CPT code and Description
H0001 Alcohol and/or drug assessment
H0004 Behavioral health counseling and therapy (15 min)
H0002 Behavioral health screening to determine eligibility for admission to treatment program
H0005 Alcohol and/or drug services; group counseling by a clinician
H0046 Mental Health Services, Not Otherwise Specified (60 Min)
H0047 Alcohol and/or other drug abuse services, not otherwise specified
Billing Guidelines
CPT H0046- Direct communications with the client and/or collaterals designed to help an enrolled individual attain goals as prescribed in his/her individual service plan. Usage is limited to medically necessary contacts less than 10 minutes that cannot otherwise be reported elsewhere. (Excludes: reminder (non-therapeutic) phone calls, listening to voice mails, e-mails)
For example, a clinician providing a half-hour of individual psychotherapy may code the service as 90832 (Psychotherapy, 30 min with patient and/or family member). If, however, the client leaves after 10 minutes, coding 90832 for that service would not meet fidelity for that code. It would not only be difficult to contend that insight-oriented, behavior modifying or supportive psychotherapy had been provided during such a short time, and CPT guidelines specifically require a minimum of 16 minutes for the use of this code. The service could be coded and reported using H0046, “Mental Health Services Not Otherwise Specified,” which can be reported in minutes. See Individual Treatment services modality for H0046 usage limitations.
CPT H0047 – Direct communications with the client and/or collaterals designed to help an enrolled individual attain goals as prescribed in his/her individual service plan. (Excludes: reminder (non-therapeutic) phone calls, listening to voice mails, e-mails) For Medicaid funded services, this service may only be provided by a CDP or CDPT.
If H0046 (Mental health services, not otherwise specified) is provided for 9 minutes, report 9 minutes.
If H0047 (Alcohol and/or other drug abuse services, not otherwise specified) is provided for 7 minutes, report 7 minutes.
CPT H0001 – Must be doneface-to-face. Provider type – 20-Chemical Dependency Professional 21-Chemical Dependency Professional Trainee
CPT H004 – 10 Minutes minimumfor first unit – Provider type – 20-Chemical Dependency Professional 21-Chemical Dependency Professional Trainee. 01-RN/LPN 02-ARNP/PA 03-Psychiatrist/MD 04-MA/Ph.D. 05-Below Masters Degree 09-Bachelors Level w/Exception Waiver 10-Master Level w/Exception Waiver.
Reimbursement Guidelines from UHC insurance
Documentation maybe reviewed for appropriate coding, existence of a more appropriate code, coverage, reimbursement allowance and prior notification if needed. Unlisted codes that do not have documentation will be denied.
Texas
Documentation and review not needed for:
** 99429,State requires providers to bill unlisted code 99429 whenproviding dental varnish
** A4335 when billed with an U9 modifier
** H0046when billed by an FQHC for Texas MMP
** H0046 when billed for Texas Chip, Star Kidsand Star Plus** B9998 when billed with modifiers U1-U5
SUBSTANCE ABUSE PROCEDURE CODES
H0001 Alcohol and/or drug assessment – means the evaluation of an individual by a clinician to determine the presence, nature, and extent of substance use disorder with the goal of formulating a plan for services (if such services are offered) and treating the client in the most appropriate treatment environment.
H0003 Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs – means the laboratory testing of client specimens to detect the presence of alcohol and other drugs.
H0005 Alcohol and/or drug services; group counseling by a clinician – means services provided by a clinician to assist two or more individuals and/or their families/significant others to achieve treatment objectives through the exploration of substance use disorders and their ramifications, including an examination of attitudes and feelings, and considering alternative solutions and decision making with regard to alcohol and other drug related problems.
H0006 Alcohol and/or drug services; case management – means services provided to link individuals to, or to assist and support clients in gaining access to or to develop their skills for gaining access to needed medical, social, educational and other services essential to meeting basic human needs, as appropriate; to train the individual in the use of basic community services; and to monitor treatment progress and overall service delivery.
H0007 Alcohol and/or drug services; crisis intervention (outpatient) – means a face-to-face response to a crisis or emergency situation experienced by an individual, family member and/or significant others related to substance use disorders.
H0008 Alcohol and/or drug services; sub-acute detoxification (hospital inpatient) – means face-to-face interactions with an individual for the purpose of medically managing and monitoring withdrawal symptoms from alcohol and/or drug addiction in a hospital with appropriate accreditation, certification, and licensure, staffed with a registered nurse on the premises twenty-four hours per day and a licensed physician on call twenty-four hours per day. Detoxification services must be supervised by a licensed physician.
Q:Will UnitedHealthcare reimburse more than one presumptive and/or one definitive drug test on the same date of service if a modifier is appended?
A:No, each of the presumptive and definitive drug codes define a single manual or automated laboratory service that is reported once per day, per patient,irrespective of the number of Drug Classes, sample validations, or Specimen Validity Testsperformed related to that service on any date of service. In accordance with the CPT and CMS guidelines UnitedHealthcare will not reimburse more than one presumptive and/or one definitive drug test per dayregardless of the number of billing providers.
Presumptive Codes
H0003 Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs(The H codes are used by those state Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services that include alcohol and drug treatment services.)
Prenatal and Postnatal Psychosocial Counseling
Psychosocial evaluation is provided as a prenatal and postnatal service to identify members and families with high psychological and social risks, to develop a psychosocial care plan and provide or coordinate appropriate intervention, counseling or referral necessary to meet the identified needs of each family.
Counseling may be provided by one of the following licensed Medicaid providers:
** Licensed Clinical Social Worker
** Clinical Psychologist
** Marriage and Family Therapist
The service is reported using HCPCS H0046 Mental Health Services, Not Otherwise Specified. Limited to twelve (12) visits during any 12-month period.
