Information For Dates of Service On and After October 1, 2015

Procedure Codes

The following table lists the HCPCS or CPT procedure codes and modifiers that providers are required to use when submitting claims for intensive in-home mental health and substance abuse treatment services for children.

Procedure Codes for Intensive In-Home Mental Health and Substance Abuse Treatment Services for Children

HCPCS/CPT Code	Description	Program Modifier Code	Enrolled Providers Who May Perform Service	Service Modifier Code	ICD Diagnoses Allowed*	Allowable POS Codes	Telehealth Services Covered?
H0004	Behavioral health counseling and therapy, per 15 minutes	HA Child/adolescent program	Less than bachelor degree level	HM	F07.0–F09, F20–F69, F90.0–F99	04, 12, 99	Yes (use "GT" modifier)
			Bachelors degree level	HN
			Masters degree level	HO
			Doctoral level	HP
			QTT	U6
			Psychiatrist	UA
H0022	Alcohol and/or drug intervention service (planned facilitation) (60 minutes)	HA Child/adolescent program	Less than bachelor degree level	HM	F10–F19.99, F55.0–F55.8	04, 12, 99	Yes (use "GT" modifier)
			Bachelors degree level	HN
			Masters degree level	HO
			Doctoral level	HP
			Psychiatrist	UA
T1006	Alcohol and/or substance abuse services, family/couple counseling (60 minutes) (This code should be used only when the primary diagnosis is alcohol or drug abuse related.)	HA Child/adolescent program	Less than bachelor degree level	HM	F10–F19.99, F55.0–F55.8	04, 12, 99	Yes (use "GT" modifier)
			Bachelors degree level	HN
			Masters degree level	HO
			Doctoral level	HP
			Psychiatrist	UA
99082	Unusual travel (eg, transportation and escort of patient) (60 minutes)	HA Child/adolescent program	Less than bachelor degree level	HM	F07.0–F69, F80–F82, F88–F99	99**	No
			Bachelors degree level	HN
			Masters degree level	HO
			Doctoral level	HP
			QTT	U6
			Psychiatrist	UA

The list of allowable ICD diagnosis codes for intensive in-home mental health and substance abuse treatment services is inclusive. However, not all Medicaid-covered intensive in-home mental health and substance abuse treatment services are appropriate or allowable. Professional consultants base approval of services on a valid diagnosis, acceptable intensive in-home mental health and substance abuse treatment practice, and clear documentation of the probable effectiveness of the proposed service. Federal regulations do not allow federal funding of rehabilitation services, such as child/adolescent day treatment or intensive in-home or outpatient mental health and substance abuse services, for persons with a sole or primary diagnosis of a developmental disability or intellectual disability. Approval of services is based on a valid diagnosis, acceptable intensive in-home mental health and substance abuse treatment practice, and clear documentation of the probable effectiveness of the proposed service.

When submitting claims with procedure code 99082, always use POS code "99." This code should also be used when the service is provided in any place other than the home or homeless shelter and explained in the clinical information.