| Service and Code | Medicaid | State | Scope of Work |
|---|---|---|---|
| ACT Step-Down (H0040 TS) | Alternative Service Description | N/A | |
| Ambulatory Detoxification (H0014) | Clinical Coverage Policy 8A | N/A | |
| Assertive Community Treatment Team (H0040) | Clinical Coverage Policy 8A-1 | State-Funded ACT Policy | Scope of Work |
| Assertive Engagement (YA323) | N/A | Alternative Service Definition | |
| BHUC (Behavioral Health Urgent Care -T2016 U5) | Service Definition | N/A | |
| Child and Adolescent Day Treatment (H2012 HA) | Clinical Coverage Policy 8A | State-Funded Enhanced MH and SA Services 2019 Effective 11/1/19 | |
| Clinical and Diagnostic Assessment (90791, 90792, T2013) | 90791 and 90792 Clinical Coverage Policy 8C T1023 Clinical Coverage Policy 8A | 90791 and 90792 Clinical Coverage Policy 8C T1023 N/A | - |
| Community Support Team (H2015 HT) | Clinical Coverage Policy 8A-6 | State-Funded Community Support Team (CST) 11-1-19 | Scope of Work |
| Community Transition-One-Time Transitional Costs (H0043 U4) | B3 Service Definition | N/A | Scope of Work |
| Criterion V (902) | Clinical Coverage Policy 8B | N/A | |
| Dialectical Behavior Therapy (DBT) (Individual YA386; Group YA387) | N/A | N/A | Scope of Work |
| Enhanced Therapeutic Foster Care (S5145 Z1) | N/A | N/A | Scope of Work |
| Evaluation and Management (multiple codes 99xxx) | Clinical Coverage Policy 8C | Clinical Coverage Policy 8C | |
| Facility-Based Crisis Program (S9484-Adult; S9484HA-Child) | Clinical Coverage Policy 8A (Adult) Clinical Coverage Policy 8A-2 (Child) | 2017 State-Funded Enhanced MH/SA Services | |
| Family Centered Treatment (H2022 U3 HE) | Alternative Service Definition | N/A | |
| Group Living (High-YP 780, Moderate-YP 770, Low-YP 760) | N/A | State-Funded Enhanced MH/DD/SA Service Definitions | |
| High Fidelity Wraparound Team (H0032 U3 Monthly; H0032 U3 Z1 Encounter) | In Lieu of Definition | ||
| Hospital Discharge Transition Service (YA346) | N/A | Alternative Service Definition | |
| IAFT (Intensive Alternative Family Treatment S5145 22 HA-IAFT) | N/A | N/A | Scope of Work |
| Individual Support (T1019 U4) | B3 Service Definition | N/A | |
| Inpatient Hospital Psychiatric Treatment-MH (RC100) | Clinical Coverage Policy 8B | N/A | |
| Inpatient Hospitalization (YP 820, YP 821) | N/A | Clinical Coverage Policy 8B | |
| Intensive In-Home Services (H2022) | Clinical Coverage Policy 8A | State-Funded Enhanced MH and SA Services 2019 Effective 11/1/19 | Scope of Work |
| Intercept (H0036 U3 HK) | N/A | N/A | Scope of Work |
| Level II Group Home (H2020) | Clinical Coverage Policy 8D-2 | N/A | |
| Level II Therapeutic Foster Care (S5145) | Clinical Coverage Policy 8D-2 | N/A | Scope of Work |
| Medication-Assisted Treatment-Buprenorphine (99212 22, 99213 22, 99214 22) | N/A | N/A | Scope of Work |
| Mobile Crisis Management (H2011) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | |
| Multisystemic Therapy (MST) (H2033) | Clinical Coverage Policy 8A | State-Funded Enhanced MH and SA Services 2019 Effective 11/1/19 | |
| Non-Hospital Medical Detoxification (H0010) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | |
| Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers | Clinical Coverage Policy 8C | Clinical Coverage Policy 8C | |
| Opioid Treatment (H0020) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | |
| Outpatient Plus (90837 U3 HE) | Alternative Service Description | N/A | |
| Parent Child Interaction Therapy-PCIT (90837 22 Z2) | Clinical Coverage Policy 8C | N/A | Scope of Work |
| Partial Hospitalization (H0035) | Clinical Coverage Policy 8A | N/A | |
| Peer Support (H0038, H0038HQ) | Clinical Coverage Policy 8G | N/A | |
| Physician Consultation (99241 U4, 99242 U4, 99244 U4) | B3 Service Definition | N/A | |
| Psychiatric Residential Treatment Facility (PRTF) (RC911) | Clinical Coverage Policy 8D-1 | N/A | |
| Psychological and Developmental Testing (Medicaid: 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96146; State: 96130, 96131, 96136, 96137, 96146) | Clinical Coverage Policy 8C | Clinical Coverage Policy 8C | |
| Psychosocial Rehabilitation (H2017) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | Scope of Work |
| Rapid Response (S5145 22 Z3) | Alternative Service Description | N/A | |
| Research Based Behavioral Health Treatment for Autism Spectrum Disorder | Clinical Coverage Policy 8F | N/A | |
| Residential Level I (H0046) | Clinical Coverage Policy 8D-2 | N/A | |
| Residential Level III-4 Or Less Beds (H0019 HQ) | Clinical Coverage Policy 8D-2 | N/A | |
| Residential Level III-5 Or More Beds (H0019 TJ) | Clinical Coverage Policy 8D-2 | N/A | |
| Residential Level IV-4 Beds Or Less (H0019 HK) | Clinical Coverage Policy 8D-2 | N/A | |
| Respite B3 (Individual H0045 U4, Group H0045 HQ U4) | B3 Service Definition | N/A | |
| Substance Abuse Comprehensive Outpatient Treatment Program (H2035) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | |
| SA Halfway House (H2034) | N/A | State-Funded Enhanced MH and SA Services 2019 Effective 11/1/19 | |
| Substance Abuse Intensive Outpatient Program (H0015) | Clinical Coverage Policy 8A | 2017 State-Funded Enhanced MH/SA Services | |
| Substance Abuse Medically Monitored Community Monitored Residential Treatment (H0013) | Clinical Coverage Policy 8A | N/A | |
| SA Medically Monitored Intensive Inpatient Detox (H2036) | Clinical Coverage Policy 8A | N/A | |
| Substance Abuse Non-Medical Community Residential Treatment (H0012 HB) | Clinical Coverage Policy 8A | N/A | |
| Supervised Living (Low-YP710, Moderate-YP720) | N/A | State-Funded Enhanced MH/DD/SA Service Definitions | |
| Supported Employment (H2023 U4 HE, H2026 U4 HE) | B3 Service Definition | N/A | |
| Supported Employment (State Funded YP630) | N/A | State Funded IPS-SE for AMH/SAS | |
| TF-CBT (90791 22 Z1, 90837 22 Z1) | Clinical Coverage Policy 8C | N/A | Scope of Work |
| Transition Management Services (YM130) | N/A | State Funded Transition Management Services | |
| COVID-19 SERVICES AND CODES | |||
| Residential Level II Group Home, (H2020) | COVID-19 Scope of Work | ||
| Residential Level III, Service Codes H0019 HQ and H0019 TJ | COVID-19 Scope of Work | ||
| Residential Level IV, Service Codes H0019 HK and H0019 UR | COVID-19 Scope of Work | ||
| Rapid Response, Service Code S5145 22 Z3 | COVID-19 Scope of Work | ||
| Psychiatric Residential Treatment Facility (PRTF), Service Code RC 911 | COVID-19 Scope of Work | ||
| Residential Level I, Family Type, Service Code H0046 | COVID-19 Scope of Work | ||
| Residential Level II, Family Type, Service Code S5145 | COVID-19 Scope of Work | ||
| Enhanced Therapeutic Foster Care, Service Code S5145 22 Z1 | COVID-19 Scope of Work | ||
| IAFT, Service Code S5145 22 HA | COVID-19 Scope of Work | ||
| IDD/MH Therapeutic Foster Care, Service Code S5145 22 Z2 | COVID-19 Scope of Work | ||
| PSR During Disaster H2017 U5 | COVID In-Lieu of Service Definition | ||
| Day Treatment During Disaster H2012 HA 22 | COVID In-Lieu of Service Definition |
Page last modified: January 15, 2021
