Tuesday, August 9, 2016


Assessment H0031 $93.00 Per service 

Description - Mental health assessment, by non-physician
Place of Service where its performed - 03, 12, 13, 31, 32, 53, 99
Service Limits -  Daily 1 service, Yearly 4 service

Eligible service providers  - Aide, Assistant, Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS), Counselor Trainee (CT), Doctor of Osteopathic Medicine (DO), Independent Marriage & family Therapist (IMFT), Independent Social Workers (ISW/ISW-S)

Eligible service supervisors - Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS),  Doctor of Osteopathic Medicine (DO), Independent Marriage & family Therapist (IMFT), Independent Social Workers (ISW/ISW-S)

As you submit new and renewing treatment plans for your Anthem members, beginning with dates of service January 1, 2014, please request ABA services using H0031, H0032, H2012, H2019 & H2014. For dates of service prior to January 1, 2014, Anthem will continue to process claims with the previously approved CPT codes until December 31, 2013. If you have authorized treatment plans dating after January 1, 2014, we will contact you to change the authorized CPT codes for those plans to the new H codes.  A schedule of the new codes and their maximum allowable amounts, effective for dates of service on and after January 1, 2014, will be available online, at our secure provider portal, on or after December 1, 2013.

 Effective January 1, 2014, the only codes payable to ABA will be H0031, H0032, H2012, H2019 & H2014. All other codes will be denied.

Any services provided under a current authorization should be billed to match that authorization, except for authorized dates of service on or after January 1, 2014, which we will change to H codes with your assistance. Requests for concurrent reviews and/or new authorizations will reflect the coding changes and should be billed to match what is authorized. Coding other than what is reflected in an authorization for ABA services should not be billed and is not covered.

H0031 Service Definition 

Mental Health Assessment by non-physician (Behavioral Health Assessment and Initial Treatment Plan)

Assessment is an integrated series of procedures conducted with an individual to provide the basis for the development of an effective, comprehensive and individualized treatment plan. It is an intensive clinical and psychosocial evaluation of an individual’s mental health and/or co-occurring (mental health/substance abuse) conditions which results in an issuance of an integrated written document. This service may be conducted by an individual or by a multidisciplinary team and includes face-to-face interview contacts with the individual; and may include the individual’s family and/or significant others, collateral contacts and other agencies to determine the individual’s problems and strengths, to identify the disability(ies), and to identify natural supports.

An initial treatment plan, including discharge criteria and/or treatment recommendations is included as part of the assessment.

Billing and coding Guide

Authorized practitioners:

ƒ Bachelor’s degree in human servicesrelated field and a combination of relevant education, training, and experience totaling four years; or ƒ LADAC; or ƒ Masters Degree in human servicesrelated field.

NOTE: Completed assessment must be signed and dated by staff completing the assessment and, as appropriate, a masters level supervisor.

Special Instructions:
 DOH will use for all individuals. ƒ For DOH school-based, use modifier TR.
ƒ CYFD will use for mental health assessment to determine eligibility for services. Use modifier HA.
ƒ HSD/Medicaid will use this code for PSR only. Use modifier U8.
ƒ For multi-disciplinary team, use modifier HT. ƒ For substance abuse assessment, use modifier HF. ƒ For substance abuse/mental health assessment, use modifier HH

H0031/2 - Initial Assessment and Plan Development Performed by masters/doctorallevel provider

Magellan provides authorizations for the Initial FBA and plan development using H0031 code (1-hour increments) or H0032 code (15-minute increments).

For continued services, Magellan provides the authorization in units of 15-minute increments:

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