Covered and Noncovered Services : Outreach and Case Management Services

Procedure Codes

Outreach and case management providers may seek Medicaid reimbursement when either targeted or non-targeted outreach has been provided that results in a comprehensive HealthCheck screen by either the same agency or an outside screener such as a physician clinic. Assisting the member in scheduling follow-up appointments to the screen is included in the reimbursement for the case management.

Covered HealthCheck outreach and case management services are identified by the following allowable HCPCS procedures codes:

• T1017 — Targeted outreach case management, each 15 minutes
• T1016 — Outreach case management, each 15 minutes

Providers may bill up to 4.0 units of outreach and targeted outreach case management services with each comprehensive HealthCheck screen.