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["Key"]
[]
[null,"Codes for MH graduate students"]
[null,"new or updated"]
["strikethrough","removed"]

{"sheet":"Standard Service Code List","index":1,"n_rows":131,"n_cols":18,"rows_kept":131,"cut":false,"hidden":false,"merged":[[130,1,130,3],[0,0,0,1],[0,2,0,17],[125,4,125,5],[25,2,27,2],[35,2,38,2],[39,2,42,2],[43,2,45,2],[46,2,49,2],[50,2,53,2],[54,2,57,2],[124,0,124,3],[22,2,24,2],[129,1,129,3],[129,4,129,5],[125,1,125,3],[126,1,126,3],[126,4,126,5],[127,1,127,3],[127,4,127,5],[128,1,128,3],[128,4,128,5],[47,24,47,28],[48,24,48,28],[35,24,35,28],[36,24,36,28],[37,24,37,28],[38,24,38,28],[39,24,39,28],[40,24,40,28],[41,24,41,28],[42,24,42,28],[43,24,43,28],[44,24,44,28],[45,24,45,28],[46,24,46,28]]}
["FOR REFERENCE PURPOSE: ACBH InSyst System Information, for dates of service prior to 7/1/2023 ",null,"SmartCare Standard Procedure Code List (effective 7/1/2023)"]
["InSyst Procedure Code","InSyst Proc Description"," SmartCare Procedure Code "," SmartCare Procedure Code Description ","Service Category","Mode of Service","Service Function Code","* See \"Special Procedure Code Information\" table below","Add on/Dependent on Code (X)"," Standard Billing CPT or HCPC Code ","Time associated with Code (Mins) ","Maximum Units that Can be Billed","*Medicare COB Required (Yes or No)","**OHC COB Required (Yes or No)","Allowable Disciplines","Allowable Place of Service","Lockout Codes/Rules","Dependent on Codes"]
["323","90791 Psychiatric Diag Eval","90791 Psychiatric Diag Evaluation, 15 min.","Psychiatric Diagnostic Evaluation, 15 Minutes ","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"90791","8-15","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90792\n90832-90834\n90836-90838\n90839-90840*\n90847\n90849\n90853\n90865\n90867-90870*\n90880\n90885*\n90887*\n96112\n96113\n96116\n96121\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\r\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["565","90792 Psy Diag Eval w-medical","90792 Psy Diag Eval w-medical, 15 min.","Psychiatric Diagnostic Evaluation with Medical Services, 15 Minutes ","ASSESSMENT (w E/M)","15 - (Outpatient Services)","60",null,null,"90792","8-15","1","Yes ","Yes","MD/DO\nPA\nNP or CNS","All except 09","90791\n90832-90834\n90836-90838\n90839-90840*\n90847\n90849\n90853\n90865\n90867-90870*\n90880\n90885*\n90887*\n96112\n96113\n96116\n96121\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
[null,"New CalAIM code","90885 Psych. Eval. of Hospital records, reports, test, or data. for Diag. Purposes, 15 Mins.","Psych. Eval. of Hospital Records, Other Psych. Reports, or Psychometric and/or Projective Tests, and Other Accumulated Data for Diag. Purposes, 15 Mins.","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"90885","8-15","1","No","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90839-90840","No "]
[null,"New CalAIM code","96105 Assessment of Aphasia, per Hour","Assessment of Aphasia, per Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96105","31-60","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nNP or CNS","All except 09","96110*\n96125*\n96127*\n96146*\n96161*","No "]
[null,"New CalAIM code","96110 Developmental Screening, 15 Minutes","Developmental Screening, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96110","8-15","1","No","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC\nRN","All except 09","96105\n96116\n96121\n96125*\n96130\n96131-96133\n96136-96139\n96146*\n96161","No "]
[null,"New CalAIM code","96116 Neurobehavioral Status Exam, First Hour","Neurobehavioral Status Exam, First Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96116","31-60","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC\nRN","All except 09","90791\n90792\n90832-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90880\n96110*\n96112*\n96125*\n96127*\n96146*\n96161*\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350","No"]
[null,"New CalAIM code","96121 Neurobehavioral Status Exam, Each Add'l Hour","Neurobehavioral Status Exam, Each Add'l Hour","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96121","31-60","22","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC\nRN","All except 09","90791\n90792\n96110*\n96112-96113*\n96125*\n96127*\n96146\n96161*","Must code 96116 before coding 96121"]
[null,"New CalAIM code","96125 Standardized Cognitive Performance Testing, per Hour","Standardized Cognitive Performance Testing, per Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96125","31-60","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nNP or CNS","All except 09","96105\n96110\n96112-96113\n96116\n96121\n96127*\n96130-96133\n96136-96139\n96146*\n96161*\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350","No"]
[null,"New CalAIM code","96127 Brief Emotional/Behavioral Assessment, 15 Minutes","Brief Emotional/Behavioral Assessment, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96127","8-15","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW \nMFT\nNP/CNS\nPCC\nRN","All except 09","90791-90792\n90832-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90870\n90880\n96105\n96112-96113\n96116\n96121\n96125\n96130-96133\n96136-96139\n96146*\n96161*\n99217-99223\n99231-99236\n99251-99255\n99304-99310\n99366-99368\n99441-99443\n99451\n99484","No"]
["415","96101 PSYCH TESTING","96130 Psych Testing Eval., First Hour","Psychological Testing Evaluation, First Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96130","31-60","1","Yes","Yes","MD/DO\nPhD/PsyD \nPA\nNP or CNS","All except 09","96110*\n96112\n96113*\n96125*\n96127*\r\n96161*\n96146*\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350","No "]
[null,"New CalAIM code","96131 Psych Testing Eval, Ea. Add'l Hour","Psychological Testing Evaluation, Each Additional Hour","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96131","31-60","22","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96110*\n96112\n96113*\n96125*\n96127*\n96161*\n96146*","Must code 96130\nbefore coding 96131"]
["417","96118 Neuro Psych Testing","96132 NeuroPsych Test, First Hour","Neuropsychological Testing Evaluation, First Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96132","31-60","1","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96110*\n96125*\n96127*\n96146*\n96161*\n99202-99205\n99212-99215\r\n99217-99220\n99231-99236\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350","No "]
[null,"New CalAIM code","96133 NeuroPsych Test, Ea. Add'l  Hour","Neuropsychological Testing Evaluation, Each Additional Hour","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96133","31-60","22","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96110*\n96125*\n96127*\n96146*\n96161*","Must code 96132\nbefore coding 96133"]
["415","New CalAIM code","96136 Psych or NeuroPsych Test Admin, First 30 Min.","Psychological or Neuropsychological Test Administration, First 30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96136","16-30","1","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96110*\n96125*\n96127* \n96138* \n96146* \n96161* \n99202-99205 \n99212-99215 \n99217-99220 \n99231-99236 \n99304-99310 \n99324-99328 \n99334-99337 \n99341-99345\n99347-99350","No"]
[null,"New CalAIM code","96137 Psych or NeuroPsych Test Admin, Each Add'l 30 Min.","Psychological or Neuropsychological Test Administration, Each Additional 30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96137","16-30","45","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96110*\n96125*\n96127* \n96138* \n96146* \n96161*","Must code 96136 before coding 96137"]
["415/417","New CalAIM code","96138 Psych or NeuroPsych Test Admin by PT, First 30 Mins","Psychological or Neuropsychological Test Administration by Technician, First 30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96138","16-30","1","Yes","Yes","PT","All except 09","96110*\n96113*\n96125*\n96127* \n96146* \n96161* \n96136-96137 \n99202-99205 \n99212-99215 \n99217-99220 \n99231-99236 \n99304-99310 \n99324-99328 \n99334-99337 \n99341-99345 \n99347-99350","No"]
[null,"New CalAIM code","96139 Psych or NeuroPsych Test Administration by PT, Each Add'l 30 Min.","Psychological or Neuropsychological Test Administration by Technician, Each Additional 30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96139","16-30","45","Yes","Yes","PT","All except 09","96110*\n96125*\n96127*\n96146* \n96161* ","Must code 96138 before coding 96139"]
[null,"New CalAIM code","96146 Psych or NeuroPsych Test Admin, 15 Min.","Psychological or Neuropsychological Test Administration, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96146","8-15","1","Yes","Yes","MD/DO\nPhD/PsyD\nPA\nNP or CNS","All except 09","96105\n96110\n96112-96113 \n96116 \n96121 \n96125 \n96127 \n96130-96133 \n96136-96139 \n96161* \n99202-99205 \n99212-99215 \n99217-99220 \n99231-99236 \n99304-99310 \n99324-99328 \n99334-99337 \n99341-99345 \n99347-99350","No"]
["535","96111EXT Dev Test Interp RPT","96112 Developmental Test, First Hour","Developmental Testing, First Hour","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"96112","31-60","1","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nNP or CNS","All except 09","90791-90792*\n90832-90834*\n90836-90839*\n90845*\n90847*\n90849*\r\n90853*\n90865*\n90870*\n90880*\n96121\n96125*\n96127*\n96130\n96131*\n96138\n96146*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**","No "]
[null,"New CalAIM code","96113 Developmental Test, Ea. Add'l 30min","Developmental Testing, Each Additional 30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30","ADD, DEP","X","96113","16-30","44","Yes","Yes","MD/DO\nPA\nPhD/PsyD\nNP or CNS","All except 09","90791-90792*\n90832-90834*\n90836-90839*\n90845*\n90847*\n90849*\r\n90853*\n90865*\n90870*\n90880*\n96121\n96125*\n96127*\n96130\n96131*\n96138\n96146*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**","Must code 96112 (first hour) before coding 96113 (each\nadditional\n30 minutes) before coding 96113"]
[null,"New CalAIM code","98966 - 98968 Tel. Assess and Mng Svc., 5-30 Min.","98966 - Telephone Assessment and Management Service, 5-10 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"98966","5-10","1","Yes","Yes","PA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","02\n10","98966\n98967\n99484","No"]
[null,"New CalAIM code",null,"98967 -Telephone Assessment and Management Service, 11-20 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"98967","11-20","1","Yes","Yes","PA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","02\n10","98966\n98968\n99484","No"]
[null,"New CalAIM code",null,"98968 -Telephone Assessment and Management Service, 21-30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"98968","21-30","1","Yes","Yes","PA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","02\n10","98966\n98968\n99484","No"]
[null,"New CalAIM code","99441 - 99443 Tel. Assess and Mng Svc., 5-30 Min.","99441 -Telephone Evaluation and Management Service, 5-10 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"99441","5-10","1","Yes","Yes","MD/DO\nPA\nNP or CNS","02\n10","90791\n90792\n90832-90834\n90836-90838\n96127*\n99442\n99443\n99484","No"]
[null,"New CalAIM code",null,"99442 -Telephone Evaluation and Management Service, 11-20 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"99442","11-20","1","Yes","Yes","MD/DO\nPA\nNP or CNS","02\n10","90791\n90792\n90832-90834\n90836-90838\n96127*\n99441\n99443\n99484","No"]
[null,"New CalAIM code",null,"99443 -Telephone Evaluation and Management Service, 21-30 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"99443","21-30","1","Yes","Yes","MD/DO\nPA\nNP or CNS","02\n10","90791\n90792\n90832-90834\n90836-90838\n96127*\n99441\n99442\n99484","No"]
[null,"New CalAIM code","H0031 MH Assessment non-Phy, 15min.","Mental Health Assessment by Non-Physician, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"H0031","8-15","96","No ","Yes","Pharmacist\nPhD/PsyD\nLCSW\nMFT\nPCC\nPsychiatric Technician\nPA\nNP or CNS\nRN\nLVN\nMHRS\nOccupational Therapist\nOther Qualified Practitioner\nPeer","All except 09","No","No "]
[null,"New CalAIM code","H2000 Comp. Multi-disciplinary Eval., 15 Mins","Comprehensive Multidisciplinary Evaluation, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"H2000","8-15","96","No","Yes","All disciplines, including non-licensed practitioners","All except 09","No","No"]
[null,"New CalAIM code","T1001 Nursing Assessment/Eval., 15 Min.","Nursing Assessment/Evaluation, 15 Minutes","ASSESSMENT ","15 - (Outpatient Services)","30",null,null,"T1001","8-15","96","No","Yes","PT\nNP or CNS\nRN\nLVN","All except 09","No","No"]
["377","90839 Crisis Thpy 60 min","90839 PsychThpy for Crisis, First 30-74 Min. ","Psychotherapy for Crisis, First 30-74 Minutes ","CRISIS INTERVENTION","15 - (Outpatient Services)","70",null,null,"90839","30-74","1 ","Yes ","Yes","MD/DO\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP or CNS","01, 03-08, 11-26, 31-34, 41-42, 49-58, 60-62, 65, 71-72, 81, 99","90785\n90791-90792\n90832-90834\n90836-90838\n90845\n90847\n90849\n90853\n90865\n90867-90870*\n90880\n90885*\n90887*\r\n96112-96113\n96116*\n96127*\n99605-99606**","No "]
["378","90840 + Crisis Thpy Add 30min","90840 PsychThpy for Crisis, Ea. Add'l 30 Min.","Psychotherapy for Crisis, Each Additional 30 Minutes ","CRISIS INTERVENTION","15 - (Outpatient Services)","70","ADD, DEP","X","90840","15-44","13 ","Yes ","Yes","MD/DO\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP or CNS","01, 03-08, 11-26, 31-34, 41-42, 49-58, 60-62, 65, 71-72, 81, 99","90785\n90791-90792\n90832-90834\n90836-90838\n90845\n90847\n90849\n90853\n90865\n90867-90870*\n90880\n90885*\n90887*\n96116*\n96127*\n99605-99606**","90839"]
["377,378","90839 Crisis Thpy 60 min\n90840 + Crisis Thpy Add 30min","H2011 Crisis Intervention, per 15 Min.","Crisis Intervention Service, per 15 Minutes ","CRISIS INTERVENTION","15 - (Outpatient Services)","70",null,null,"H2011","8-15","32","No ","Yes","All disciplines, including non-licensed practitioners","All except 09 and 15","No","No"]
[690,"90839 CCRP Mobile Crisis 60min (county only)","H2011 Mobile Crisis, per 15 Min.","Community-based mobile crisis intervention services provide rapid response, individual assessment and community-based stabilization for Medi-Cal beneficiaries who are experiencing a mental health crisis.\nMobile crisis services are designed to provide relief to beneficiaries experiencing a behavioral health crisis, including through de-escalation and stabilization techniques that reduce the immediate risk and subsequent harm; and avoid unnecessary emergency department care, psychiatric inpatient hospitalizations, and law enforcement involvement.","COMMUNITY BASED MOBILE CRISIS INTERVENTION","15 - (Outpatient Services)","70",null,null,"H2011","8-15","24","No ","No ","All disciplines, including non-licensed practitioners",15,"Community-Based Mobile Crisis Intervention services cannot be billed with:\n•Residential services, except for the day of admission and discharge\n• Inpatient services, except for the day of admission and discharge\n• Psychiatric Health Facility, except for the day of admission and discharge ","No"]
["546","99202 E/M NEW OFC EXP","99202 - 99205 E/M New Office/OTP, 15-74 Min.","99202 - Office or Other Outpatient Visit (for the Evaluation and Management) of New Patient, 15-29 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99202","15-29","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792 \n90832 \n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116* \n96125* \n96130* \n96132* \n96136* \n96138* \n96146* \n96365 \n96369 \n96372-96374 \n96377 \n99203-99205 \n99212-99215** \n99218-99220 \n99234-99236 \n99304-99306 \n99605-99606**","No "]
["547","99203 E/M NEW OFC DETAIL",null,"99203 - Office or Other Outpatient Visit (for the Evaluation and Management) of a New patient, 30-44 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99203","30-44","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792 \n90832 \n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116* \n96125* \n96130* \n96132* \n96136* \n96138* \n96146* \n96365 \n96369 \n96372-96374 \n96377 \n99203-99205 \n99212-99215** \n99218-99220 \n99234-99236 \n99304-99306 \n99605-99606**","No "]
["548","99204 E/M NEW OFC COMPRE",null,"99204 - Office or Other Outpatient Visit (for the Evaluation and Management) of a New Patient, 45-59 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99204","45-59","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792 \n90832 \n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116* \n96125* \n96130* \n96132* \n96136* \n96138* \n96146* \n96365 \n96369 \n96372-96374 \n96377 \n99203-99205 \n99212-99215** \n99218-99220 \n99234-99236 \n99304-99306 \n99605-99606**","No "]
["549","99205 E/M NEW OFC COMPLEX60MIN",null,"99205 - Office or Other Outpatient Visit (for the Evaluation and Management) of a New Patient, 60-74 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99205","60-74","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792 \n90832 \n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116* \n96125* \n96130* \n96132* \n96136* \n96138* \n96146* \n96365 \n96369 \n96372-96374 \n96377 \n99203-99205 \n99212-99215** \n99218-99220 \n99234-99236 \n99304-99306 \n99605-99606**","No "]
["643","99212 E/M EST OP PRBFOCUS","99212- 99215 E/M Est Office/OTP, 10-54 Min.","99212 - Office or Other Outpatient Visit (for the Evaluation and Management) of an Established Patient, 10-19 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99212","10-19","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365\n96369\n96372-96374\n96377\n99202-99205\n99212**\n99214-99215\n99218-99220\r\n99234-99236\n99304-99306\n99605-99606**","No "]
["644","99213 E/M EST OP EXPANDED",null,"99213 - Office or Other Outpatient Visit (for the Evaluation and Management) of an Established Patient, 20-29 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99213","20-29","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365\n96369\n96372-96374\n96377\n99202-99205\n99212**\n99214-99215\n99218-99220\r\n99234-99236\n99304-99306\n99605-99606**","No "]
["645","99214 E/M EST OP MOD COMPL",null,"99214 - Office or Other Outpatient Visit (for the Evaluation and Management) of an Established Patient, 30-39 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99214","30-39","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365\n96369\n96372-96374\n96377\n99202-99205\n99212**\n99214-99215\n99218-99220\r\n99234-99236\n99304-99306\n99605-99606**","No "]
["646","99215 E/M EST OP HIGHCOMPL 40M",null,"99215 -Office or Other Outpatient Visit (for the Evaluation and Management) of an Established Patient, 40-54 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99215","40-54","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","01-08, 10-20, 22-26, 31-34, 41-42, 49-50, 52-55, 57-58, 60, 62, 65, 71-72, 81, 99","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365\n96369\n96372-96374\n96377\n99202-99205\n99212**\n99214-99215\n99218-99220\r\n99234-99236\n99304-99306\n99605-99606**","No "]
["657","99304 SNF E/M INIT LOWCOMP 25M","99304 - 99306 E/M SNF Init Low Sev, 16-60 Min.","99304 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. Usually, the Problem(s) requiring Admission are of Low Severity, 16- 29 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99304","16-29","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["658","99305 SNF E/M INIT MODCOMP 35M",null,"99305 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. Usually, the Problem(s) requiring Admission are of Moderate Severity, 30-39 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99305","30-39","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["650","99306 SNF E/M INIT HGHCOMP 45M",null,"99306 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. Usually, the Problem(s) Requiring Admission are of High Severity, 40-60 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99306","40-60","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["653","99307 SNF SUB E&M STRAIGHTFWD 10","99307 - 99310 E/M SNF Sub Minor Comp., 1-40 Min.","99307 -Subsequent Nursing Facility Care per Day for the Evaluation and Management of a Patient. Usually, the Patient is Stable, Recovering or Improving, 1-12 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99307","1-12","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["654","99308 SNF SUB E&M LOW COMPLEX 15",null,"99308 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. Usually, the Patient is Responding Inadequately to Therapy or Has Developed a Minor Complication, 13-19 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99308","13-19","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["655","99309 SNF SUB E&M MODERATE COM 25",null,"99309 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. Usually, the Patient has Developed a Significant Complication or a Significant New Problem, 20-29 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99309","20-29","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["656","99310 SNF SUB E&M HIGH COMPLEX",null,"99310 -Initial Nursing Facility Care per Day, for the Evaluation and Management of a Patient. The Patient May Be Unstable or May Have Developed a Significant New Problem Requiring Immediate Physician Attention, 30-40 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99310","30-40","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","26, 31, 32","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96127*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\n96369*\n96372-96374*\n96377*\n99202-99205**\n99212-99215**\n99218-99220**\n99221-99223\n99231-99233**\r\n99304**\n99306\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99451\n99605-99606**","No "]
["471","99341 E/M HOME NEW PROBFOC 20M","(99341 - 99342 and 99344 -99345) E/M New Home, 15-66+ Min.","99341 - Home Visit (for the Evaluation and Management) of a New Patient, 15-25 minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99341","15-25","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["472","99342 E/M HOME NEW EXPAND 30M",null,"99342 - Home Visit (for the Evaluation and Management) of a New Patient, 26-50 minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99342","26-50","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["474","99344 E/M HOME NEW COMPRE 60M",null,"99344 - Home Visit (for the Evaluation and Management)of a New Patient, 51-65 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99344","51-65","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["475","99345 E/M HOME NEW COMPLEX 75M",null,"99345 - Home Visit (for the Evaluation and Management) of a New Patient, 66+ minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99345","66+","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["476","99347 E/M HOME EST PROBFOC 15M"," 99347 - 99350 E/M Est Home, 10-70 Min.","99347 - Home Visit (for the Evaluation and Management) of an Established Patient, 10-20 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99347","10-20","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["477","99348 E/M HOME EST EXPAND 25M",null,"99348 - Home Visit (for the Evaluation and Management) of an Established Patient, 21-35 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99348","21-35","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["478","99349 E/M HOME EST DETAIL 40M",null,"99349 - Home Visit (for the Evaluation and Management) of an Established Patient, 36-50 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99349","36-50","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["479","99350 E/M HOME EST COMPLEX 60M",null,"99350 -Home Visit (for the Evaluation and Management) of an Established Patient, 51-70 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99350","51-70","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","04, 12-16, 31-34","90791\n90792\n90832\n90834\n90837\n90845\n90847\n90849\n90853\n90865\n90867-90869\n90880\n96112-96113\n96116*\n96125*\n96130*\n96132*\n96136*\n96138*\n96146*\n96365*\r\n96369*\n96372-96374*\n96377*\n99218-99220\n99234-99236\n99304-99306\n99341**\n99343-99345\n99451\n99605-99606**","No "]
["675","99605 MedTxMgt New 15M Pharm","99605 Pharm (f/f) MedTxMgt New 15min","Medication Therapy Management Service(s) Provided by a Pharmacist, Individual, Face-to-Face with New Patient with Assessment and Intervention, 15 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99605","8-15","1 ","No ","Yes","Pharm","All except 09","90791\n90792\n90832-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90870\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99304-99310\n99324-99328\r\n99334-99337\n99341-99345\n99347-99350\n99484\n99606**","No "]
["676","99606 MedTxMgt Estab 15M Pharm","99606 Pharm (f/f) MedTxMgt Est. 15min ","Medication Therapy Management Service(s) Provided by a Pharmacist, Individual, Face-to-Face with Established Patient with Assessment and Intervention, 15 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"99606","8-15","1 ","No ","Yes","Pharm","All except 09","90791\n90792\n90832-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90870\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350\n99484\n99605","No "]
["677","99607 MedTxMgt AddOn 15M Pharm","99607 Pharm (f/f) MedTxMgt Add On 15min ","Medication Therapy Management Service(s) Provided by a Pharmacist, Individual, Face-to-Face with Patient with Assessment and Intervention, each Additional 15 Minutes beyond 99605 or 99606. ","MEDICATION SUPPORT","15 - (Outpatient Services)","60","ADD, DEP","X","99607","8-15","15 ","No ","Yes","Pharm","All except 09","99484","99605\n99606"]
[null,"New CalAIM code","96372 Therapeutic, Prophylactic, or Diagnostic Injection; Subcutaneous or Intramuscular, 15 Min. ","Therapeutic, Prophylactic, or Diagnostic Injection; Subcutaneous or Intramuscular, 15 minutes. Do not use this code to indicate administration of vaccines/toxoids or intradermal cancer immunotherapy injection.","MEDICATION SUPPORT","15-(Outpatient Services)","60",null,null,"96372","8-15","1","Yes",null,"MD/DO\nPA\nNP or CNS\nRN","01\n03-08\n11-26\n31-34\n41-42\n49-58\n60-62\n65\n71-72\n81\n99","Cannot be billed with:\n90870\n96365\n96369\n96374\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**","No"]
[null,"New CalAIM code","H0033 Oral Med. Admin, Direct Obs., 15 Min.","Oral Med. Admin, Direct Obs., 15 Mins","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"H0033","8-15","16","No ","Yes","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["367,369","MEDICATION TRAINING & SUPPORT\nMeds Management by RN/LVN only\n","H0034 Medication Train/Supp. per 15 Min","Medication Training and Support, per 15 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"H0034","8-15","16 ","No ","Yes","MD/DO\nPharmacist\nPA\nNP or CNS\nRN\nLVN\nPT","All except 09","No","No "]
["367,369","MEDICATION TRAINING & SUPPORT\nMeds Management by RN/LVN only\n","H0034 Group Medication Train/Supp., per 15 Min","Group Medication Training and Support, per 15 Minutes ","MEDICATION SUPPORT","15 - (Outpatient Services)","60",null,null,"H0034","8-15","16 ","No ","Yes","MD/DO\nPharmacist\nPA\nNP or CNS\nRN\nLVN\nPT","All except 09","No","No"]
["581","Plan Development","H0032 Plan Development by Non-Physician, 15min","Mental Health Service Plan Developed by Non-Physician, 15 Minutes ","PLAN DEVELOPMENT","15 - (Outpatient Services)","30",null,null,"H0032","8-15","96 ","No ","Yes","Pharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP or CNS\nRN\nPT\nLVN\nMHRS\nOT\nOther","All except 09","No","No "]
[null,"New CalAIM code","99366 MedTeam Conf-NonPhys f/f 30+min","Medical Team Conference w/Interdisciplinary Team of Health Care Professional, Participation by Non-Physician. Face-to-face w/Patient and/or Family. 30 Minutes or more","PLAN DEVELOPMENT","15 - (Outpatient Services)","30",null,null,"99366","30 >","1","No ","Yes","Pharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP or CNS\nRN","All except 09","90791\n90792\n90832-90834-\n90836-90838\n96127\n99451\n99484","No "]
[null,"New CalAIM code","99367 MedTeamConf-Phys not f/f 30+min","Medical Team Conference w/Interdisciplinary Team of Health Care Professional, Participation by Physician. Patient and/or Family not present. 30 Minutes or more","PLAN DEVELOPMENT","15 - (Outpatient Services)","30",null,null,"99367","30 >","1","No ","Yes","MD/DO","All except 09","90791\n90792\n90832-90834-\n90836-90838\n96127\n99451\n99484","No "]
[null,"New CalAIM code","99368 MedTeam Conf-NonPhys not f/f 30+min","Medical Team Conference w/Interdisciplinary Team of Health Care Professional, Participation by Non-Physician. Patient and/or Family not present. 30 Minutes or more","PLAN DEVELOPMENT","15 - (Outpatient Services)","30",null,null,"99368","30 >","1","No ","Yes","Pharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP/CNS\nRN","All except 09","90791\n90792\n90832-90834-\n90836-90838\n96127\n99451\n99484","No "]
[null,"New CalAIM code","99484 BehavHlth Care Mgmt. Phys 20min","Care Management Services for Behavioral Health Conditions, Directed by Physician. At least 20 Minutes.","PLAN DEVELOPMENT","15 - (Outpatient Services)","30",null,null,"99484","20 >","1 per calendar month","Yes ","Yes","MD/DO\nPharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP or CNS\nRN \nPT\nLVN","01-08\n10-20\n22-26\n33-34\n41-42\n49-50\n52-53\n57-58\n60\n62\n65\n71\n72\n81\n99","96127*\n98966-98968*\n99366-99368**\n99441-99443**\n99605-99607**","No "]
["571","Brokerage Services","T1017 Targeted Case/Mgmt, per 15 min.","Targeted Case Management, Each 15 Minutes ","REFERRAL CODES","15 - (Outpatient Services)","01",null,null,"T1017","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["580","CASE MGMT/BROKERAGE MEDICAL SV","T1017 Targeted Case/Mgmt (Medical Svc.), per 15 min.","Targeted Case Management, Each 15 Minutes \nAssists a beneficiary to access needed medical services. Service activities may include, but are not limited to: Communication, Coordination, Referral, Monitoring service delivery to ensure beneficiary access to medical services and/or Monitoring beneficiary's progress in use of medical services . ","REFERRAL CODES","15 - (Outpatient Services)","01","CM",null,"T1017","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
[557,"INT HOME-BAS SRV KATIE A (IHBS)","T1017 IHBS (KATIE A), per 15 min.","Targeted Case Management IHBS (Katie A), Each 15 Minutes ","REFERRAL CODES","15 - (Outpatient Services)","57",null,null,"T1017","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["577","INTEN CARE CORD KATIE A (ICC)","T1017 ICC (KATIE A), per 15 min.","Targeted Case Management ICC (Katie A), Each 15 Minutes ","REFERRAL CODES","15 - (Outpatient Services)","07",null,null,"T1017","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["578","Child Family Team (CFT-ICC)","T1017 Child Fam Team Facilitator (CFT-ICC), per 15 min. ","Targeted Case Management Child Family Team Facilitator (CFT-ICC), Each 15 Minutes ","REFERRAL CODES","15 - (Outpatient Services)","07",null,null,"T1017","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["381","Individual Rehabilitation","H2017 Psychosocial Rehab, per 15 Min.","Psychosocial Rehabilitation, per 15 Minutes ","REHABILITATION ","15 - (Outpatient Services)","40",null,null,"H2017","8-15","96 ","No ","Yes","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["391","Group Rehabilitation","H2017 Group Psychosocial Rehab, per 15 Min.","Group Psychosocial Rehabilitation, per 15 Minutes ","REHABILITATION ","15 - (Outpatient Services)","40",null,null,"H2017","8-15","96 ","No ","Yes","All disciplines, including non-licensed practitioners","All except 09","No","No "]
[null,"New CalAIM code","H2021 Community-based Wrap-Around Svcs, per 15 Mins","Community-based Wrap-Around Svcs, per 15 Mins","REHABILITATION ","15 - (Outpatient Services)","40",null,null,"H2021","8-15","96","No","Yes","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["491","90785 + Interactive Complexity","90785 + Interactive Complexity","The interactive complexity code is used when psychiatric services have been complicated by communication difficulties during the visit. This add-on code is meant to reflect increased intensity, not increased time.","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","30","SC, DEP","X","90785","per occurrence","1 per allowed procedure per provider per beneficiary ","Yes ","Yes","All disciplines, including non-licensed practitioners","All except 09","90839-90840\nT1013","90791-90792\n90832-90834\n90836-90838\n90853\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350"]
["491","90785 + Interactive Complexity","STDNT 90785 + Interactive Complexity","The interactive complexity code is used when psychiatric services have been complicated by communication difficulties during the visit. This add-on code is meant to reflect increased intensity, not increased time. This code may ONLY be used by students actively enrolled in a MH graduate program.","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","30","SC, DEP","X","90785","per occurrence","1 per allowed procedure per provider per beneficiary ","Yes ","Yes","Only for active students in a qualifying MH graduate program who meet the critieria for one of the following disciplines:\nMHRS\nOther Qualified Provider\nPeer","All except 09","90839-90840\nT1013","90791-90792\n90832-90834\n90836-90838\n90853\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350"]
[null,"New CalAIM code","T1013 Sign Language or Oral Interpretive Services, 15 Min.","Use of an oral interpreter service required to provide therapy. Code can not be claimed if the service provider delivers treatment and communicates information to the beneficiary in the beneficiary’s language. ","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","30","SC, DEP","X","T1013","8-15","Variable","No","Yes","All disciplines, including non-licensed practitioners","All except 09","90785","90791-90792\n90832-90834\n90836-90840\n90845\n90847\n90849\n90853 \n90865 \n90867-90870 \n90880 \n90885 \n96105 \n96110 \n96112-96113 \n96116 \n96121 \n96125 \n96127 \n96130-96133 \n96136-96139 \n96365-96377 \n98966-98968 \n99202-99205 \n99212-99215 \n99217-99220 \n99231-99236 \n99241-99245 \n99251-99255 \n99304-99310 \n99324-99328 \n99334-99337 \n99341-99345 \n99347-99350 \n99366-99368 \n99441-99443 \n99484 \n99605-99607\nG2212\nH0031 \nH0032 \nH0033 \nH0034 \nH2000 \nH2011 \nH2017 \nH2019 \nH2021 \nS5145 \nT1001 \nT1017"]
["310","COLLATERAL - CAREGIVER","90887 Interpret or Explain Results of Psych/Other Med. Proc. to Caregiver, 15 Min.","Interpretation or Explanation of Results of Psychiatric or Other Medical Procedures to Family or Other Responsible Persons, 15 Minutes ","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","10","SC, DEP","X","90887","8-15","1 ","No ","Yes","MD/DO\nPharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP/CNS\nOT","All except 09","90791\n90792\n90839-90840","90832\n90834\n90837\n90845\n90847\n90849\n90853\r\n90865\n90867\n90870\n96105\n96110\n96112\n96116\n96125\n96127\n96130\n96132\n96136\n96138\n96146\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350\n99366-99368\n99484\n99605-99606"]
["310","COLLATERAL - CAREGIVER","STDNT 90887 Interpret or Explain Results of Psych/Other Med. Proc. to Caregiver, 15 Min.","Interpretation or Explanation of Results of Psychiatric or Other Medical Procedures to Family or Other Responsible Persons, 15 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","10","SC, DEP","X","90887","8-15","1 ","No ","Yes","MD/DO\nPharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP/CNS\nOT","All except 09","90791\n90792\n90839-90840","90832\n90834\n90837\n90845\n90847\n90849\n90853\r\n90865\n90867\n90870\n96105\n96110\n96112\n96116\n96125\n96127\n96130\n96132\n96136\n96138\n96146\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350\n99366-99368\n99484\n99605-99606"]
["614","COLLATERAL HEALTHCARE PROVIDER","90887 Interpret or Explain Results of Psych/Other Med. Proc. to Healthcare Prov, 15 Min.","Interpretation or Explanation of Results of Psychiatric or Other Medical Procedures to Family or Other Responsible Persons, 15 Minutes ","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","10","SC, DEP","X","90887","8-15","1 ","No ","Yes","MD/DO\nPharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP/CNS\nOT","All except 09","90791\n90792\n90839-90840","90832\n90834\n90837\n90845\n90847\n90849\n90853\r\n90865\n90867\n90870\n96105\n96110\n96112\n96116\n96125\n96127\n96130\n96132\n96136\n96138\n96146\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350\n99366-99368\n99484\n99605-99606"]
["614","COLLATERAL HEALTHCARE PROVIDER","90887 Interpret or Explain Results of Psych/Other Med. Proc. to Healthcare Prov, 15 Min.","Interpretation or Explanation of Results of Psychiatric or Other Medical Procedures to Family or Other Responsible Persons, 15 Minutes . This code may ONLY be used by students actively enrolled in a MH graduate program.","SUPPLEMENTAL SERVICES","15 - (Outpatient Services)","10","SC, DEP","X","90887","8-15","1 ","No ","Yes","MD/DO\nPharm\nPhD/PsyD\nLCSW\nPCC\nMFT\nPA\nNP/CNS\nOT","All except 09","90791\n90792\n90839-90840","90832\n90834\n90837\n90845\n90847\n90849\n90853\r\n90865\n90867\n90870\n96105\n96110\n96112\n96116\n96125\n96127\n96130\n96132\n96136\n96138\n96146\n99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350\n99366-99368\n99484\n99605-99606"]
["498","THERAPEUTIC BEHAVIORAL SVCS","H2019 Therapeutic Behvl Serv., per 15 Min.","Therapeutic Behavioral Services, per 15 Minutes ","THERAPEUTIC BEHAVIORLA SERVICES","15 - (Outpatient Services)","58",null,null,"H2019","8-15","96 ","No ","No ","All disciplines, including non-licensed practitioners","All except 09","No","No "]
["441","90832 Psychotherapy 30 min","90832 Psychotherapy, 30 Min. w/Patient ","Psychotherapy, 30 Minutes with Patient ","THERAPY ","15 - (Outpatient Services)","40",null,null,"90832","16-37","1 ","Yes ","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90833-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\r\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["441","90832 Psychotherapy 30 min","STDNT 90832 Psychotherapy, 30 Min. w/Patient ","Psychotherapy, 30 Minutes with Patient. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","40",null,null,"90832","16-37","1 ","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\n90833-90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\r\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["465","90833 +PsyThpy with E/M 30min","90833 Psychotherapy w/E/M, 30 Min. w/Patient","Psychotherapy, 30 Minutes with Patient when Performed with an Evaluation and Management Service ","Therapy (w/E/M)","15 - (Outpatient Services)","60","DEP","X","90833","16-37","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","All except 09","90791\n90792\n90832*\n90834\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\r\n96161*\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350"]
["442","90834 Psychotherapy 45 min","90834 Psychotherapy, 45 Min. w/Patient ","Psychotherapy, 45 Minutes with Patient ","THERAPY ","15 - (Outpatient Services)","40",null,null,"90834","38-52","1 ","Yes ","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90832-90833*\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\r\n99334-99337**\n99341-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["442","90834 Psychotherapy 45 min","STDNT 90834 Psychotherapy, 45 Min. w/Patient ","Psychotherapy, 45 Minutes with Patient. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","40",null,null,"90834","38-52","1 ","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\n90832-90833*\n90836-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\r\n99334-99337**\n99341-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["467","90836 + PsyThpy with E/M 45min","90836 Psychotherapy w/E/M, 45 Min. w/Patient ","Psychotherapy, 45 Minutes with Patient when Performed with an Evaluation and Management Service ","Therapy (w/E/M)","15 - (Outpatient Services)","60","DEP","X","90836","38-52","1 ","Yes ","Yes","MD/DO\nPA\nNP or CNS","All except 09","90791\n90792\n90832-90834*\n90837-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350"]
["443","90837 Psychotherapy 60 min","90837 Psychotherapy, 60 Min. w/Patient ","Psychotherapy, 60 Minutes with Patient ","THERAPY ","15 - (Outpatient Services)","40",null,null,"90837","53-60","1","Yes ","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\r\n90832-90834*\n90836*\n90838-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["443","90837 Psychotherapy 60 min","STDNT 90837 Psychotherapy, 60 Min. w/Patient ","Psychotherapy, 60 Minutes with Patient. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","40",null,null,"90837","53-60","1","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\r\n90832-90834*\n90836*\n90838-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99241-99245**\n99251-99255**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","No "]
["468","90838 + PsyThpy with E/M 60min","90838 PsychThpy w/E/M, 60 Min. w/Patient ","Psychotherapy, 60 Minutes with Patient when Performed with an Evaluation and Management Service ","Therapy (w/E/M)","15 - (Outpatient Services)","60","DEP","X","90838","53-60","1","Yes ","Yes","MD/DO\nPA\nNP or CNS","All except 09","90791\n90792\n90832-90834*\n90836-90837*\n90839-90840\n90845\n90847\n90849\n90853\n90865\n90867-90869*\n90870\n90880\n96112-96113\n96116*\n96127*\n96161*\n99366-99368**\n99441-99443**\n99451**\n99605-99606**","99202-99205\n99212-99215\n99217-99220\n99231-99236\n99241-99245\n99251-99255\n99304-99310\n99324-99328\n99334-99337\n99341-99345\n99347-99350"]
["449","90847 FAMILY PSYCH W PATIENT","90847 Family PsychThpy w/Patient, 50 Min. ","Family Psychotherapy [Conjoint Psychotherapy] (with Patient Present), 50 Minutes ","THERAPY ","15 - (Outpatient Services)","40",null,null,"90847","26-50","1","Yes ","Yes","MD/DO \nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90853\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\r\n99347-99350**\n99605-99606**","No "]
["449","90847 FAMILY PSYCH W PATIENT","STDNT 90847 Family PsychThpy w/Patient, 50 Min. ","Family Psychotherapy [Conjoint Psychotherapy] (with Patient Present), 50 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","40",null,null,"90847","26-50","1","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90853\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\r\n99347-99350**\n99605-99606**","No "]
["455","90849 MULTI FAMGRP CLIENT PRES","90849 Mult-Family Grp. PsychThpy, 15 Min.","Multiple-Family Group Psychotherapy, 15 Minutes ","THERAPY ","15 - (Outpatient Services)","50",null,null,"90849","8-15","1","Yes ","Yes","MD/DO \nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90853\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\r\n99347-99350**\n99605-99606**","No "]
["455","90849 MULTI FAMGRP CLIENT PRES","STDNT 90849 Mult-Family Grp. PsychThpy, 15 Min.","Multiple-Family Group Psychotherapy, 15 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","50",null,null,"90849","8-15","1","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90853\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99304-99310**\n99324-99328**\n99334-99337**\n99341-99345**\r\n99347-99350**\n99605-99606**","No "]
["456","90853 GROUP PSYCHOTHERAPY","90853 Group PsyThpy (non-MFG), 15 Min.","Group Psychotherapy (Other Than of a Multiple-Family Group), 15 Minutes ","THERAPY ","15 - (Outpatient Services)","50",null,null,"90853","8-15","1","Yes ","Yes","MD/DO\nPA\nPhD/PsyD\nLCSW\nMFT\nNP or CNS\nPCC","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90849*\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99605-99606**","No "]
["456","90853 GROUP PSYCHOTHERAPY","STDNT 90853 Group PsyThpy (non-MFG), 15 Min.","Group Psychotherapy (Other Than of a Multiple-Family Group), 15 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","THERAPY ","15 - (Outpatient Services)","50",null,null,"90853","8-15","1","Yes ","Yes","MHRS\nOther Qualified Provider\nPeer","All except 09","90791\n90792\n90832-90834*\n90836-90838*\n90839-90840\n90849*\n90865*\n90867-90869\n90870*\n90880\n96112-96113\n96116*\n96127*\n99202-99205**\n99212-99215**\n99217-99223**\n99231-99236**\n99307-99310**\n99324-99328**\n99334-99337**\n99341-99345**\n99347-99350**\n99605-99606**","No "]
["111","Local Inpatient","H2015-General Psych Inpatient Day ","General Psychiatric Inpatient","Existing 24-Hour Service","05 - (24-Hour Service)","10",null,null,"H2015","1440","1","Yes","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H2015-Psych Inpatient Day (Under 21)","Psychiatric Hospital Inpatient: Under Age 21","Existing 24-Hour Service","05 - (24-Hour Service)","10",null,null,"H2015","1440","1","Yes","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H2015-Psych Inpatient Day (Over 64)","Psychiatric Hospital Inpatient: Over Age 64","Existing 24-Hour Service","05 - (24-Hour Service)","10",null,null,"H2015","1440","1","Yes","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
["113","Local Inpatient Day Adm M-Cal","H0046- General Inpatient Admin. Day","General Hospital Inpatient: Administrative Day","Existing 24-Hour Service","05 - (24-Hour Service)","19",null,null,"H0046","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H0046-Inpatient  Admin. Day (Under 21)","Psychiatric Hospital Inpatient: Administrative Day Under 21","Existing 24-Hour Service","05 - (24-Hour Service)","19",null,null,"H0046","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H0046-Inpatient  Admin. Day (Over 64)","Psychiatric Hospital Inpatient: Administrative Day Over 64","Existing 24-Hour Service","05 - (24-Hour Service)","19",null,null,"H0046","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
["121","PHF Contract Day","H2013 - Psychiatric Health Facility Day","Psychiatric Health Facility","Existing 24-Hour Service","05 - (24-Hour Service)","20",null,null,"H2013","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","51,52","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
["141","Crisis Residential Day","H0018 - Children's Crisis Residential","Children’s Crisis Residential","Existing 24-Hour Service","05 - (24-Hour Service)","40",null,null,"H0018","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H0018-Adult Crisis Residential: Geriatric","Adult Crisis Residential: Geriatric","Existing 24-Hour Service","05 - (24-Hour Service)","40",null,null,"H0018","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H0018-Adult Crisis Resid: NonGeriatric","Adult Crisis Residential: Non-Geriatric","Existing 24-Hour Service","05 - (24-Hour Service)","40",null,null,"H0018","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
["165","Adult Residential Day","H0019 - Adult Residential: Geriatric","Adult Residential: Geriatric","Existing 24-Hour Service","05 - (24-Hour Service)","65",null,null,"H0019","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","H0019 - Adult Residential: Non Geriatric","Adult Residential: Non-Geriatric","Existing 24-Hour Service","05 - (24-Hour Service)","65",null,null,"H0019","1440","1","No","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
["185","TFC Child Residential","S5145 - Therapeutic Foster Care","Therapeutic Foster Care","Existing 24-Hour Service","05 - (24-Hour Service)","96",null,null,"S5145","1440","1","No","No","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","56","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission.  Note: Outpatient services are not locked out against therapeutic foster care (S5145).","No"]
["221","Crisis Stabilization","S9484 - Crisis Stabilization ER","Crisis Stabilization: Emergency Room","Existing Day Service","10 - (Day Services)","20",null,null,"S9484","1200","20","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","20,23","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"Crisis Stabilization","S9484 - Crisis Stabilization Urgent Care","Crisis Stabilization: Urgent Care","Existing Day Service","10 - (Day Services)","25",null,null,"S9484","1200","20","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","20,23","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[281,"Day Care Intens Half Day","H2012 Day Tx Intensive: Half Day","Day Treatment Intensive: Half Day","Existing Day Service","10 - (Day Services)","81",null,null,"H2012","Min.3 hours to <4.0 hours","3","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","11","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[285,"Day Care Intens Full Day","H2012 Day Tx Intensive: Full Day","Day Treatment Intensive: Full Day","Existing Day Service","10 - (Day Services)","85",null,null,"H2012",">=4.0 hours","8","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","11","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[291,"Day Care Rehab Half Day","H2012 Day Rehabilitation: Half Day","Day Rehabilitation: Half Day","Existing Day Service","10 - (Day Services)","91",null,null,"H2012","Min.3 hours to <4.0 hours","3","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","11","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[295,"Day Care Rehab Full Day","H2012 Day Rehabilitation: Full Day","Day Rehabilitation: Full Day","Existing Day Service","10 - (Day Services)","95",null,null,"H2012",">=4.0 hours","8","No ","Yes","MD/DO\nCNS\nNP\nRN\nLCSW\nLVN\nMFT\nPCC\nPhD\nPsyD\nPA\nOTHER\n","11","Except for Case Management services, Day Services, 24-hour, Inpatient and Outpatient services are locked out against each other except for the day of admission. ","No"]
[null,"New CalAIM code","G2212 Prolonged E/M (each add'l 15min)","Prolonged Office or Other Outpatient Evaluation and Management Service(s) beyond the Maximum Time; Each Additional 15 Minutes","MEDICATION SUPPORT","15 - (Outpatient Services)","60","ADD, DEP","X","G2212","8-15","14","YES","YES","MD/DO\nPA\nPhD/PsyD\nNP or CNS\nLCSW\nLPCC\nLMFT\nPharm\nRN\nLVN\n","All except 09","No","90791\n90792\n90837\n90838\n90845\n90847\n90849\n90853\n90865\n90870\n90880\n90885\n96105\n96110\n96125\n96127\n96146\n96367\n96368\n96372\n96373\n96376\n96377\n99205\n99215 \n99217 \n99220 \n99223 \n99233 \n99236 \n99245 \n99255 \n99306 \n99310\n99337\n99350"]
[null,"New CalAIM code","G2212 (GROUP SRV.) Prolonged E/M (each add'l 15min)","Group Services Only - Prolonged Office or Other Outpatient Evaluation and Management Service(s) beyond the Maximum Time; Each Additional 15 Minutes. To be used for additional time for Group Services  Only (e.g. 90849, 90853, H0034 and H2017)","MEDICATION SUPPORT","15 - (Outpatient Services)","60","ADD, DEP","X","G2212","8-15","14","YES","YES","MD/DO\nPA\nPhD/PsyD\nNP or CNS\nLCSW\nLPCC\nLMFT\nPharm\nRN\nLVN\n","All except 09","No","90849\n90853\nH0034\nH2017"]
[null,"New CalAIM code","STDNT G2212 Prolonged E/M (each add'l 15min)","Prolonged Office or Other Outpatient Evaluation and Management Service(s) beyond the Maximum Time; Each Additional 15 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","MEDICATION SUPPORT","15 - (Outpatient Services)","60","ADD, DEP","X","G2212","8-15","14","YES","YES","MHRS\nOther Qualified Provider\nPeer","All except 09","No","90837\n90847\n90849\n90853"]
[null,"New CalAIM code","STDNT G2212 (GROUP SRV.) Prolonged E/M (each add'l 15min)","Student Group Services ONLY - Prolonged Office or Other Outpatient Evaluation and Management Service(s) beyond the Maximum Time; Each Additional 15 Minutes. This code may ONLY be used by students actively enrolled in a MH graduate program.","MEDICATION SUPPORT","15 - (Outpatient Services)","60","ADD, DEP","X","G2212","8-15","14","YES","YES","MHRS\nOther Qualified Provider\nPeer","All except 09","No","90853"]
["Special Procedure Code Information"]
["*","The Medi-Cal state plan covers some Specialty Mental Health services that Medicare does not cover. If the \"Medicare COB Required\" column indicates \"No\", the corresponding service may be billed directly to Medi-Cal.  If the \"Medicare COB Required\"\" column indicates \"Yes\", the corresponding service is covered by Medicare. Providers must bill Medicare first when the Medicare covered service(s) is rendered by a Medicare eligible licensed provider as follows:\n1. Physician\n2. Physician assistant\n3. Nurse practitioner\n4. Clinical Nurse Specialist\n4. Licensed clinical social worker\n5. Clinical psychologist\nNote: If Medicare does not respond within 90 days, the provider may submit a claim to Medi-Cal on the 91st day."]
["**","The Medi-Cal state plan covers some Specialty Mental Health services that a beneficiary’s Other Health Coverage (aka Commercial Insurance) does not cover. If the \"OHC COB Required\" column indicates \"No\", the corresponding service may be billed directly to Medi-Cal. See OHC Exempt Service Types Below.\nIf the \"OHC COB Required\"\" column indicates \"Yes\", the corresponding service may be covered by a beneficiaries OHC. This means that providers must submit a claim to a beneficiary’s other health coverage (aka Commercial Insurance) for eligible services before submitting a claim to Medi-Cal. Note: If the beneficiary’s OHC does not respond within 90 days, the provider may submit a claim to Medi-Cal on the 91st day.\n\nOHC Exempt Service Types:\n• Targeted case management (T1017)\n• Therapeutic behavioral services (H2019)\n• Therapeutic foster care (S5145)\n• H0025 or H0038: Peer Support Services\n• H2011 with Place of Service 15: Mobile Crisis\n• A0140, transportation mileage\n• T2007, transportation staff time"]
["SC","Supplemental codes cannot be billed independently. They are considered add-on codes that can only be billed with a (primary) procedure, on a separate service line. See the dependent on codes column for the list of primary codes this code can be billed with."]
["CM","This code is to be used for Case Management activities related to medical services ONLY. (e.g. Referring the client to a medical provider or following up with their medical appointment."]
["ADD","Add-on Codes: All Evaluation and Management (E/M) codes and standard Outpatient CPT codes, that do not have a dedicated add-on code to extend the service time, use G2212, as the add-on code. If a practitioner provides a service that exceeds the maximum time allowed for the series of evaluation and management codes, use G2212 to claim reimbursement for the additional time. \nFor example, CPT codes 99202-99205 are used to claim reimbursement for an office visit for a new patient. The maximum time that can be claimed with this series of codes is 74 minutes using CPT code 99205. If the provider sees a beneficiary for 89 minutes, the provider would bill 1 unit of 99205 for the first 74 minutes and  one unit of G2212 for the remaining 15 minutes.\nNote: See the G2212 dependent on codes column for the list of codes G2212 can be used with, as an add-on code, to extend the maximum time allowed. Also, use the G2212 (Group Srv.) code to extend the maximum time allowed for group procedure codes 90849, 90853 and H2017."]
["DEP","Dependent-on Codes: Procedure codes that must be provided to a client along with a primary procedure. The dependent service must be entered as its own unique service line, at the same time the primary service is entered to ensure proper Medi-Cal claiming. Note:  SD/MC will deny a service line with the primary procedure code if a Dependent on Code was not billed on the same claim or approved on the same day for the same beneficiary in history."]

{"sheet":"Additional Service Code List","index":2,"n_rows":84,"n_cols":6,"rows_kept":84,"cut":false,"hidden":false,"merged":[]}
["InSyst Proc Code","InSyst Proc Description",null," SmartCare Procedure Code ","Mode of Service","*Non-Billable Code (X)"]
["110","Local Inpatient Day CJ",null,"110 - Local Inpatient Day CJ ER","05 - (24-Hour Service)","X"]
["130","IMD Non-Contract Day",null,"130 - IMD Non Contract Day ER","05 - (24-Hour Service)","X"]
["131","IMD Day",null,"131 - IMD Day ER","05 - (24-Hour Service)","X"]
["132","IMD Day - No Patch",null,"132 - IMD Day No Patch ER","05 - (24-Hour Service)","X"]
["133","IMD Bed Hold Day",null,"133 - IMD Bed Hold Day ER","05 - (24-Hour Service)","X"]
["129","IMD Bed Hold Day-No Patch",null,"129 - IMD Bed Hold Day No Patch ER","05 - (24-Hour Service)","X"]
["136","SNF Intensive Bed Hold Day",null,"136 - SNF Intensive Bed Hold Day ER","05 - (24-Hour Service)","X"]
["191","MH REHABILITATION CENTER DAY",null,"191 - MH REHABILITATION CENTER DAY ER","05 - (24-Hour Service)","X"]
["199","MH REHAB CTR NON-CONTRACT DAY",null,"199 - MH REHAB CTR NON CONTRACT DAY ER","05 - (24-Hour Service)","X"]
["220","Crisis Stabilization CJ",null,"220 - Crisis Stabilization Criminal Justice","10 - (Day Services)","X"]
["261","SNF Augmentation Day",null,"261 - SNF Augmentation Day ER","10 - (Day Services)","X"]
["348","ALL COUNSELING CALWORKS",null,"348 - All Counseling CalWORKS ","15 - (Outpatient Services)","X"]
["349","SUD SERVICES CALWORKS",null,"349 - SUD Services CalWORKS ","15 - (Outpatient Services)","X"]
["358","Treatment/Disch Plan CalWORKs",null,"358 - Treatment/Disch Plan CalWORKs ","15 - (Outpatient Services)","X"]
["426","COMMUNITY/INDIV CONSULTATION",null,"426 - Community/Indiv Consultation ","45 - (Outreach Services)","X"]
["427","COMMUNITY/FAMILY CONSULTATION",null,"427 - Community/Family Consultation","45 - (Outreach Services)","X"]
["428","COMMUNITY/LINKAGE CONSULTATION",null,"428 - Community/Linkage Consultation","45 - (Outreach Services)","X"]
["429","OUTREACH WITH COLLATERAL",null,"429 - Outreach w/Collateral","45 - (Outreach Services)","X"]
["430","OUTREACH WITH BENEFICIARY",null,"430 - Outreach w/Beneficiary","45 - (Outreach Services)","X"]
["561","CM Linkage & Advocacy",null,"561 - CM Linkage & Advocacy","15 - (Outpatient Services)","X"]
["570","Brokerage Services IMD",null,"570 - Brokerage Services IMD","15 - (Outpatient Services)","X"]
["576","Brokerage/Case Mgmt CalWORKs",null,"576 - Brokerage/Case Mgmt CalWORKs","15 - (Outpatient Services)","X"]
["592","CO-OCCURRING MHS SUD TX",null,"592 - Co-Occurring MHS SUD TX","15 - (Outpatient Services)","X"]
["593","Non Claimable Brokerage",null,"593 - Non Claimable Brokerage","15 - (Outpatient Services)","X"]
["594","Non Claimable MHS Serv",null,"594 - Non Claimable MHS Serv","15 - (Outpatient Services)","X"]
["610","CONREP Annual Review",null,"610 - CONREP Annual Review","15 - (Outpatient Services)","X"]
["611","CONREP Home Visit",null,"611 - CONREP Home Visit","15 - (Outpatient Services)","X"]
[690,"CCRP Mobile Team Crisis Outreach (County only)",null,"690 - CCRP Mobile TM Crisis Outreach ","15 - (Outpatient Services)","X"]
["737","DR Employment Svcs-Individual",null,"737- DR Employment Svcs-Individual","15 - (Outpatient Services)","X"]
["807","CONREP Tox-Random Observed",null,"807 - CONREP Tox-Random Observed","15 - (Outpatient Services)","X"]
["808","CONREP Tox-Non-Random Observed",null,"808 - CONREP Tox-Non-Random Observed","15 - (Outpatient Services)","X"]
["809","CONREP Tox-Random Unobserved",null,"809 - CONREP Tox-Random Unobserved","15 - (Outpatient Services)","X"]
["810","CONREP Tox-Non-Rand Unobserved",null,"810 - CONREP Tox-Non-Rand Unobserved","15 - (Outpatient Services)","X"]
["400","No Show/Episode Admission",null,"400 - No Show/Episode Admission","45 - (Outreach Services)","X"]
["401","Mental Health Promotion",null,"401 - Mental Health Promotion","45 - (Outreach Services)","X"]
["402","Community/Client On Site",null,"402 - Community/Client On Site","45 - (Outreach Services)","X"]
["403","Community/Client Off Site",null,"403 - Community/Client Off Site","45 - (Outreach Services)","X"]
["404","Consultation To Organizations",null,"404 -Consultation To Organizations","45 - (Outreach Services)","X"]
["405","Community Services Other",null,"405 - Community Services Other","45 - (Outreach Services)","X"]
["423","PROGRAM SUPPORT HOUSING",null,"423 - Program Support Housing","45 - (Outreach Services)","X"]
["424","PROGRAM SUPPORT VOCATIONAL",null,"424 - Program Support Vocational","45 - (Outreach Services)","X"]
["425","PROGRAM SUPPORT EDUCATION",null,"425 - Program Support Education","45 - (Outreach Services)","X"]
["686","ENGAGEMENT CALWORKS",null,"686 -  Engagement CalWORKS","45 - (Outreach Services)","X"]
["502","Medi-Cal Eligibility Intake",null,"502 - Medi-Cal Eligibility Intake","55 - (MAA Services)","X"]
["504","Inform Elig About MC Services",null,"504 - Inform Elig About MC Services","55 - (MAA Services)","X"]
["505","Understand Need for MH Service",null,"505 - Understand Need for MH Service","55 - (MAA Services)","X"]
["506","Acceptance of MH Services",null,"506 - Acceptance of MH Services","55 - (MAA Services)","X"]
["508","Crisis Referral To MH Services",null,"508 - Crisis Referral To MH Services","55 - (MAA Services)","X"]
["514","Develop MC Provider Contracts",null,"514 - Recruit Medi-Cal Providers","55 - (MAA Services)","X"]
["515","Monitor MC Provider Contracts",null,"515 - Develop MC Provider Contracts","55 - (MAA Services)","X"]
["516","Monitor MC Provider Contracts",null,"516 - Monitor MC Provider Contracts","55 - (MAA Services)","X"]
["517","Provide Technical Assistance",null,"517 - Provide Technical Assistance","55 - (MAA Services)","X"]
["527","SPMP Gather Info Re:Health Nds",null,"527 - SPMP Gather Info Re:Health Nds","55 - (MAA Services)","X"]
["528","SPMP Assist Access To MC Svs",null,"528 - SPMP Assist Access To MC Svs","55 - (MAA Services)","X"]
["537","Non-SPMP Gather Info Health Nd",null,"537 - Non-SPMP Gather Info Health Nd","55 - (MAA Services)","X"]
["538","Non-SPMP Assist Access To MC",null,"538 - Non-SPMP Assist Access To MC","55 - (MAA Services)","X"]
["601","TECH AST TO CONT CBO PER REGS",null,"601 - TECH AST TO CONT CBO PER REGS","55 - (MAA Services)","X"]
["607","ID & RECRUIT CBO MCAL PROVIDER",null,"607 - ID & RECRUIT CBO MCAL PROVIDER","55 - (MAA Services)","X"]
["608","DEV&NEG MCAL PROV CONTRACTS",null,"608 - DEV&NEG MCAL PROV CONTRACTS","55 - (MAA Services)","X"]
["609","MONITOR MCAL PROV CONTRACTS",null,"609 - MONITOR MCAL PROV CONTRACTS","55 - (MAA Services)","X"]
["639","NON-SPMP PROG PLNG & DEVELOPMT",null,"639-  NON-SPMP PROG PLNG & DEVELOPMT","55 - (MAA Services)","X"]
["670","SPMP Utilization Review & QA",null,"670 - SPMP Utilization Review & QA","55 - (MAA Services)","X"]
["674","Non-SPMP Util Review & QA",null,"674 - Non-SPMP Util Review & QA","55 - (MAA Services)","X"]
["680","General Administration",null,"680 - General Administration","55 - (MAA Services)","X"]
["684","Program Planning & Development",null,"684 -Program Planning & Development","55 - (MAA Services)","X"]
["693","MAA ACTIVITY H",null,"693 - MAA ACTIVITY H","55 - (MAA Services)","X"]
["695","Paid Time Off",null,"695 - Paid Time Off","55 - (MAA Services)","X"]
["696","MAA AOD CONTRACT MGMT",null,"696- MAA AOD CONTRACT MGMT","55 - (MAA Services)","X"]
["697","MAA AOD OTHER",null,"697 - MAA AOD OTHER","55 - (MAA Services)","X"]
["698","MAA OTHER COMBINED",null,"698 - MAA OTHER COMBINED","55 - (MAA Services)","X"]
["699","Other Activity",null,"699 - Other Activity","55 - (MAA Services)","X"]
["621","Conservatorship Investigation",null,"621 - Conservatorship Investigation","60 - (Supportive Services)","X"]
["622","NON CLAIMABLE CLIENT SUPPORT",null,"622 - Non Claimable Client Support","60 - (Supportive Services)","X"]
["623","CLIENT SUPPORT HOUSING",null,"623 - Client Support Housing","60 - (Supportive Services)","X"]
["624"," Client Support Vocational",null,"624 - Client Support Vocational","60 - (Supportive Services)","X"]
["624","CLIENT SUPPORT VOCATIONAL",null,"625 - Client Support Education","60 - (Supportive Services)","X"]
["625","CLIENT SUPPORT EDUCATION",null,"784 - Voc-Program Plan & Development","60 - (Supportive Services)","X"]
["197","CG-INFORMATIONAL NOTE",null,"197 - CG Informational Note","ACBH CG Use","X"]
["198","CLINICIANS GATEWAY FSP ADMIN USE",null,"198 - Clinicians Gateway FSP Admin Use","ACBH CG Use","X"]
["300","No Show ",null,"300 - No Show ","N/A","X"]
["301","Cancellation",null,"301 - Cancellation ","N/A","X"]
[]
["* Codes that are not billable to any plan (e.g. Medi-Cal, Medicare, OHC). These are either tracking codes or service codes reimbursed by ACBH under alternative funding sources."]

{"sheet":"Disciplines","index":3,"n_rows":20,"n_cols":2,"rows_kept":20,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["SMHS DISCIPLINES"]
["Abbreviation","Discipline"]
["MD","Medical Doctor"]
["DO","Doctor of Osteopathy"]
["Pharm","General Pharmacist or Advanced Practice Pharmacist"]
["CNS","Clinical Nurse Specialist (Certified)"]
["NP","Nurse Practitioner"]
["RN","Registered Nurse"]
["LCSW","Licensed Clinical Social Worker (Licensed, Registered, or Waivered)"]
["LVN","Licensed Vocational Nurse"]
["OT","Occupational Therapist"]
["PCC","Professional Clinical Counselor  (Licensed or Registered)"]
["MFT","Marriage and Family Therapist  (Licensed, Registered, or Waivered)"]
["MHRS","Mental Health Rehabilitation Specialist"]
["PhD","Doctor of Philosophy, Clinical Psychologist (Licensed or Waivered)"]
["PsyD","Doctor of Psychology, Clinical Psychologist (Licensed or Waivered)"]
["PA","Physician Assistant"]
["Peer","Certified Peer Specialist"]
["PT","Psychiatric Technician"]
["Other","Other Qualified Provider"]

{"sheet":"Place of Service-Location Codes","index":4,"n_rows":51,"n_cols":4,"rows_kept":51,"cut":false,"hidden":false,"merged":[]}
["Place of\nService Code","Place of Service Name","Place of Service Description","ACBH SmartCare Tx Location"]
[1,"Pharmacy","A facility where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients.","Pharmacy"]
[2,"Telehealth Provided Other than in\nPatient’s Home’","The location, other than in patients home, where health services and health related services are provided or received, through a telecommunication system.","Phone (audio only) – Patient not at home or not present\nTelehealth (audio/video) – Patient not at home or not present"]
[3,"School","A facility whose primary purpose is education","School              "]
[4,"Homeless Shelter","A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters)","Homeless/ER Shelter "]
[5,"Indian Health Service Free-Standing Facility","A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization."]
[6,"Indian Health Service Provider-\nBased Facility","A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients."]
[7,"Tribal 638 Free-Standing Facility","A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non- surgical), and rehabilitation services to tribal members who do not require hospitalization."]
[8,"Tribal 638 Provider-Based Facility","A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non- surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients."]
[9,"Prison/Correctional Facility","A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State, or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.","Prison/Correctional Facility"]
[10,"Telehealth Provided in Patient’s Home","Health services and health related services are provided or received, through a telecommunication system in the patient’s home.","Phone (audio only) – Patient at home\nTelehealth (audio/video) – Patient at home"]
[11,"Office","Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis.","Office (Primary)       "]
[12,"Home","Location, other than a hospital or other facility, where the patient receives care in a private residence.","Patient's Home                "]
[13,"Assisted Living Facility","Congregate residential facility with self-contained units providing assessment of each resident’s needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services."]
[14,"Group Home","A residence with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial services, and minimal services (e.g., medication administration).","Group/Board and Care Home  "]
[15,"Mobile Unit","A facility/unit that moves from place to place equipped to provide preventive screening, diagnostic, and/or treatment services.","Crisis Mobile Unit-Service      "]
[16,"Temporary Lodging","A short-term accommodation such as a hotel, campground, hostel, cruise ship or resort where the patient receives care and which is not identified by any other Place of Service code.","Temporary Lodging        "]
[17,"Walk-in Retail Health Clinic","A walk-in retail clinic, other than an office, urgent care facility, pharmacy, or independent clinic and not described by any other Place of Service code that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services."]
[18,"Place of Employment-Worksite","A location, not described by any other Place of Service code, owned and operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic, or rehabilitative services to the individual.","Patient's Work Site   "]
[19,"Off Campus—Outpatient Hospital","A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization."]
[20,"Urgent Care Facility","Location, distinct from a hospital emergency room, an office or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.","Urgent Care Facility"]
[21,"Inpatient Hospital","A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and non- surgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.","Inpatient (Non-Psych) Hosp  "]
[22,"On-Campus Outpatient Hospital","A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and non- surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization."]
[23,"Emergency Room—Hospital","A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.","Emergency Room (Hospital)"]
[24,"Ambulatory Surgical Center","A freestanding facility, other than a physician’s office, where surgical and diagnostic services are provided on an ambulatory basis."]
[25,"Birthing Center","A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting for labor, delivery, and immediate postpartum care as well as immediate care of newborn infants."]
[26,"Military Treatment Facility","A medical facility operated by one or more of the Uniformed Services. Military Treatment Facility (MTF) also refers to certain U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF)."]
[31,"Skilled Nursing Facility","A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.","Skilled Nursing  Facility"]
[32,"Nursing Facility","A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities."]
[33,"Custodial Care Facility","A facility that provides room, board, and other personal assistance services, generally on a long-term basis, and which does not include a medical component.","Custodial Care Facility"]
[34,"Hospice","A facility, other than a patient’s home, in which palliative and supportive care for terminally ill patients and their families are provided.","Hospice"]
[41,"Ambulance—Land","A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured."]
[42,"Ambulance—Air or Water","An air or water vehicle specifically designed, equipped, and staffed for lifesaving and transporting the sick or injured."]
[49,"Independent Clinic","A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only."]
[50,"Federally Qualified Health Center","A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.","FQHC"]
[51,"Inpatient Psychiatric Facility","A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.","Inpatient (Psych) Hosp "]
[52,"Psychiatric Facility—Partial\nHospitalization","A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.","Psych Facility (Partial Hosp)"]
[53,"Community Mental Health Center\n(CMHC)","A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of CMHC’s mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services.","Comm Mental Health Center"]
[54,"Intermediate Care Facility/Individuals with Intellectual\nDisabilities","A facility, which primarily provides health-related care and services above the level of custodial care to individuals with intellectual disabilities but does not provide the level of care or treatment available in a hospital or SNF."]
[55,"Residential Substance Abuse\nTreatment Facility","A facility, which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.","Resid'l Substance Abuse Fac"]
[56,"Psychiatric Residential Treatment\nCenter","A facility or a distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment.","Psych Residential Tx Ctr (Adlt)\nPsych Residential Tx Ctr (Chld)"]
[57,"Non-residential Substance Abuse\nTreatment Facility","A location, which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Services include individual  and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing."]
[58,"Non-residential Opioid Treatment\nFacility","A location that provides treatment for opioid use disorder on an ambulatory basis. Services include methadone and other forms of Medication Assisted Treatment (MAT).","Outpat Substance Abuse Tx Fac\nOpioid (Non-Resid'l) Tx Facility"]
[60,"Mass Immunization Center","A location where providers administer pneumococcal pneumonia or influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting."]
[61,"Comprehensive Inpatient Rehabilitation Facility","A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetic services."]
[62,"Comprehensive Outpatient Rehabilitation Facility","A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Services include physical therapy, occupational therapy, and speech pathology services."]
[65,"End-Stage Renal Disease Treatment Facility","A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis."]
[71,"Public Health Clinic","A facility maintained by either State or local health departments that provide ambulatory primary medical care under the general direction of a physician.","Public Health Clinic"]
[72,"Rural Health Clinic","A certified facility, which is located in a rural medically underserved area, that provides ambulatory primary medical care under the direction of a physician."]
[81,"Independent Laboratory","A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office."]
[99,"Other Place of Service","Other place of service not identified above.","Field\nOffice (Satellite)\nCrisis Field\nHealth/Primary Care\nFaith Based\nLicensed Care\nOther Community Location\nCourt"]

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["Proc Code Column","Column Field Description"]
["ACBH SmartCare Tx Location","ACBH defined Location values that further describe where services are performed, which map to an associated POS code for claiming"]
["Add on Code (X)","An \"X\" in this column indicates the procedure code is an \"add on\" code to another code for extending the time of a service. Some service encounters may need to be claimed with two procedure codes, the primary code and an add-on code, to comply with the 'Maximum Units\" rule.\n \nSome services have a specific primary procedure code and a specific add-on code. For example, if 96170 (Health Behavior intervention, family (without the patient present), face-to-face. 16-30 minutes), takes 45 minutes, the claim would need to include 1 unit of procedure code 96170 for the first 30 minutes and 1 unit of procedure code 96171 (Health behavior intervention, family (without the patient present), face-to-face. Each additional 15 min.), for the remaining 15 minutes. \n\nAll evaluation and management codes and CPT codes that do not have a dedicated add-on code use G2212 as the add-on code. If a practitioner provides a service that exceeds the maximum time allowed for the series of evaluation and management codes, use G2212 to claim reimbursement for the additional time. For example, CPT codes 99202-99205 are used to claim reimbursement for an office visit for a new patient. The maximum time that can be claimed with this series of codes is 74 minutes using CPT code 99205. If the provider sees a beneficiary for 89 minutes, the provider would bill 1 unit of 99205 for the first 74 minutes and  one unit of G2212 for the remaining 15 minutes."]
["Allowable Place of Service","Location where the procedure/service is allowed to be rendered, per DHCS Short Doyle Medi-Cal standards. *See Place of Service tab for list of Place of Service Codes and corresponding Location codes."]
["Dependent on Codes","Identifies procedure codes that must be provided to a client along with a primary procedure. The dependent service must be entered as its own unique service line, at the same time the primary service is entered to ensure proper Medi-Cal claiming. Note:  SD/MC will deny a service line with the primary procedure code if a Dependent on Code was not billed on the same claim or approved on the same day for the same beneficiary in history."]
["InSyst Proc Code","InSyst Procedure Code Number"]
["InSyst Proc Description","InSyst Procedure Code Description"]
["Lockout Codes","Identifies procedure codes that should not be billed on the same day for the same beneficiary unless certain conditions are met. Procedure codes in this column are locked out for the corresponding procedure code in the \"Smart Care Procedure Code\" column, when provided to the same beneficiary on the same day, unless one of the codes is a \"Target\" code with an over-riding modifier. Target codes are identified by one or two asterisks (*). See DMC ODS Billing Manual for instructions on Target Codes and applicable overriding lock-out modifiers."]
["Maximum Units that Can be Billed","Maximum units the procedure code/service can be provided to a beneficiary in a 24 hour period. All codes will be billed in whole units. \n\nWhen selecting a CPT code, providers should follow the CPT Manual for instructions on how to bill each code using time. DHCS policy states that only direct patient care should be counted toward selection of time. Direct patient care does not include travel time, administrative activities, chart review, documentation, utilization review and quality assurance activities or other activities a provider engages in either before or after a patient visit. Some service encounters may need to be claimed with two procedure codes, the primary code and an add-on code, to comply with this rule."]
["Medicare COB  Required (Yes/No)","This column specifies whether a procedure, if rendered to a Medi-Medi beneficiary must first be claimed to Medicare before being submitted to Medi-Cal, if it is rendered by an eligible licensed provider (Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Clinical Social Worker, Occupational Therapist, or Clinical Psychologist) and the service does not carry an HL or GC modifier. If there is a \"Yes\" in the Column then the procedure must be submitted to Medicare first and providers must submit copies of the Coordination of Benefits (COB) to the ACBH Billing & Benefits Support Unit per the ACBH OHC Guidelines. If there is a \"No\" in the column or If the procedure/service was not provided by a licensed professional listed above, then it does not need to be submitted to Medicare first and can be billed directly to Medi-cal. "]
["Mode of Service","Identifies the DHCS categories of Mental Health service or activities"]
["Non-Billable Code (X)","Codes that are not billable to any plan (e.g. Medi-Cal, Medicare, OHC, etc.). These are either tracking codes or service codes reimbursed by ACBH under alternative funding sources"]
["OHC COB Required (Yes/No)","This column specifies whether a procedure must be claimed to a beneficiary’s other health coverage (OHC) for eligible services before submitting a claim to Medi-Cal.  If there is a \"Yes\" in the Column then the procedure/service must be submitted to the OHC first and providers must submit copies of the Coordination of Benefits (COB) to the ACBH Billing & Benefits Support Unit, per the ACBH OHC Guidelines. If there is a \"No\" in the column or if the procedure/service is an exempt code below, then the service does not need to be submitted to the OHC first and can be billed directly to Medi-cal. \nOHC Exempt Services inlcude:\n• Targeted case management (T1017)\n• Therapeutic behavioral services (H2019)\n• Therapeutic foster care (S5145)\n• H0025 or H0038: Peer Support Services\n• H2011 with Place of Service 15: Mobile Crisis\n• A0140, transportation mileage\n• T2007, transportation staff time"]
["Place of Service Code","The place of service (POS) is a two-digit code that designates where services are performed. The POS should match the setting in which the beneficiary received the service for face-to-face services, or the setting in which the technical portion of the service was delivered for non face-to-face services. DHCS uses the POS values maintained by the Centers for Medicare & Medicaid Services (CMS)  and used throughout the health care industry."]
["Place of Service Description","Description associated with the POS code"]
["Place of Service Name","Name associated with the POS code"]
["Procedure Code Description ","Procedure Code description"]
["SD/MC Allowable Disciplines","Disciplines that are allowed to provide the procedure/service per DHCS Short Doyle Medi-Cal standards. *See Disciplines tab for list of disciplines"]
["See \"Special Procedure Code Information\" table below","Table located at the bottom of each tab that describes specific or special information related to the corresponding procedure code"]
["Service Category","Describes each service type in accordance with the State Mental Health Plan: \nAssessment, Crisis, Medication Support, Mobile Crisis, Peer Support Services, Plan Development, Referral, Rehabilitation, Supplemental Services, Therapeutic, Therapy, Existing 24-Hour and Day Services. See DHCS Billing manual for desccription of each category."]
["Service Function Code","Identiifes the DHCS specific level or detail of Mental Health services within modes of service"]
["SmartCare Procedure Code ","Procedure Code used in the ACBH SmartCare system for the service"]
["SMHS Discipline","List of rendering providers/practitioners types allowed to provide Specialty Mental Health Services (SMHS) per DHCS guidelines, consistent with their education/licensure (scope of practice), length of experience and/or job description."]
["Standard Billing CPT or HCPC Code ","CPT or HCPC codes used to bill Medi-Cal, Medicare or OHC (Commercial Insurance) plans"]
["Time associated with Code (Mins) ","Minimum and maximum duration/time assoicated with the procedure code/service, per unit "]