Exhibit 1K - SHARE 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 1K - State Hospital Access to Rehabilitation Education Initiative (SHARE) Enhancements Authorization Parameters, which outlines the fee-for-service enhancement authorization parameters for the SHARE program, a joint initiative between the Connecticut Department of Mental Health and Addiction Services (DMHAS) and the State of Connecticut. The document provides details on the covered services, service rates, unit types, CPT codes, service limits per day/month/year, and other authorization parameters for various clinical, recovery support, co-occurring clinical, and medication-assisted treatment services. The services include urine drug screens, oral swabs, tuberculin tests, care management, case management, comprehensive evaluations, and Vivitrol/buprenorphine administration and monitoring. The authorization parameters are effective for State Fiscal Year 2025, from July 1, 2024 through June 30, 2025.
The document also specifies the encounter entry requirements before the expiration of the authorization period for the residential and Vivitrol/buprenorphine-related services. Additionally, it lists the maximum annual client limits for certain service enhancements. The pricing terms, funding sources, and other financial details are not explicitly stated in this document, which appears to be focused on outlining the specific service and authorization parameters for the SHARE program.
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Exhibit 1K - State Hospital Access to Rehabilitation Education Initiative (SHARE) Enhancements Authorization
Parameters
Clinical Review
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Urine Drug Screen - Presumptive Testing $ 8.46 service Clinical H0003HF 1 2 n/a n/a
Oral Swab $ 8.46 service Clinical ZSWB 1 1 n/a n/a
Mantoux Tuberculin Test $ 10.57 service Clinical 86580 1 1 n/a n/a
Continuing Care LOCI $ 26.43 20 minutes Clinical ZLOCI 2 2 n/a n/a
Limit Clinical Review Enhancements $80.35
Recovery Support
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Recovery Support Care Management $ 26.40 15 minutes Recovery Sup H0023 HF 4 16 n/a n/a
Limit Recovery Support Enhancements $422.40
Co-occurring Clinical Services
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Case Management - COOC $ 13.32 15 minutes Co-occurring T2022 HF 8 16 n/a n/a
Comprehensive Intake Evaluation $ 171.99 service Co-occurring 90791 1 1 n/a n/a
Limit Co-occurring Clinical Services
Enhancement $385.11
State Hospital Access to Rehabilitation & Education Initiative (SHARE)
Fee for Service Enhancement Authorization Parameters
Encounter entry required before expiration of authorization (days) -
Encounter entry required before expiration of authorization (days) -
Residential Limits
Residential Limits
Encounter entry required before expiration of authorization (days) -
Residential Limits
DMHAS SHARE Page 1 of 3
SFY 2025
Effective 07/01/24
Revised 04/08/24
Exhibit 1K - State Hospital Access to Rehabilitation Education Initiative (SHARE) Enhancements Authorization
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 4 4 n/a n/a
Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 1 1 6 6
Limit V or B: Vivitrol - Pre-Induction
Enhancements $56.13
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Medication Monitoring - MAT $ 47.54 15 minutes V or B Z3353 2 4 n/a n/a
Buprenorphine/Naloxone Maint. (2mg/0.5mg) $ 7.66 unit V or B ZM05 3 93 n/a n/a
Buprenorphine/Naloxone Maint. (8mg/2mg) $ 10.40 unit V or B ZM2G 4 124 n/a n/a
Buprenorphine Maintenance (8mg) $ 12.03 unit V or B ZM8G 4 124 n/a n/a
Case Management - Vivitrol $ 13.32 15 minutes V or B T2022 HF 2 2 n/a n/a
Urine Preg Test Visual Color Comp $ 2.85 1 test V or B 81025 1 1 6 6
Vivitrol Medication and Injection $ 1,232.34 injection V or B ZVIV 1 1 6 6
Limit V or B: Vivitrol - On-going Induction
Enhancements $1,711.37
Encounter entry required before expiration of authorization (days) -
Vivitrol or Buprenorphine: Vivitrol - Pre-Induction
Residential Limits
Residential Limits
Vivitrol or Buprenorphine
Encounter entry required before expiration of authorization (days) -
DMHAS SHARE Page 2 of 3
SFY 2025
Exhibit 1K - State Hospital Access to Rehabilitation Education Initiative (SHARE) Enhancements Authorization
Service Rate Unit Type CPT Code Day Month Year Annual client limit
Comprehensive Metabolic Panel $9.99 service V or B - Lab 80053 1 1 n/a n/a
Transferase, Alanine Amino Panel (ALT) $2.85 service V or B - Lab 84460 1 1 n/a n/a
Transferase, Aspartate Amino Panel (AST) $2.85 service V or B - Lab 84450 1 1 n/a n/a
Bilirubin Panel $2.85 service V or B - Lab 82247 1 1 n/a n/a
Mantoux Tuberculin Test $10.57 service V or B - Lab 86580 1 1 n/a n/a
Hepatic Function Panel $6.66 service V or B - Lab 80076 1 1 n/a n/a
Complete Blood Count $4.76 service V or B - Lab 85025 1 1 n/a n/a
Quantitative Syphilis Test $2.85 service V or B - Lab 86593 1 1 n/a n/a
Urine Drug Screen - Presumptive Testing $8.46 service V or B - Lab H0003 HF 1 1 n/a n/a
Urine Preg Test Visual Color Comp $2.85 service V or B - Lab 81025 1 1 6 6
Limit V or B: Lab Services Enhancements $46.14
Residential Limits
Encounter entry required before expiration of authorization (days) -
Vivitrol or Buprenorphine: Lab Services
DMHAS SHARE Page 3 of 3
SFY 2025
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