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Sheet 1: Applied Behavior Analysis
| E/M codes for mental health include 99201-99255; 99281-99285; 99304-99337; 99341-99350. Providers utilizing E/M codes may also bill mental health procedure codes listed in this fee schedule as listed in the Current Procedural Terminology (CPT) Code List and contained in this fee schedule. |
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| Chapter 410, Division 172 - Medicaid Behavioral Health Rules | Except for 97151, all ABA codes require PA. Find PA forms and instructions on the KEPRO website. | ||||||
| BCBA, BCaBA and BAI certification requirements | |||||||
| * Legislatively approved providers of ABA are listed in Senate Bill 696 Section 1 (2)(a-h). Also see OAR 824-010-0005 (13). | |||||||
| Code | Description | Rate | Unit | Required modifiers | Allowed modifiers | Rendered by | Managed through |
| 97151 | Behavior identification assessment and plan of care, each 15 minutes | $12.50 | 15 MINUTES | BCBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | RR | ||
| 97153 | Behavior treatment by protocol administered by technician, each 15 minutes | $11.00 | 15 MINUTES | GT | BCBA, BCaBA, BAI, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 97154 | Group behavior treatment by protocol administered by technician, each 15 minutes, per recipient | $10.00 | 15 MINUTES | GT | BCBA, BCaBA, BAI, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 97155 | Behavior treatment with protocol modification administered by physician or other qualified health care professional, each 15 minutes | $12.50 | 15 MINUTES | GT | BCBA, BCaBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 97156 | Family behavior treatment guidance administered by qualified health care professional, each 15 minutes, single family | $13.00 | 15 MINUTES | GT | BCBA, BCaBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 97157 | Family behavior treatment guidance administered by qualified health care professional, 15 minutes, per family | $6.50 | 15 MINUTES | GT | BCBA, BCaBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 99366 | Medical team conference with patient and/or family, and nonphysician health care professionals, 30 minutes or more | $25.66 | 30 MINUTES | GT | BCBA, BCaBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA | |
| 99368 | Medical team conference with nonphysician health care professionals, 30 minutes or more | $22.08 | 30 MINUTES | XE | GT | BCBA, BCaBA, Physician, Psychologist, legislatively approved licensed healthcare professional* | PA |
| E/M codes for mental health include 99201-99255; 99281-99285; 99304-99337; 99341-99350. Providers utilizing E/M codes may also bill mental health procedure codes listed in this fee schedule as listed in the Current Procedural Terminology (CPT) Code List and contained in this fee schedule. |
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| Chapter 410, Division 172 - Medicaid Behavioral Health Rules | Chapter 309 Division 19 - Outpatient Addictions and Mental Health Services Rules | |||||||
| Find PA forms and instructions on the KEPRO website. | ||||||||
| Code | Description | Rate | Unit | Required modifiers | Allowed modifiers | Rendering provider types | Managed through | |
| 90785 | Interactive complexity code | $10.00 | PER SERVICE | HK,GT | LMP | RR | ||
| 90791 | Psychiatric diagnostic evaluation | $95.43 | PER SERVICE | HK,GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90792 | Psychiatric diagnostic evaluation with medical services | $140.94 | PER SERVICE | HK,GT | LMP | RR | ||
| 90832 | Psychotherapy, 30 minutes with patient and/or family member | $66.53 | 30 MINUTES | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90832 | Psychotherapy, 30 minutes with patient and/or family member | $70.47 | 30 MINUTES | HK,GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90833 | Psychotherapy, 30 minutes with patient and/or family member when performed with an E/M service | $66.53 | 30 MINUTES | HK,GT | LMP | RR | ||
| 90834 | Psychotherapy, 45 minutes with patient and/or family member | $99.73 | 45 MINUTES | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90834 | Psychotherapy, 45 minutes with patient and/or family member | $98.11 | 45 MINUTES | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90836 | Psychotherapy, 45 minutes with patient and/or family member when performed with an E/M service | $99.73 | 45 MINUTES | HK | GT | LMP | PA | |
| 90836 | Psychotherapy, 45 minutes with patient and/or family member when performed with an E/M service | $98.11 | 45 MINUTES | GT | LMP | RR | ||
| 90837 | Psychotherapy, 60 minutes with patient and/or family member. | $144.41 | 60 MINUTES | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90837 | Psychotherapy, 60 minutes with patient and/or family member. | $166.31 | 60 MINUTES | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90838 | Psychotherapy, 60 minutes with patient and/or family member when performed with an E/M service | $144.41 | 60 MINUTES | GT | LMP | RR | ||
| 90838 | Psychotherapy, 60 minutes with patient and/or family member when performed with an E/M service | $166.31 | 60 MINUTES | HK | GT | LMP | PA | |
| 90839 | Psychotherapy for crisis, first 60 minutes | $155.01 | 60 MINUTES | GT, HK | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90840 | Psychotherapy for crisis (each additional 30 minutes) - list separately in addition to primary service CPT code. | $70.47 | 30 MINUTES | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90846 | Family Psychotherapy (without the patient present) | $92.69 | PER SERVICE | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90846 | Family Therapy (without patient present) | $135.20 | PER SERVICE | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90847 | Family Psychotherapy (with the patient present) | $115.49 | PER SERVICE | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90847 | Family Psychotherapy (with the patient present) | $135.20 | PER SERVICE | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90849 | Multiple-family group psychotherapy | $37.38 | PER SERVICE | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | |||
| 90849 | Multiple-family group psychotherapy | $45.09 | PER SERVICE | HK | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | ||
| 90853 | Group psychotherapy | $35.13 | PER SERVICE | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90853 | Group psychotherapy | $45.09 | PER SERVICE | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 90882 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions. | $62.94 | PER SERVICE | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | |||
| 90882 | Environmental intervention for medical management purposes on a psychiatric patient’s behalf with agencies, employers, or institutions | $90.14 | PER SERVICE | HK | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA | PA | ||
| 90887 | Consultation with family - Explanation of psychiatric, medical examinations, procedures, and data to other than patient. | $65.96 | PER SERVICE | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| 90887 | Consultation with family - Explanation of psychiatric, medical examinations, procedures, and data to other than patient. | $90.14 | PER SERVICE | HK | GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| 96130 | Psychological testing evaluation by qualified health care professional, first 60 minutes | $91.19 | 60 MINUTES | LMP, psychologist | RR | These are all correct | ||
| 96131 | Psychological testing evaluation by qualified health care professional, additional 60 minutes | $91.19 | 60 MINUTES | LMP, psychologist | RR | |||
| 96132 | Neuropsychological testing, interpretation, and report by psychologist or physician, first 60 minutes | $88.44 | 60 MINUTES | GT | LMP, psychologist | RR | ||
| 96133 | Neuropsychological testing, interpretation, and report by psychologist or physician, additional 60 minutes | $88.44 | 60 MINUTES | GT | LMP, psychologist | RR | ||
| 96136 | Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes | $45.60 | 30 MINUTES | LMP, psychologist | RR | |||
| 96137 | Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes | $45.60 | 30 MINUTES | LMP, psychologist | RR | |||
| 96150 | Health and Behavior assessment each 15 minutes | $18.55 | 15 MINUTES | LPC, LMFT, LCSW, psychologist | RR | |||
| 96151 | Health and behavior re-assessment each 15 minutes. | $18.02 | 15 MINUTES | LPC, LMFT, LCSW, psychologist | RR | |||
| 96152 | Health and behavior intervention, individual each 15 minutes. | $17.21 | 15 MINUTES | LPC, LMFT, LCSW, psychologist | RR | |||
| 96153 | Health and behavior intervention, group each 15 minutes. | $4.03 | 15 MINUTES | LPC, LMFT, LCSW, psychologist | RR | |||
| 96154 | Health and behavior intervention, family and patient each 15 minutes. | $16.94 | 15 MINUTES | LPC, LMFT, LCSW, psychologist | RR | |||
| 99211 | Established patient office or other outpatient visit, typically 5 minutes | $13.50 | 5 MINUTES | HK | GT | LMP, RN | PA | |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | $17.17 | 45 MINUTES OR MORE | HK | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | PA | ||
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | $18.11 | 45 MINUTES OR MORE | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | |||
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | $18.17 | 45 MINUTES OR MORE | GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | this cost has been updated to reglect the current AMH Mental Health allowed amount in MMIS | |
| G0177 | Training and educational services related to the care and treatment of patient’s disabling mental health problems per session (45 minutes or more) | $17.17 | 45 MINUTES OR MORE | HK | GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | PA | |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | $23.86 | 15 MINUTES | GT | LPC,LMFT, LCSW, psychologist, QMHP | RR | ||
| H0004 | Behavioral health counseling and therapy, per 15 minutes | $22.47 | 15 MINUTES | HK | GT | LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| H0031 | Mental health assessment, by non-physician. | $95.43 | PER SERVICE | GT | LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| H0031 | Mental health assessment, by non-physician | $90.14 | PER SERVICE | HK | GT | LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| H0032 | Mental health service plan development by non-physician. | $95.43 | PER SERVICE | GT | LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| H0032 | Mental health service plan development by non-physician. | $95.43 | PER SERVICE | HK | GT | LPC, LMFT, LCSW, psychologist, QMHP | PA | |
| H0034 | Medication training and support, per 15 minutes. | $16.88 | 15 MINUTES | LMP, RN | RR | |||
| H0034 | Medication Training/Support, per 15 min | $22.47 | 15 MINUTES | HK | LMP, RN | #REF! | ||
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes. | $8.44 | 15 MINUTES | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | |||
| H0036 | Community psychiatric supportive treatment, face to face, per 15 min | $7.97 | 15 MINUTES | HK | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA | PA | ||
| H0039 | Assertive community treatment, face-to-face, per 15 minutes. | $26.20 | 15 MINUTES | HK, GT | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | ||
| H0046 | Home Based and Behavioral Habilitation 60 minutes. Modifier HW is used, along with HK, only when an individual has been approved for the HCBS 1915 (i) plan. | $27.50 | 60 MINUTES | HK, HW | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist, Community Habilitation Provider | PA | ||
| H2000 | Child and Adolescent Needs Survey (CANS) | $95.00 | PER SERVICE | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | |||
| H2000 | Mental health assessment, by non-physician with CANS. | $140.00 | PER SERVICE | TG | LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| H2010 | Comprehensive medication services, per 15 min | $23.75 | 15 MINUTES | HK | LMP, RN | PA | ||
| H2010 | Comprehensive medication services, per 15 min | $23.86 | 15 MINUTES | LMP, RN | RR | |||
| H2014 | Skills training and development, per 15 min | $16.88 | 15 MINUTES | HK | LMP, LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | ||
| H2018 | Psychosocial Rehabilitation Services, per diem | $93.47 | PER DIEM | GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | ||
| H2018 | Psychosocial Rehabilitation Services, per diem. | $125.00 | PER DIEM | HK | GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | |
| H2023 | Supported Employment, per 15 min | $16.88 | 15 MINUTES | HK,GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | ||
| H2023 | Supported Education, per 15 min | $16.88 | 15 MINUTES | HK,GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | ||
| H2032 | Activity therapy, per 15 min | $8.44 | 15 MINUTES | HK | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | ||
| H2033 | Multi-systemic therapy for juveniles, per 15 min | $23.86 | 15 MINUTES | LPC, LMFT, LCSW, psychologist, QMHP | RR | |||
| J1631 | Haloperidol decanoate injection | $18.67 | PER SERVICE | HK | LMP, RN | RR | this cost has been updated effective 4/1/18 to $17.57 | |
| J2794 | Injection, Risperidone, long acting, 0.5 mg | $5.98 | PER SERVICE | HK | LMP, RN | RR | this cost has been updated effectiver 4/1/18 to $8.98 | |
| T1016 | Case management, per 15 min | $21.69 | 15 MINUTES | HK, GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA, Certified Peer Support Specialist | RR | ||
| T1023 | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter | $95.43 | PER SERVICE | GT | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | RR | ||
| T1023 | Level of Care / Level of Service Assessment for Residential Treatment | $89.00 | PER SERVICE | HK | LPC, LMFT, LCSW, psychologist, QMHP, QMHA | PA | ||
| T2010 | Preadmission screening and resident review (PASSR) Level I identification screening, per screen | $176.86 | PER SERVICE | GT | LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| T2011 | Preadmission screening and resident review (PASSR) Level II evaluation, per evaluation | $619.00 | PER SERVICE | GT | LPC, LMFT, LCSW, psychologist, QMHP | RR | ||
| E/M codes for mental health include 99201-99255; 99281-99285; 99304-99337; 99341-99350. Providers utilizing E/M codes may also bill mental health procedure codes listed in this fee schedule as listed in the Current Procedural Terminology (CPT) Code List and contained in this fee schedule. |
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| Chapter 309 Division 35 - Requirements for OHA-Licensed Mental Health Residential Facilities | Facilities: See the OHA Prior Authorization Handbook for PA instructions and forms | ||||
| Chapter 309 Division 40 - Requirements for OHA-Licensed Adult Foster Homes | Adult Foster Homes: Find PA and POC forms and instructions on the KEPRO website. | ||||
| Chapter 410, Division 172 - Medicaid Behavioral Health Rules | |||||
| Code | Description | Rate | Unit | Required modifiers | Managed through |
| H0017 | Behavioral health, residential (hospital residential treatment program), without room and board, per diem | $126.13 | PER DIEM | TN | RR |
| H0019 | PRTS | $600.00 | PER DIEM | RR | |
| H0019 | Behavioral health, long term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days) without room and board, per diem | $126.13 | PER DIEM | TN | RR |
| H0037 | Community psychiatric supportive treatment program, per diem | $144.47 | PER DIEM | RR | |
| H0045 | Respite care services, not in the home, per diem | $660.00 | PER DIEM | HK | PA |
| H2013 | Psychiatric health facility service, per diem | $350.23 | PER DIEM | HK | PA |
| H2013 | Psychiatric health facility service, per diem | $700.00 | PER DIEM | RR | |
| H2016 | Comprehensive community support services, per diem | $195.01 | PER DIEM | HK | PA |
| S5141 | Personal Care Services, Adult Foster Home, per month | Cost Based Rate | PER MONTH | HK | PA |
| S5141 | Habilitation Services, Adult Foster Home, per month. Modifier HW is used, along with HK, only when an individual has been approved for the HCBS 1915 (i) plan. | Cost Based Rate | PER MONTH | HK, HW | PA |
| S5146 | Foster care, therapeutic, child; per month | $2,538.63 | PER MONTH | RR | |
| T1019 | Personal care, in a residential treatment program, per 15 minute units. Modifier HW is used, along with HK, only when an individual has been approved for the HCBS 1915 (i) plan. | Cost Based Rate | PER DIEM | HK, HW | PA |
| T1020 | Personal Care Services, in OHA licensed Residential Treatment Home, per diem. | Cost Based Rate | PER DIEM | HK | PA |
| T1020 | Personal Care Services, in a Secure Residential Treatment Home or Facility, per Diem. | Cost Based Rate | PER DIEM | HK, TG | PA |
| T1020 | Personal Care Services, in a Residential Treatment Facility, per diem. | Cost Based Rate | PER DIEM | HK, HE | PA |
| T1020 | Home Based and Behavioral Habilitation services, in Residential Treatment Facility or Home, per diem. Modifier HW is used, along with HK, only when an individual has been approved for the HCBS 1915 (i) plan. | Cost Based Rate | PER DIEM | HK, HW | PA |
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