient 99201-99205

Ambulatory Withdrawal Management is an outpatient detoxification that requires medication monitoring to either assist a recipient to detox by using medications or to assist in titrating down from medications. This requires a higher level of safety protocols to be put in place for monitoring and safety of the recipient. These codes would be best utilized through office visit codes (established 99211- 99215 and new patient 99201-99205).

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Psychotherapy for Crisis/Crisis Stabilization

90839 Psychotherapy for Crisis, first 60 mins

90840 Psychotherapy for Crisis, each additional 30 mins

24-Hour Mobile Crisis

H2011

H2011 GT/HT

Crisis Intervention Service

Behavioral Health Screening, Assessment, and Diagnosis including Assessment of Risk

Behavioral Health Screening

H0002 Behavioral Health Screening to determine eligibility for admission to treatment program (1 unit per assessment at least 30 minutes)

H0049 Alcohol/drug screening (1 unit per screening)

99408 Alcohol and/or Substance Abuse Screening

99409 Alcohol and/or Substance Abuse Screening

Interactive Complexity & Psychiatric Diagnostic Procedures

90785 Interactive Complexity

90791 Psychiatric Diagnostic Evaluation

90792 Psychiatric Diagnostic Evaluation with Medical Services

Evaluation & Management-Physician, NP's, PA's.

90833 Psychotherapy, 30 mins, with pt and/or family member when performed with an E/M service.

90836 Psychotherapy, 45 mins, with pt and/or family member when performed with an E/M service.

90838 Psychotherapy, 60 mins, with pt and/or family member when performed with an E/M service.

99201 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. 10 mins face-to-face.

99202 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 20 mins face-to-face.

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99203 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. 30 mins face-to-face.

99204 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused exam, and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. 45 mins face-to-face.

99205 Office or other outpatient visit for the E/M of a NEW PT, which requires 3 components: a problem focused history, a problem focused examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. 60 mins face-to-face.

99211 Office or other outpatient visit for the E/M of an ESTABLISHED patient, that may not require the presence of a physician or other qualified healthcare professional. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services.

99212 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are self limited or minor. Typically, 10 minutes face-to-face.

99213 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are low to moderate severity. Typically, 15 minutes face-to-face.

99214 Office/outpatient visit est

99215 Office or other outpatient visit for the E/M of an ESTABLISHED patient, which requires at least 2 of these 3 key components: a problem focused history, a problem focused examination, and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the patient's problem(s) and/or family's needs. Usually, problem(s) are of moderate to high severity. Typically, 40 minutes face-to-face.

99217 Observation care discharge day management

Psychological Assessment

96101- 96103 Psychological Testing

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96111 Developmental Testing

96118-96120 Neuropsychological Testing

96150-96151 Health and Behavior Assessment

96161 Caregiver Health Risk Assessment, administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument.

Behavioral Health Assessment

H0031 Mental Health Assessment by Non-physician

H0001 Alcohol and/or Drug Assessment (1 unit per assessment at least 30 minutes)

96116 Neurobehavioral Status Exam

Patient-Centered Treatment Planning or Similar Processes Including Risk Assessment and Crisis Planning

96101-96103, 96111, 96118-96120, 96150- 96151

Treatment Planning is combined with behavioral health and/or psychological screens and assessments to determine the needed services for a recipient.

H2011

H2011 GT/HT

Crisis Intervention Service

H0007 Risk Assessment (Suicidality); Alcohol and/or drug services; crisis intervention (outpatient)

Outpatient Mental Health and Substance Abuse Treatment

90832 Psychotherapy, 30 mins, with pt and/or family member

90834 Psychotherapy, 45 mins, with pt and/or family member

90837 Psychotherapy, 60 mins, with pt and/or family member

90846 Family Psychotherapy (without the patient present)

90847 Family Psychotherapy (conjoint therapy) (with patient present)

90849 Multiple-Family Group Psychotherapy

90853 Group Psychotherapy (other than of a multiple-family group)

90875, 90876, 90901 Biofeedback Training

90911 Biofeedback peri/uro/rectal

H0004 Behavioral Health Counseling; in home or community setting

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H0004 HQ Behavioral Health Counseling; in home or community setting; groups

H0035 Mental Health; Partial Hospitalization, treatment less than 24 hours (1 unit equals 60 minutes)

S9480 Intensive Outpatient Psychiatric Services, per diem

H0005 Alcohol and/or Drug Services; group counseling by a clinician (1 unit per group at least 30 minutes)

H0015 Alcohol and/or Drug Services; intensive outpatient program (3 hours per day at least 3 days per week) (1 unit equals 1 day/visit)

H0020 Alcohol and/or Drug Services; methadone administration and/or service (provision of the drug by a licensed program)

H0047 Alcohol and/or Drug Services; (State defined: individual counseling by a clinician). (1 unit per session at least 30 minutes)

96152-96155 Health and Behavior Intervention

Medication Management

H0034 Medication Training and Support; per 15 minutes

H0034 TD Medication Training and Support; per 15 minutes; Registered Nurse QMHA

96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular

Medication Assisted Treatment

Targeted Case Management

T1016 Case Management for Non-SMI, Non-SED (Level I-II LOCUS/CASII)

T1017 Targeted Case Management-Non-SED

T1017 Targeted Case Management-SED

T1017 Targeted Case Management-Non-SMI

T1017 Targeted Case Management-SMI

96127 Brief emotional/behavioral assessment (e.g., Depression inventory, ADHD) with scoring and documentation per standardized instrument

80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service.

80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); capable of being read by instrument assisted direct optical observation (eg, dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service.

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80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers (eg, utilizing immunoassay, [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service.

G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed.

G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed.

G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.)

G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomer’s), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed.

G0438 Annual Wellness Visit, including a personalized prevention plan of service, initial visit (21 & over)

G0439 Annual Wellness Visit, including a personalized prevention plan of service, subsequent visit (21 & over)

80061 Cardiovascular disease screening - lipid panel

82465 Cardiovascular disease screening - cholesterol, serum or whole blood, total

83718 Cardiovascular disease screening - lipoprotein, direct measurement; high density cholesterol (hdl)

84478 Cardiovascular disease screening - triglycerides

82947 Diabetes screening tests - glucose; quantitative, blood (except reagent strip)

82950 Diabetes screening tests - glucose; post glucose dose

82951 Diabetes screening tests - glucose; tolerance test, three specimens

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Psychiatric Rehabilitation Services

H2012 Behavioral Health Day Treatment (* Under an approved Model of Specialty 308)

H2014 Basic Skills Training

H2014 HQ Basic Skills Training Group

H2017 Psychosocial Rehabilitation - PSR could be utilized to assist with development of a wellness recovery action plan (WRAP) for coping with crisis scenarios.

H2017 HQ Psychosocial Rehabilitation Group - PSR could be utilized to assist with development of a wellness recovery action plan (WRAP) for coping with crisis scenarios.

98961 Education and training for patient self-management by a Qualified, non physician health care professional using standardized curriculum, face-to-face with the patient (could include caregiver/family), each 30 min; individual

98962 Education and training for patient self-management by a Qualified, non physician health care professional using standardized curriculum, face-to-face with the patient (could include caregiver/family), each 30 min; 5-8 patients

Behavior Change Intervention & Counseling Risk Factors

96152-96155 Health and Behavior Intervention

99401 Preventive med counseling

99406 Smoking and tobacco cessation counseling

99407 Smoking and tobacco cessation counseling

99420 Health risk assessment test

99490 Chronic disease self-management (disease intervention, self monitoring)

G0108 Diabetes self-management; outpatient self-management training services, individual, per 30 minutes

G0109 Diabetes self-management; outpatient self-management training services, group session, per 30 minutes

H0038 Self-Help/Peer Service; per 15 minutes

H0038 Self-Help/Peer Service; per 15 minutes; Use modifier HQ when requesting/billing for a group setting

Place of Service: Providing services in the community and in non-traditional settings

Q3014 Telehealth Originating site facility fee

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Measure Technical Specifications

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I-EVAL-A

Time to Initial Evaluation (Percent)

Description:

• The percentage of new patients with initial evaluation provided within 10 business days of first contact.

• Measure is based on patients NOT visits.

Datasets and Variables:

• Medicaid Claims ● Electronic Health Records ● Eligibility o Billing Provider ID ○ Medicaid ID ○ Medicaid ID o Medicaid ID ○ Contact Date ○ Medicare/Medicaid o Service Date ○ Date of Initial Contact o Date of Birth ○ Date of Evaluation

○ Date of Birth

Definitions:

• Business Days: Monday through Friday, excluding state and federal holidays (regardless of days of operation)

• New Consumer: An individual not seen at the clinic in the 6 months prior to measurement year.

Measurement Period:

• Denominator:

o The measurement period for the denominator is the measurement year excluding the last 30 days of the measurement year and including the 6 months preceding the measurement year.

• Numerator:

o The number of patients in the eligible population who received an initial evaluation within 10 business days of the first contact with the provider entity during the measurement year.

Flowchart:

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I-EVAL-B

Time to Initial Evaluation (Mean)

• The mean number of business days until initial evaluation for new patients.

o Billing Provider ID ○ Medicaid ID ○ Medicaid ID o Medicaid ID ○ Contact Date ○ Medicare/Medicaid o Service Date ○ Date of Initial Contact o Date of Birth ○ Date of Evaluation

○ Date of Birth

• Business Days: Monday through Friday, excluding state and federal holidays (regardless of days of operation)

• New Consumer: An individual not seen at the clinic in the 6 months prior to measurement year.

o The measurement period for the denominator is the measurement year excluding the last month of the measurement year and including the 6 months preceding the measurement year.

• Numerator:

o The total number of days between first contact and initial evaluation for all members of the eligible population seen at the provider entity during the measurement year. Anyone who received an initial evaluation after the last day of the measurement year are treated as having been evaluated 31 days after initial contact.

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BMI-SF

Body Mass Index Screening and Follow-Up

• Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.

o Billing Provider ID ○ Medicaid ID ○ Medicaid ID o Medicaid ID ○ Contact Date ○ Medicare/Medicaid o Service Date ○ Date of Birth o Date of Birth ○ BMI Quality Data Code o CPT/HCPCS Code ○ BMI Exclusion Code

○ Height

○ Weight

Definitions:

• BMI =

𝑤𝑒𝑖𝑔ℎ𝑡 [𝑙𝑏𝑠]

(ℎ𝑒𝑖𝑔ℎ𝑡 [𝑖𝑛])2 × 703

• Follow-Up Plan: A follow-up plan may include, but is not limited to: documentation of education, referral, pharmacological interventions, dietary supplements, exercise counseling, nutrition counseling, etc.

• Not eligible for BMI Calculation or Follow-Up Plan: Receiving palliative care, pregnant, refuses BMI measurement, any reason documented by provider of why BMI measurement was not appropriate, patient is in an urgent or emergent medical situation.

• Normal Parameters:

o Age 65 years and older BMI > 23 and < 30 kg/m2 o Age 18 - 64 years BMI > 18.5 and < 25 kg/m2 o The measurement period for the denominator is the measurement year.

• Numerator:

o The number of patients in the eligible population with a documented BMI during the encounter or during the previous six months AND, when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.

CPT/HCPCS Codes:

• 90791, 90792, 90832, 90834, 90837, 90839, 96150, 96151, 96152, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0101, G0108, G0438, G0439

BMI Quality Data Codes:

• 1, 2, 3, 4, 5, 6, 7

BMI Exclusion Codes:

• 1, 2, 3, 4, 5, 6

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* Exclusions (Patient is not eligible for BMI calculation or development of a follow-up plan if at least one of the following reasons are documented:

• Receiving palliative care

• Pregnant

• Refuses BMI measurement (refuses height and/or weight)

• Any other reason documented in the medical record by the provider why BMI measurement was not appropriate

• Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status

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WCC-BH

Body Mass Index Assessment for Children/Adolescents

The percentage of children ages 3 to 17 who had an outpatient visit with a primary care practitioner (PCP) or obstetrical/gynecological (OB/GYN) practitioner and who had…