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Medicaid B - Evaluation and Management (E and M) and Medication Assisted Treatment (MAT)
About
Coverage
Medicaid B
Diagnosis Group(s)
All, Assessment Only, Developmental Disability, Mental Health, Substance Use
Age Group(s)
18, 18-20, Adult, All, Child
Authorization
Submission Requirements
- Service Authorization Request (SAR)
Service Definition Authorization Parameters
Evaluation and Management (E and M)
- 22 unmanaged visits per state fiscal year
- Prior approval required beyond unmanaged benefit
Medication Assisted Treatment (MAT)
- Prior Approval required beyond benefit maximum of 30 visits per fiscal year
Authorization Guidelines
Locus Level
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Calocus Level
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ASAM Level of Care
ALL
Service Codes & Descriptions
- 99205 - E & M High, New Patient
- 99212 25 E & M
- Add on code for E&M
- 90838GT - Psychotherapy add on to E & M
- 90838 GT CR- Psychotherapy add on to E & M
- 99211 25E&M established patient
- 99213 25 E&M
- 99214 25 E&M
- 99215 25 E&M
- 99282 25 ed visit
- 99347 - home visit for the evaluation and management of an established patient, which
- 99202 - E & M Expanded, New Patient
- 99202 GT - E & M Expanded, New Patient
- 99202 GT CR - E & M Expanded, New Patient
- 99203 - E & M Detailed, New Patient
- 99203 GT - E & M Detailed, New Patient
- 99203 GT CR - E & M Detailed, New Patient
- 99204 - E & M Moderate, New Patient
- 99204 GT - E & M Moderate, New Patient
- 99204 GT CR - E & M Moderate, New Patient
- 99205 GT - E & M High, New Patient
- 99205 GT CR - E & M High, New Patient
- 99324 - domiciliary or rest home visit for the evaluation and management of a new
- 99325 - domiciliary or rest home visit for the evaluation and management of a new
- 99326 - domiciliary or rest home visit for the evaluation and management of a new
- 99327 - domiciliary or rest home visit for the evaluation and management of a new
- 99328 - domiciliary or rest home visit for the evaluation and management of a new
- 99341 - home visit for the evaluation and management of a new patient, which requires
- 99342 - home visit for the evaluation and management of a new patient, which requires
- 99343 - home visit for the evaluation and management of a new patient, which requires
- 99344 - home visit for the evaluation and management of a new patient, which requires
- 99345 - home visit for the evaluation and management of a new patient, which requires
- 90836 - Psychotherapy - 45 Minute Add on to E&M
- 90836 CR - Psychotherapy - 45 Minute Add on to E&M
- 90836 GT - Psychotherapy 45 mins
- 90836 GT CR - Psychotherapy 45 mins
- 90838 - Psychotherapy - 60 Minutes Addon to E&M
- 90838 CR - Psychotherapy - 60 Minutes Addon to E&M
- 99212 GT CR - E & M Expanded, Estab Patient
- 99211 - E&M Minimum, Estab Patient
- 99211 GT - E&M Minimum, Estab Patient
- 99211 GT CR - E&M Minimum, Estab Patient
- 99212 - E & M Expanded, Estab Patient
- 99212 GT - E & M Expanded, Estab Patient
- 99213 - E & M Detailed, Estab Patient
- 99213 GT - E & M Detailed, Estab Patient
- 99213 GT CR - E & M Detailed, Estab Patient
- 99214 - E & M Moderate, Estab Patient
- 99214 GT - E & M Moderate, Estab Patient
- 99214 GT CR - E & M Moderate, Estab Patient
- 99215 - E & M High Estab Patient
- 99215 GT - E & M High Estab Patient
- 99215 GT CR - E & M High Estab Patient
- 99283 25 ER moderate
- 99283 GT - er moderate
- 99284 25 er visit, high severity
- 99285 25 - emergency department visit for the evaluation and management of a patient,
- 99305 - initial nursing facility care, per day, for the evaluation and management of
- 99306 - initial nursing facility care, per day, for the evaluation and management of a
- 99307 - subsequent nursing facility care, per day, for the evaluation and management of
- 99308 - subsequent nursing facility care, per day, for the evaluation and management of
- 99309 - subsequent nursing facility care, per day, for the evaluation and management of
- 99310 - subsequent nursing facility care, per day, for the evaluation and management of
- 99315 - nursing facility discharge day management; 30 minutes or less
- 99316 - nursing facility discharge day management; 30 minutes or less more than 30
- 99318 - evaluation and management of a patient involving an annual nursing facility
- 99334 - domiciliary or rest home visit for the evaluation and management of an
- 99335 - domiciliary or rest home visit for the evaluation and management of an
- 99336 - domiciliary or rest home visit for the evaluation and management of an
- 99337 - domiciliary or rest home visit for the evaluation and management of an
- 99348 - home visit for the evaluation and management of an established patient, which
- 99349 - home visit for the evaluation and management of an established patient, which
- 99350 - home visit for the evaluation and management of an established patient, which
- 99354 - prolonged physician service in the office or other outpatient setting requiring
- 99355 - prolonged physician service in the office or other outpatient setting requiring
- 99356 - prolonged physician service in the inpatient setting, requiring direct
- 99357 - prolonged physician service in the inpatient setting, requiring direct
- 99291 - critical care, evaluation and management of the critically ill or critically
- 99212 22 - Medication Assisted Treatment Expanded
- 99212 22 GT - Medication Assisted Treatment Expanded
- 99212 22 GT CR- Medication Assisted Treatment Expanded
- 99213 22 - Medication Assisted Treatment, Detailed
- 99213 22 GT - Medication Assisted Treatment, Detailed
- 99213 22 GT CR- Medication Assisted Treatment, Detailed
- 99214 22 Medication Assisted Treatment, Moderate
- 99214 22 GT Medication Assisted Treatment, Moderate
- 99214 22 GT CR Medication Assisted Treatment, Moderate
Full Service Definition
Alliance Statement of Work
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