Exhibit 1J - SAPTI Enhancements Authorization Parameters.pdf

PDF 187 KB Posted

Attached to
T2590 - Fiscal Agent for the Division of Mental Health and Addiction Services (DMHAS)
Solicitation number
25DPP01060
Issued by
Mercer County, New Jersey

About this file

Written by GovTribe AI ·

This document is the Exhibit 1J - Substance Abuse Prevention and Treatment Initiative (SAPTI) Enhancements Authorization Parameters, which outlines the fee-for-service enhancement authorization parameters for the SAPTI program administered by the Department of Mental Health and Addiction Services (DMHAS). It details the covered services, service rates, unit types, CPT codes, authorization parameters, and annual client limits for various clinical, co-occurring, medication-assisted treatment, recovery support, and medical services. The services include urine drug screens, tuberculin tests, case management, psychiatric evaluations, medication monitoring, methadone maintenance, and more. The authorization parameters specify the day, month, and year limits for each service, as well as the annual client limits.

The document provides the pricing information and authorization details for the covered SAPTI services. It establishes the reimbursement rates, unit types, and billing codes for the various clinical, recovery, and medical services. The authorization parameters define the utilization limits in terms of days, months, and annual client caps for each service type. This information is intended to guide providers in delivering and billing for SAPTI-covered substance abuse treatment and related services.

View the file

Other files

File Type Posted
Exhibit 1A - DAS Contract Enhancements Authorization Parameters.pdf PDF
Exhibit 5 - Annex A3 Enhancement Descriptions SFY 2024-2025 (Final).pdf PDF
T2590 Bid Solicitation.docx DOCX document
Exhibit 2R - SJI ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 6 ??? Service Rates, Units, Modalities-Types, and CPT Codes~1.pdf PDF
Attachment 1 - State of New Jersey Standard Terms and Conditions (2.8.2024).pdf PDF
Exhibit 1C- Interim Services Enhancements Authorization Parameters.pdf PDF
T2590 Bid Amendment 1.pdf PDF
Exhibit 2H - NJSI ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 2G - MATI ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 2F - MATI ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 1E - MATI Enhancements Authorization Parameters.pdf PDF
Exhibit 2E - MAP SPB ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 2C - ISI ASAM Ambulatory & Residential LOC Authorization Parameters.pdf PDF
Exhibit 2I - NJSI ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 1H - RCC Enhancements Authorization Parameters.pdf PDF
Exhibit 1F - NJSI Enhancements Authorization Parameters.pdf PDF
Attachment 2 - Standard Procurement Forms Packet~3.pdf PDF
REVISED T2590 Bid Solicitation~1.docx DOCX document
Exhibit 2O - SAPTI ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 1D - MAP SPB Enhancements Authorization Parameters.pdf PDF
Exhibit 2P - SAPTI ASAM Residential LOC Authorization Parameters.pdf PDF
T2590_Pre-Quote Conference.pptx PPTX presentation
Exhibit 1L - SJI Enhancements Authorization Parameters.pdf PDF
Exhibit 2J - RCI ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 1I - RCE Enhancements Authorization Parameters.pdf PDF
Exhibit 8 Funding Initiative Service Packages.pdf PDF
Exhibit 7 NJSAMS - IME - FlowChart.pdf PDF
Attachment 3 State-Supplied Price Sheet.xlsx XLSX spreadsheet
Exhibit 1G - RCI Enhancements Authorization Parameters.pdf PDF
Exhibit 4 - Annex A2 Initiative Specific SFY 2024-2025 (Final).pdf PDF
Exhibit 2N - RCE ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 2K - RCI ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 3 - Annex A1 ASAM LOC Service Descriptions SFY 2024-2025 (Final).pdf PDF
Exhibit 2L - RCC ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 2M - RCE ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 2A - DUII ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 2D - MAP SPB ASAM Ambulatory LOC Authorization Parameters.pdf PDF
Exhibit 1K - SHARE Enhancements Authorization Parameters.pdf PDF
Exhibit 2Q - SHARE ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 2S - SJI ASAM Residential LOC Authorization Parameters.pdf PDF
SONJ Third-Party Information Security Questionnaire.pdf PDF
Exhibit 2B - DUII ASAM Residential LOC Authorization Parameters.pdf PDF
Exhibit 1B - DUII Enhancements Authorization Parameters.pdf PDF
Show all 44

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Exhibit 1J - Substance Abuse Prevention and Treatment Initiative (SAPTI) Enhancements Authorization Parameters

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Urine Drug Screen - Presumptive Testing $ 8.46 service Clinical H0003HF 1 5 n/a H0003HF 1 5 n/a H0003HF 1 5 n/a H0003HF 1 5 n/a n/a

Oral Swab $ 8.46 service Clinical ZSWB 1 5 n/a ZSWB 1 5 n/a ZSWB 1 5 n/a ZSWB 1 5 n/a n/a

Mantoux Tuberculin Test $ 10.57 service Clinical 86580 1 1 n/a 86580 1 1 n/a 86580 1 1 n/a 86580 1 1 n/a n/a

Continuing Care LOCI $ 26.43 20 minutes Clinical ZLOCI 1 1 n/a ZLOCI 1 1 n/a ZLOCI 1 1 n/a ZLOCI 0 0 0 n/a

Limit Clinical Review Enhancements $79.30 $79.30 $79.30 $52.87

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Case Management - COOC $ 13.32 15 minutes Co-occurring T2022 HF 8 16 n/a T2022 HF 8 16 n/a T2022 HF 0 0 0 T2022 HF 0 0 0 n/a

Comprehensive Intake Evaluation $ 171.99 service Co-occurring 90791 1 1 n/a 90791 1 1 n/a 90791 1 1 n/a 90791 1 1 n/a n/a

Limit Co-occurring Clinical Services

Enhancement $385.11 $385.11 $171.99 $171.99

Methadone Outpatient LimitsIntensive Outpatient LimitsLong Term Residential T2 LimitsInpatient Withdrawal Management Limits

Substance Abuse Prevention and Treatment Initiative (SAPT)

Fee for Service Enhancement Authorization Parameters

Clinical Review

Co-occurring Clinical Services

Methadone Outpatient Limits

Encounter entry required before expiration of authorization (days) -

Intensive Outpatient LimitsInpatient Withdrawal Management Limits Long Term Residential T2 Limits

Encounter entry required before expiration of authorization (days) -

DMHAS SAPT Page 1 of 4

SFY 2025

Effective 07/01/24

Revised 04/08/24

Exhibit 1J - Substance Abuse Prevention and Treatment Initiative (SAPTI) Enhancements Authorization Parameters

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Medication Monitoring $ 47.54 15 minutes CO Med 90862 HF 0 0 0 90862 HF 0 0 0 90862 HF 2 2 n/a 90862 HF 2 2 n/a n/a

Limit Co-occurring Medication Monitoring

Service Enhancement $0.00 $0.00 $95.08 $95.08

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Psychiatric Evaluation $ 437.76 service Psych Eval 90792 1 1 4 90792 1 1 4 90792 1 1 4 90792 1 1 4 4

Limit Co-occurring Pyschiatric Evaluation

Service Enhancement $437.76 $1,751.04 $437.76 $1,751.04 $437.76 $1,751.04 $437.76 $1,751.04 $1,751.04

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Medication Monitoring - MAT $ 47.54 15 minutes MAT- MM Z3353 0 0 0 Z3353 0 0 0 Z3353 0 0 0 Z3353 0 0 0 0

Methadone Maintenance $ 4.05 unit MAT- MM H0020 HF 0 0 0 H0020 HF 1 31 365 H0020 HF 1 31 365 H0020 HF 0 0 0 0

Limit Medication Assisted-Methadone

Maintenance Enhancements $0.00 $125.55 $125.55 $0.00

Encounter entry required before expiration of authorization (days) -

Inpatient Withdrawal Management Limits

Intensive Outpatient Limits

Encounter entry required before expiration of authorization (days) -

Long Term Residential T2 LimitsInpatient Withdrawal Management Limits

Medication Assisted - Methadone Maintenance

Methadone Outpatient Limits

Co-occurring Med Monitoring Services Enhancement

Psychiatric Evaluation

Long Term Residential T2 LimitsInpatient Withdrawal Management Limits

Encounter entry required before expiration of authorization (days) -

Intensive Outpatient Limits

Intensive Outpatient Limits

Methadone Outpatient LimitsLong Term Residential T2 Limits

Methadone Outpatient Limits

DMHAS SAPT Page 2 of 4

SFY 2025

Exhibit 1J - Substance Abuse Prevention and Treatment Initiative (SAPTI) Enhancements Authorization Parameters

Recovery Support

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Recovery Support Care Management $ 26.40 15 minutes Recovery Sup H0023 HF 4 16 n/a H0023 HF 4 16 n/a H0023 HF 4 16 n/a H0023 HF 4 16 n/a n/a

Limit Recovery Support Enhancements $422.40 $422.40 $422.40 $422.40

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

E & M visit - new patient (20 min) $ 82.94 20 minutes Medical Srvcs 99202 0 0 0 99202 0 0 0 99202 1 n/a n/a 99202 1 1 n/a 0

E & M visit - new patient (30 min) $ 117.03 30 minutes Medical Srvcs 99203 0 0 0 99203 0 0 0 99203 1 n/a n/a 99203 1 1 n/a 0

E & M visit - new patient (45 min) $ 177.73 45 minutes Medical Srvcs 99204 0 0 0 99204 0 0 0 99204 1 n/a n/a 99204 1 1 n/a 0

E & M visit - new patient (60 min) $ 224.19 60 minutes Medical Srvcs 99205 0 0 0 99205 0 0 0 99205 1 n/a n/a 99205 1 1 n/a 0

E & M visit - established patient (10 min) $ 49.91 10 minutes Medical Srvcs 99212 0 0 0 99212 0 0 0 99212 1 n/a n/a 99212 1 1 n/a 0

E & M visit - established patient (15 min) $ 81.64 15 minutes Medical Srvcs 99213 0 0 0 99213 0 0 0 99213 1 n/a n/a 99213 1 1 n/a 0

E & M visit - established patient (25 min) $ 118.08 25 minutes Medical Srvcs 99214 0 0 0 99214 0 0 0 99214 1 n/a n/a 99214 1 1 n/a 0

E & M visit - established patient (40 min) $ 158.24 40 minutes Medical Srvcs 99215 0 0 0 99215 0 0 0 99215 1 n/a n/a 99215 1 1 n/a 0

Limit Medical Services Enhancements $0.00 $0.00 $469.11 $469.11

Medical Services

Inpatient Withdrawal Management Limits Methadone Outpatient LimitsLong Term Residential T2 Limits

Encounter entry required before expiration of authorization (days) -

Encounter entry required before expiration of authorization (days) -

Inpatient Withdrawal Management Limits Long Term Residential T2 Limits

Intensive Outpatient Limits

Intensive Outpatient Limits Methadone Outpatient Limits

DMHAS SAPT Page 3 of 4

SFY 2025

Exhibit 1J - Substance Abuse Prevention and Treatment Initiative (SAPTI) Enhancements Authorization Parameters

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 0 0 0 T2022 HF 4 4 n/a T2022 HF 0 0 0 T2022 HF 0 0 0 n/a

Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 1 1 6 81025 1 1 6 81025 1 1 6 81025 1 1 6 n/a

E & M visit - new patient (20 min) $ 82.94 20 minutes V or B 99202 0 0 0 99202 0 0 0 99202 1 n/a n/a 99202 1 n/a n/a n/a

Limit V or B: Vivitrol - Pre-Induction

Enhancements $2.85 $56.13 $85.79 $85.79

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 0 0 0 T2022 HF 2 2 n/a T2022 HF 0 0 0 T2022 HF 0 0 0 n/a

Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 0 0 0 81025 1 1 6 81025 0 0 0 81025 0 0 0 n/a

E & M visit - established patient (10 min) $ 49.91 10 minutes V or B 99212 0 0 0 99212 1 n/a n/a 99212 0 0 0 99212 0 0 0 n/a

Vivitrol Medication and Injection $ 1,232.34 injection V or B ZVIV 0 0 0 ZVIV 1 1 6 ZVIV 0 0 0 ZVIV 0 0 0 n/a

Limit V or B: Vivitrol - On-going Induction

Enhancements $0.00 $1,311.74 $0.00 $0.00

Service Rate Unit Type CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year CPT Code Day Month Year Annual client limit

Comprehensive Metabolic Panel $ 9.99 service V or B - Lab 80053 1 1 n/a 80053 1 1 n/a 80053 1 1 n/a 80053 1 1 n/a n/a

Transferase, Alanine Amino Panel (ALT) $ 2.85 service V or B - Lab 84460 1 1 n/a 84460 1 1 n/a 84460 1 1 n/a 84460 1 1 n/a n/a

Transferase, Aspartate Amino Panel (AST) $ 2.85 service V or B - Lab 84450 1 1 n/a 84450 1 1 n/a 84450 1 1 n/a 84450 1 1 n/a n/a

Bilirubin Panel $ 2.85 service V or B - Lab 82247 1 1 n/a 82247 1 1 n/a 82247 1 1 n/a 82247 1 1 n/a n/a

Hepatic Function Panel $ 6.66 service V or B - Lab 80076 1 1 n/a 80076 1 1 n/a 80076 1 1 n/a 80076 1 1 n/a n/a

Limit V or B: Lab Services Enhancement $9.99 $9.99 $9.99 $9.99

Methadone Outpatient Limits

Inpatient Withdrawal Management Limits

Vivitrol or Buprenorphine: Vivitrol - Pre-Induction

Methadone Outpatient Limits

Encounter entry required before expiration of authorization (days) -

Inpatient Withdrawal Management Limits

Encounter entry required before expiration of authorization (days) -

Vivitrol or Buprenorphine - Lab Services

Long Term Residential T2 Limits

Long Term Residential T2 Limits

Vivitrol or Buprenorphine

Encounter entry required before expiration of authorization (days) -

Intensive Outpatient Limits

Intensive Outpatient Limits

Inpatient Withdrawal Management Limits Long Term Residential T2 Limits Intensive Outpatient Limits Methadone Outpatient Limits

DMHAS SAPT Page 4 of 4

SFY 2025

File details come from the government source that posted it. Updated .