Exhibit 2M - RCE 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 Exhibit 2M - Recovery Court Efficiency (RCE) ASAM Ambulatory LOC Authorization Parameters, which outlines the authorization parameters for addiction services provided under the state's Recovery Court Efficiency (RCE) program for the fiscal year 2025 effective July 1, 2024. The document details the specific Ambulatory Levels of Care (LOC) and associated service types, such as Ambulatory Withdrawal Management (Detox), Outpatient, Intensive Outpatient, and Partial Care, along with the corresponding CPT codes, maximum units per authorization, authorization time frames, daily and weekly limits, and other program requirements.
The document specifies the reimbursement rates per unit for each service type, ranging from $6.61 to $209.33, as well as the annual client limits for some services. It also identifies shared service names, such as Detox, Outpatient Non-Methadone, Intensive Outpatient and Opioid Maintenance - Intensive Outpatient, Partial Hospitalization/Care, and Standard/Traditional Outpatient and Opioid Maintenance Outpatient, along with their respective rate per unit and maximum units per diem.
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Text version
Exhibit 2M - Recovery Court Efficiency (RCE) ASAM Ambulatory LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024
Service
Ambulatory Withdrawal
Management (Detox)
Outpatient 1 units per
30 day authorization
Outpatient 5 units per
30 day authorization
Outpatient 2 units per week
Outpatient 3 units per week
Outpatient 5 units per week
Outpatient 6 units per week
Intensive Outpatient Partial Care
Type/Modality Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory Ambulatory
ASAM LOC AWM2D Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Level 2.1 Level 2.5
CPT Code H0014 HF see OP rate table see OP rate table see OP rate table see OP rate table see OP rate table see OP rate table H0015 HF H2036 HF
Maximum units per Authorization 0 1 5 9 14 21 25 0 0
Authorization time frame (days) 5 30 30 30 30 30 30 30 30
Unit Per diem Per service Per service Per service Per service Per service Per service Per diem Per diem
Daily Limits 0 1 3 2 3 3 3 0 0
Weekly Limits 0 1 5 2 3 5 6 0 0
# of days at which initial ERL needed 0 N/A N/A N/A N/A N/A N/A 0 0
# of days at which ERL can be submitted 0 N/A N/A N/A N/A N/A N/A 0 0
Authorization RED ZONE (67% of annual allocation) N/A N/A N/A N/A N/A N/A N/A 0 0
Adult Annual Client Limits (units) N/A N/A N/A N/A N/A N/A N/A 0 0
Rate Per Unit 209.33$ 109.38$ 78..23
Authorization Value $0 6.61$ 33.05$ 59.49$ 92.54$ 138.81$ 165.25$ $0 $0
Shared Service Name Detox Outpatient Non-Methadone
Intensive Outpatient and
Opioid Maintenance -
Intensive Outpatient
Partial Hospitalization/
Care
$ 6.61 (Psychoeducational Group Services only)
Standard/Traditional Outpatient and Opioid Maintenance Outpatient
Recovery Court Efficiency (RCE) Fee for Service - Adult Co-occurring Capable Ambulatory
ASAM Level of Care Authorization Parameters
Page 1 of 2 DMHAS RCE
Exhibit 2M - Recovery Court Efficiency (RCE) ASAM Ambulatory LOC Authorization Parameters SFY 2025 Effective 07/01/2024 Revised 04/08/2024 overy Court Efficiency ( Psychoeducational Group Services
Unit 90 minutes
Weekly Limits See LOC Limits
Rate Per Unit $6.61
Max units per diem 3
CPT Code Z3355
Page 2 of 2 DMHAS RCE
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