Mcare-mcaid no prior auth codes 11 26 13.xls

MHNet NO Prior Authorization Required Service Codes
PROCEDURE CODES NOT REQUIRING AUTHORIZATION TO BE PAYABLE, PER BENEFIT
Until 1/1/14, this applies to all members, all products.
EFFECTIVE 1/1/14: this applies to MEDICARE/MEDICARE
ADVANTRA & MEDICAID PRODUCTS ONLY!
Description
Comments
Psychiatric diagnostic evaluation (without medical services) Psychiatric diagnostic evaluation (with medical services) Crisis psychotherapy, each additional 30 minutes (in-home service)medication management, ONLY for prescribing psychologists who Altius Health Plan still requires auth. Requires a BH diagnosis Altius Health Plan still requires auth. Requires a BH diagnosis Altius Health Plan still requires auth. Requires a BH diagnosis Altius Health Plan still requires auth. Requires a BH diagnosis Altius Health Plan still requires auth. Requires a BH diagnosis Pays 1/day authorized on stay. Psych testing requires separate auth Pays 1/day authorized on stay. Psych testing requires separate auth Pays 1/day authorized on stay. Psych testing requires separate auth Pays 1/day authorized on stay. Psych testing requires separate auth MHNet NO Prior Authorization Required Service Codes
Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill MHNet NO Prior Authorization Required Service Codes
For Maryland Medicaid and KY Medicaid ONLY
INJECTION, ARIPIPRAZOLE (Abilify), INTRAMUSCULAR, 0.25 MG Only available for prescribing providers to bill Only available for prescribing providers to bill INJECTION, NALTREXONE (Vivitrol), DEPOT FORM, 1 MG Only available for prescribing providers to bill INJECTION, HALOPERIDOL, DECANOATE, PER 50 MG Only available for prescribing providers to bill Only available for prescribing providers to bill INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE, 1 MG Only available for prescribing providers to bill INJECTION, FLUPHENAZINE, DECANOATE, UP TO 25 MG Only available for prescribing providers to bill INJECTION, RESPIRADONE, LONG ACTING, 0.5MG Only available for prescribing providers to bill Only available for prescribing providers to bill INJECTION, TRIFLUPROMAZINE, HCL, UP TO 20MG Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Only available for prescribing providers to bill Medicaid products ONLY
THE FOLLOWING CODES CANNOT BE ACCOMMODATED W/MODIFIER ONLY AND ARE USED EXCLUSIVELY FOR FLORIDA MEDICAID
Modifier
Description
Bio-psychosocial Evaluation (Bachelor's level) The following services are billable only when the appropriate ICD-9 CM diagnosis code
(290 through 290.43, 293 through 298.9, 302.7, 306.51 through 312.4 and 312.81 through 314.9, 315.3, 315.31, 315.5, 315.8, and 315.9) has been documented:
HCPCS
Modifier
Description
In-Depth Assessment Substance Abuse (Master's Level) Bio-psychosocial evaluation Substance Abuse (Bachelor's level) Limited Functional Assessment Substance Abuse Behavioral Health Screening Service Substance Abuse THE FOLLOWING CODES/MODIFIERS ARE USED FOR KENTUCKY MEDICAID
CPT/HCPCS
Modifier
Description
"add-on" code for interactive complexity when performed WITH office Psychiatric Diagnostic Interview, invalid code as of 1.1.13 Any, psychiatric diagnostic evaluation (without medical services) Formerly 90801, new CPT code, effective 1.1.13 Any, psychiatric diagnostic evaluation (with medical services) Formerly 90801, new CPT code, effective 1.1.13 First 3 sessions per member ONLY--Individual Psychotherapy, invalid code as of 1.1.13
First 3 sessions per member ONLY, formerly 90804, new CPT code, effective 1.1.13
Pharmacologic Management, invalid code as of 1.1.13 MHNet NO Prior Authorization Required Service Codes
Informing Family of Psych Med Exam Results Alcohol and/or Drug Services; case management Behavioral Health Prevention Education Service Alcohol or Drug Abuse Services, not otherwise specified DELETIONS
99221-99239 (IP pro fees) removed, claims will pay when IP fac day is auth'd.
99324-99350 (domiciliary and home services) removed, as the location is the member's home. Many codes became invalid with CPT book changes.

Source: http://www.mhnet.com/web/groups/public/@cvty_regional_mhnet/documents/webcontent/c109374.pdf