A HCPCS code is required on all CSP claims submitted on the 1500 Health Insurance Claim Form. A list of services that professional level providers may perform and a list of staff qualifications is available. Providers should refer to the mental health and substance abuse maximum allowable fee schedule for maximum allowable fees.
These procedure codes represent 15 minutes of service. Rounding guidelines are available.
The following tables list the HCPCS code and modifier that providers are required to use when requesting PA and submitting claims for CSP services and clozapine management. Not all providers may be reimbursed for all substance abuse services.
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Community Support Program Procedure Codes and Modifiers for an Individual Session |
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HCPCS Code |
Description |
Enrolled Providers Who May Perform Service |
Modifiers |
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Professional Level Modifier (Required) |
Information Modifier (Optional) |
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| H0039 | Assertive community treatment, face-to-face, per 15 minutes | Psychiatrist | UA | U5 — Used when transitioning the member from a nursing home to a hospital. |
| Doctoral level | HP | |||
| APNP/MH specialty | UB | |||
| Masters degree level | HO | |||
| Masters degree level RN | HO and TD | |||
| Bachelors degree level | HN | |||
| Bachelors degree level RN | HN and TD | |||
| Less than bachelor degree level | HM | |||
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Community Support Program Procedure Codes and Modifiers for a Group Session |
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HCPCS Code |
Description |
Enrolled Providers Who May Perform Service |
Modifiers |
|
|
Professional Level Modifier (Required) |
Information Modifier (Optional) |
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| H0039 | Assertive community treatment, face-to-face, per 15 minutes | Psychiatrist | U4 | U5 — Used when transitioning the member from a nursing home to a hospital. |
| Doctoral level | U3 | |||
| APNP/MH specialty | U4 | |||
| Masters degree level | U2 | |||
| Masters degree level RN | U2 | |||
| Bachelors degree level | U1 | |||
| Bachelors degree level RN | U1 | |||
| Less than bachelor degree level | Not allowed | |||
| HCPCS Code | Description | Program Modifier Code | Allowable ICD-9-CM Diagnosis Codes Allowed | Telehealth Services Covered? |
| H0034 | Medication training and support, per 15 minutes | UD* — Clozapine Management | 295.10-295.95 | No |
| * | This includes all components of clozapine management services. |