Exhibit 2A - DUII ASAM Ambulatory LOC Authorization Parameters.pdf
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- Solicitation number
- 25DPP01060
- Issued by
- Mercer County, New Jersey
About this file
This document is the Exhibit 2A - Driving Under the Influence Initiative (DUII) Ambulatory ASAM LOC Authorization Parameters for State Fiscal Year 2025, effective July 1, 2024. It outlines the authorization parameters for various ambulatory withdrawal management, outpatient, intensive outpatient, and partial hospitalization/care services for the DUII program. The document specifies the ASAM level of care, CPT codes, maximum units per authorization, authorization time frame, daily and weekly limits, emergency release limits, and authorization red zone for each service type. The authorization values for the different service types are also provided.
The document establishes the fee-for-service rates for adult co-occurring capable ambulatory ASAM level of care services, including family therapy, individual therapy, psychoeducational group services, and group therapy. The rates per unit and maximum units per diem are specified for each service type. This information is intended to guide the authorization and provision of DUII services within the state during the specified fiscal year.
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Exhibit 2A - Driving Under the Influence Initiative (DUII) Ambulatory ASAM LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024
Service Assessment
Ambulatory Withdrawal
Management (Detox)
Outpatient 2 units per
30 day authorization
Outpatient 6 units per
30 day authorization
Outpatient 2 units per week
Outpatient 3 units per week
Outpatient 5 units per week
Outpatient 6 units per week
Intensive Outpatient Partial Care
Type/Modality Pre-Admission Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory
ASAM LOC N/A AWM2D Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 2.1 Level 2.5
CPT Code H0001 HF H0014 HF see OP rate table see OP rate table see OP rate table see OP rate table see OP rate table see OP rate table H0015 HF H2036 HF
Maximum units per Authorization 4 5 2 6 10 13 22 26 18 22
Authorization time frame (days) 30 5 30 30 30 30 30 30 30 30
Unit 30 minutes Per diem Per service Per service Per service Per service Per service Per service Per diem Per diem
Daily Limits 4 1 2 2 2 3 3 3 1 1
Weekly Limits 4 7 2 2 2 3 5 6 4 5
# of days at which initial ERL needed N/A 5 N/A N/A N/A N/A N/A N/A 60 60
# of days at which ERL can be submitted N/A 3 N/A N/A N/A N/A N/A N/A 50 50
Authorization RED ZONE (67% of annual allocation) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Adult Annual Client Limits (units) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Rate Per Unit 28.49$ 209.33$ 109.38$ 78.23$
Authorization Value 113.96$ 1,046.65$ 208.30$ 624.90$ 1,041.50$ 1,056.96$ 1,371.26$ 1,481.18$ 1,968.84$ 1,721.06$
Shared Service Name N/A Detox Outpatient Non-Methadone
Intensive Outpatient and
Opioid Maintenance -
Intensive Outpatient
Partial Hospitalization/
Care see OP rate table
Fee for Service - Adult Co-occurring Capable Ambulatory ASAM Level of Care Authorization Parameters
Driving Under the Influence Initiative (DUII)
Standard/Traditional Outpatient and Opioid Maintenance Outpatient
Page 1 of 2 DMHAS DUII
Exhibit 2A - Driving Under the Influence Initiative (DUII) Ambulatory ASAM LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024
Service Family Therapy Individual Therapy Individual Therapy Psychoeducational Group Services Group Therapy
Unit 60 minutes 30 minutes 45 - 50 minutes 90 minutes 90 minutes
Weekly Limits See LOC Limits See LOC Limits See LOC Limits See LOC Limits See LOC Limits
Rate Per Unit $113.84 $71.39 $94.46 $6.61 $27.48
Max units per diem 1 1 1 3 2
CPT Code 90847 HF 90832 HF 90834 HF Z3355 90853 HF
Page 2 of 2 DMHAS DUII
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