For Dates of Service On and Before December 31, 2018

Procedure Codes

Use of CPT procedure codes and applicable modifiers is required on all behavioral treatment claims. Claims or claim adjustments received without an appropriate CPT code and corresponding modifier will be denied. The maximum allowable fee schedule indicates maximum allowable fees and copayment rates.

The following table lists CPT codes and applicable modifiers that providers are required to use when requesting PA and submitting claims for behavioral treatment services. Information on PA coding guidance and procedure codes for claims when commercial health insurance is the primary payer is available.

Note: ForwardHealth is required to comply with the CMS NCCI standards. If NCCI standards change, ForwardHealth will comply with the updated standards.

Behavioral Treatment Procedure Codes

Procedure Code	Procedure Code Description	Required Modifier	Renderer	*National NCCI and CPT Coding Guidelines (Note:* Subject to industry change.)**	Required Documentation	PA Limits
0359T	Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/ caregiver(s), and preparation of report.	TG (comprehensive) or TF (focused)	Licensed supervisor	This code is considered a single unit of service regardless of the number of hours or days required to complete the assessment. The DOS is reported as the date the assessment is completed.	Time in/time out Names of staff and caregiver(s) present POS Assessment report POC Renderer's signature	PA required for assessment of member more than one time per six months per provider.
0360T	Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient	TG or TF	Licensed supervisor or treatment therapist	Do not report less than 16 minutes of face-to-face technician time (subject to CPT Time-Rule for face-to-face technician time). Includes time spent by physician or other qualified health care professional involved in technician tasks which is considered technician time. Only the time of one technician is reported when more than one is in attendance.	Time in/time out Names of staff and caregiver(s) present POS Assessments completed Renderer's signature	PA required for assessment of member more than two months after 0359T service date.
0361T	Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the patient (List separately in addition to code for primary service)	TG or TF	Licensed supervisor or treatment therapist	Add-on code that must be used in conjunction with 0360T. Do not report less than 16 minutes of face-to-face technician time (subject to CPT Time-Rule for face-to-face technician time).	Time in/time out Names of staff and caregiver(s) present POS Assessments completed Renderer's signature	PA required for assessment of member more than two months after 0359T service date.
0364T^*	Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time.	TG, TF, or TF–52^**	Any level of behavioral treatment provider for comprehensive and focused.		Time in/time out Names of staff and caregiver(s) present POS Goals addressed Data collected regarding goals Renderer's signature	PA required
0365T^*	Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; each additional 30 minutes of technician time (List separately in addition to code for primary procedure)	TG, TF, or TF–52^**	Any level of behavioral treatment provider for comprehensive and focused.	Add-on code that must be used in conjunction with 0364T.	Time in/time out Names of staff and caregiver(s) present POS Goals addressed Data collected regarding goals Renderer's signature	PA required
0368T^*	Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time.	TG or TF	Licensed supervisor or treatment therapist		Time in/time out Names of staff and caregiver(s) present Narrative description of observations, changes implemented or feedback provided, and outcome of changes/feedback Renderer's signature	PA required
0369T^*	Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional with one patient; each additional 30 minutes of patient face-to-face time (List separately in addition to code for primary procedure)	TG or TF	Licensed supervisor or treatment therapist	Add-on code that must be used in conjunction with 0368T.	Time in/time out Names of staff and caregiver(s) present Narrative description of observations, changes implemented or feedback provided, and outcome of changes/feedback Renderer's signature	PA required
0370T	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) [Family Treatment Guidance]	TG or TF	Licensed supervisor	This is not a time-based service. The service is face to face with parent or caregiver. Member is not present.	Length of meeting, including time in and time out Names of the licensed supervisor and family members or caregivers who were present Measurable family goals addressed Information collected from family Information shared with family Update of family goals resulting from the family treatment guidance session Renderer's signature	PA required
0370T	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) [Team Meeting]	AM (Physician, team member service) in addition to modifier TG or TF	Licensed supervisor or treatment therapist	This is not a time-based service. The service is face to face with parent or caregiver. Member is not present.	Length of the meeting Name of the parents, caregivers, and team members who were present Learning objectives that were targeted Outcome of the learning objectives Goals resulting from the meeting Renderer's signature	PA required

^*	To simplify the PA submission process, providers may request all direct treatment units for CPT codes 0364T, 0365T, 0368T, and 0369T by including the cumulative total of requested treatment units as a single line item, using a single code (0365T). Direct treatment units submitted on claims using any of these CPT codes will be deducted from the cumulative total of approved treatment units.
^**	Modifier TF–52 must be appended to prior authorization requests and claims when the services provided meet the level of focused treatment that can be rendered by technicians.