CENPATICO AMERIGROUP OPTUM SERVICE TYPE CPT CODE/UNIT Fax 1-866-694-3649 Fax 1-800-505-1193 Fax 1-855-268-9392 INFORMATION Phone 1-866-896-7293 Phone 1-800-454-3730 Phone 1-855-802-7095 LIFETIME LIMITS LIFETIME LIMITS LIFETIME LIMITS No limits Peer Support CPT Code – H0038 1000 units (250 hours) 250 hours Unit = 15 minutes Units authorized after initial units will be in 150 unit increments. Crisis Intervention CPT Code – H2011 288 units per episode No limits Re-evaluation by QMHP every Unit = 15 minutes 72 hours Difference between MCOs Maximum 96 units per day Requires evaluation by QMHP Re-evaluation by QMHP every 72 hours must be documented Susan Nay to provide though Amerigroup does NOT definition of an episode. need to be notified. Psychosocial Rehabilitation CPT Code – H2017 3000 units (750 hours) 3000 units (750 hours) 3000 units (750 hours) Individual/Group – Child/Adult Unit = 15 minutes Extension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units. TCM CPT Code – T1017 60 units per quarter* 48 units (12 hours) in the first 3 96 units Unit = 15 minutes (As of 5/8/13, with the first months (As of 1/1/14) Difference between MCOs quarter starting 4/1/13) Extension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units. No limits Case Conference CPT Codes – 99366, 99367, 32 units 32 units & 99368 Unit = Visit Maximum 1 unit per day Attendant Care 1915 (b) 3 CPT Code – T1019 2000 units No limits 2000 units Unit = 15 minutes *If units exceed initial units authorized per quarter, an OTR would need to be submitted. Otherwise, units will automatically renew each quarter without an OTR.
SERVICE TYPE CPT CODE/UNIT INFORMATION CENPATICO Fax 1-866-694-3649 Phone 1-866-896-7293 LIFETIME LIMITS AMERIGROUP Fax 1-800-505-1193 Phone 1-800-454-3730 LIFETIME LIMITS OPTUM Fax 1-855-268-9392 Phone 1-855-802-7095 LIFETIME LIMITS Peer Support CPT Code – H0038 Unit = 15 minutes 1000 units (250 hours) Units authorized after initial units will be in 150 unit increments. No limits 250 hours Crisis Intervention Difference between MCOs CPT Code – H2011 Unit = 15 minutes Maximum 96 units per day 288 units per episode Requires evaluation by QMHP Susan Nay to provide definition of an episode. No limits Re-evaluation by QMHP every 72 hours must be documented though Amerigroup does NOT need to be notified. Re-evaluation by QMHP every 72 hours Psychosocial Rehabilitation Individual/Group – Child/Adult CPT Code – H2017 Unit = 15 minutes 3000 units (750 hours) 3000 units (750 hours) Extension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units. 3000 units (750 hours) TCM Difference between MCOs CPT Code – T1017 Unit = 15 minutes 60 units per quarter* (As of 5/8/13, with the first quarter starting 4/1/13) 48 units (12 hours) in the first 3 months Extension spreadsheet can be used to extend timeframe of auth. if units are still available though timeframe of auth. is close to expiration. Otherwise an OTR is necessary to request additional units. 96 units (As of 1/1/14) Case Conference CPT Codes – 99366, 99367, & 99368 Unit = Visit Maximum 1 unit per day 32 units No limits 32 units Attendant Care 1915 (b) 3 CPT Code – T1019 Unit = 15 minutes 2000 units No limits 2000 units *If units exceed initial units authorized per quarter, an OTR would need to be submitted. Otherwise, units will automatically renew each quarter without an OTR.
Summary-of-Initial-Units-Authorized-040814.ACMHC_.docx