Exhibit 1H - RCC Enhancements Authorization Parameters.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is the Exhibit 1H - Recovery Court Contract (RCC) Enhancements Authorization Parameters for a state-level Recovery Court Contract (RCC) opportunity. The document outlines the service rates, billing codes, and authorization parameters for various clinical services, co-occurring clinical services, medication-assisted treatment, recovery support services, medical services, and laboratory services related to the RCC program. It specifies the service rate, unit type, CPT/billing codes, and authorization limits (in terms of days, months, and yearly) for each type of service. The services range from urine drug screens and clinical consultations to psychiatric evaluations, medication monitoring, and Vivitrol/Buprenorphine induction and maintenance.
The document provides the detailed pricing information and authorization parameters for the various clinical and support services that can be billed under the RCC program. It includes set rates for each service, the applicable billing codes, and the limits on the number of authorized encounters or units per day, month, and year. This information is intended to guide providers in understanding the reimbursement structure and service utilization limits for the RCC program.
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Exhibit 1H - Recovery Court Contract (RCC) Enhancements Authorization Parameters
Clinical Review
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Urine Drug Screen - Presumptive Testing $ 8.46 service Clinical H0003HF 1 12 n/a H0003HF 1 12 n/a
Oral Swab $ 8.46 service Clinical ZSWB 1 12 n/a ZSWB 1 12 n/a
Mantoux Tuberculin Test $ 10.57 service Clinical 86580 1 1 n/a 86580 1 1 n/a
Continuing Care LOCI $ 26.43 20 minutes Clinical ZLOCI 2 2 n/a ZLOCI 2 2 n/a
Limit Clinical Review Enhancements $164.95 $164.95
Co-occurring Clinical Services
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Case Management - COOC $ 13.32 15 minutes Co-occurring T2022 HF 8 8 n/a T2022 HF 8 8 n/a
Comprehensive Intake Evaluation $ 171.99 service Co-occurring 90791 1 1 n/a 90791 1 1 n/a
Crisis Intervention - Individual $ 15.12 15 minutes Co-occurring S9484 HF 0 0 0 S9484 HF 4 8 n/a
Family Therapy $ 113.84 60 minutes Co-occurring 90847 HF 0 0 0 90847 HF 1 5 n/a
Individual Therapy $ 71.39 30 minutes Co-occurring 90832 HF 0 0 0 90832 HF 1 5 n/a
Individual Therapy $ 94.46 45 - 50 minutes Co-occurring 90834 HF 0 0 0 90834 HF 1 5 n/a
Group Therapy $ 27.48 90 min Co-occurring 90853 HF 0 0 0 90853 HF 1 5 n/a
Clinical Consultation $ 27.75 15 minutes Co-occurring 90887 0 0 0 90887 4 6 n/a
Limit Co-occurring Clinical Services
Enhancement $278.55 $801.79
Recovery Court Contract (RCC)
Fee for Service Enhancement Authorization Parameters
Encounter entry required before expiration of authorization (days) -
Encounter entry required before expiration of authorization (days) -
LTRT2 Limits HWH Limits
LTRT2 Limits HWH Limits
DMHAS RCC Page 1 of 6
SFY 2025
Effective 07/01/24
Revised 04/08/24
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Medication Monitoring $ 47.54 15 minutes CO Med 90862 HF 0 0 0 90862 HF 2 6 n/a
Limit Co-occurring Medication Monitoring
Service Enhancement $0.00 $285.24
Psychiatric Evaluation
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Psychiatric Evaluation $ 437.76 service Psych Eval 90792 1 1 4 90792 1 1 4
Limit Co-occurring Pyschiatric Evaluation
Service Enhancement $437.76 $1,751.04 $437.76 $1,751.04
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Medication Monitoring - MAT $ 47.54 15 minutes MAT- MM Z3353 2 4 n/a Z3353 2 4 n/a
Methadone Maintenance $ 4.05 unit MAT- MM H0020 HF 1 31 n/a H0020 HF 1 31 n/a
Limit Medication Assisted-Methadone
Maintenance Enhancements $315.71 $315.71
Recovery Support .
HWH Limits
HWH Limits
Encounter entry required before expiration of authorization (days) -
LTRT2 Limits HWH Limits
Medication Assisted - Methadone Maintenance
Encounter entry required before expiration of authorization (days) -
Co-occurring Med Monitoring Services Enhancement
Encounter entry required before expiration of authorization (days) -
LTRT2 Limits
LTRT2 Limits
DMHAS RCC Page 2 of 6
SFY 2025
Recovery Support Care Management $ 26.40 15 minutes Recovery Sup H0023 HF 4 16 n/a T2022 HF 4 16 n/a
Transportation - staff time $ 9.30 hour Recovery Sup ZTRAV 10 10 n/a ZTRAV 10 10 n/a
Transportation - mileage $ 0.33 a mile Recovery Sup ZMIL 300 300 n/a ZMIL 300 300 n/a
Court Liaison $ 6.87 15 minutes Recovery Sup ZCTLI 6 6 n/a ZCTLI 6 6 n/a
Limit Recovery Support Enhancements $655.62 $655.62
Encounter entry required before expiration of authorization (days) -
LTRT2 Limits HWH Limits
DMHAS RCC Page 3 of 6
SFY 2025
Medical Services
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
E & M visit - new patient (20 min) $ 82.94 20 minutes Medical Srvcs 99202 0 0 n/a 99202 1 1 n/a
E & M visit - new patient (30 min) $ 117.03 30 minutes Medical Srvcs 99203 0 0 n/a 99203 1 1 n/a
E & M visit - new patient (45 min) $ 177.73 45 minutes Medical Srvcs 99204 0 0 n/a 99204 1 1 n/a
E & M visit - new patient (60 min) $ 224.19 60 minutes Medical Srvcs 99205 0 0 n/a 99205 1 1 n/a
E & M visit - established patient (10 min) $ 49.91 10 minutes Medical Srvcs 99212 0 0 n/a 99212 1 1 n/a
E & M visit - established patient (15 min) $ 81.64 15 minutes Medical Srvcs 99213 0 0 n/a 99213 1 1 n/a
E & M visit - established patient (25 min) $ 118.08 25 minutes Medical Srvcs 99214 0 0 n/a 99214 1 1 n/a
E & M visit - established patient (40 min) $ 158.24 40 minutes Medical Srvcs 99215 0 0 n/a 99215 1 1 n/a
Limit Medical Services Enhancements $0.00 $469.11
Service Rate Unit Type CPT Code Day Month Year Billing Code Day Month Year
Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 4 4 n/a T2022 HF 4 4 n/a
Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 1 1 6 81025 1 1 6
E & M visit - new patient (20 min) $ 82.94 20 minutes V or B 99202 0 0 0 99202 1 n/a n/a
Limit V or B: Vivitrol - Pre-Induction
Enhancements $56.13 $139.07
LTRT2 Limits HWH Limits
Encounter entry required before expiration of authorization (days) -
Encounter entry required before expiration of authorization (days) -
Vivitrol or Buprenorphine: Vivitrol - Pre-Induction
HWH LimitsLTRT2 Limits
DMHAS RCC Page 4 of 6
SFY 2025
Medication Monitoring - MAT $ 47.54 15 minutes V or B Z3353 2 2 n/a Z3353 2 2 n/a
Buprenorphine/Naloxone Maint. (2mg/0.5mg) $ 7.66 unit V or B ZM05 3 93 n/a ZM05 3 93 n/a
Buprenorphine/Naloxone Maint. (8mg/2mg) $ 10.40 unit V or B ZM2G 4 124 n/a ZM2G 4 124 n/a
Buprenorphine Maintenance (8mg) $ 12.03 unit V or B ZM8G 4 124 n/a ZM8G 4 124 n/a
Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 2 2 n/a T2022 HF 2 2 n/a
Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 1 1 6 81025 1 1 6
E & M visit - established patient (10 min) $ 49.91 10 minutes V or B 99212 0 0 0 99212 1 n/a n/a
Vivitrol Medication and Injection $ 1,232.34 injection V or B ZVIV 1 1 6 ZVIV 1 1 6
Limit V or B: Vivitrol - On-going Induction
Enhancements $1,616.29 $1,666.20
LTRT2 Limits HWH Limits
Vivitrol or Buprenorphine
Encounter entry required before expiration of authorization (days) -
DMHAS RCC Page 5 of 6
SFY 2025
Comprehensive Metabolic Panel $ 9.99 service V or B - Lab 80053 1 1 n/a 80053 1 1 n/a
Transferase, Alanine Amino Panel (ALT) $ 2.85 service V or B - Lab 84460 1 1 n/a 84460 1 1 n/a
Transferase, Aspartate Amino Panel (AST) $ 2.85 service V or B - Lab 84450 1 1 n/a 84450 1 1 n/a
Bilirubin Panel $ 2.85 service V or B - Lab 82247 1 1 n/a 82247 1 1 n/a
Mantoux Tuberculin Test $ 10.57 service V or B - Lab 86580 1 1 n/a 86580 1 1 n/a
Hepatic Function Panel $ 6.66 service V or B - Lab 80076 1 1 n/a 80076 1 1 n/a
Complete Blood Count $ 4.76 service V or B - Lab 85025 1 1 n/a 85025 1 1 n/a
Quantitative Syphilis Test $ 2.85 service V or B - Lab 86593 1 1 n/a 86593 1 1 n/a
Urine Drug Screen - Presumptive Testing $ 8.46 service V or B - Lab H0003 HF 1 1 n/a H0003 HF 1 1 n/a
Urine Preg Test Visual Color Comp $ 2.85 service V or B - Lab 81025 1 1 6 81025 1 1 6
Limit Laboratory Services Enhancements $46.14 $46.14
LTRT2 Limits HWH Limits
Encounter entry required before expiration of authorization (days) -
Vivitrol or Buprenorphine: Lab Services
DMHAS RCC Page 6 of 6
SFY 2025
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