Data Sources State of Wisconsin Reporting Requirements Program Participation System PPS Required of all programs that receive State or Federal funding Mental Health PPS MH PPS AODA PPS AODA PPS ID: 670063
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Slide1
CARS PPS/NOMS
Data CollectionSlide2
Data Sources
State of Wisconsin Reporting Requirements: Program Participation System (PPS)
Required of all programs that receive State or Federal fundingMental Health PPS (MH PPS)AODA PPS (AODA PPS)National Outcomes Measurement System (NOMS)CARS Program Evaluation
2Slide3
The CARS PPS Bundles
The PPS Modules that must be completed will be different depending on the type of service you are providing
Providers of clinical and care management services will complete one set of PPS forms – “Clinical Providers”Providers of ancillary services will complete a briefer set of PPS forms – “Ancillary Providers”
3Slide4
The PPS Bundle
MUST
Be Collected in Provider ConnectWhy?There are forms available for modification in PCONN which are not available in AvatarBecause of its connection to Avatar, completion of the PPS Bundle in PCONN will actually reduce the number of steps required to complete the bundle.
Not every provider has access to Avatar, and we would like all providers to use the same processes, if they are available to them
Use of PCONN eliminates the possibility of attaching the PPS Bundle to the wrong episode of care, a mistake which is possible in Avatar
4Slide5
The CARS PPS Bundles – By Service Type
*Please refer to CPT to SPC Crosswalk at the end of this
ppt
to determine if the service you are providing is “Clinical” or “Ancillary”
** The Demographics and
CARS Client Change/Update
should be reviewed for accuracy at every PPS administration
5Slide6
Completing the CARS PPS Bundles: By Client Type
Primary Mental Health Clients
Demographics/CARS Client
Change/Update
State
of Wisconsin MH PPS
State
of Wisconsin General PPS
CARS PPS/NOMS
Supplemental*
Select “Mental Health” for the Primary Diagnosis
Primary AODA Clients
Demographics/CARS Client Change/Update
State
of Wisconsin AODA PPS
State of Wisconsin General PPS
CARS PPS/NOMS
Supplemental*
Select “AODA” for the Primary Diagnosis
Both AODA and MH Clients
Demographics/CARS Client Change/Update State of Wisconsin MH PPS**State of Wisconsin AODA PPSState of Wisconsin General PPSCARS PPS/NOMS Supplemental*Select “Mental Health and AODA” for the Primary Diagnosis
* These apply only to providers of “clinical” services**Currently, clients who are both MH and AODA should fill the most applicable State PPS module, based on the client’s presenting issue (they should only complete one)
6Slide7
The CARS Bundle
In order for data in the forms to properly carry forward, the forms should be completed in the order listed on the previous two slides. For example:
7Slide8
Why All Five Forms?
There are unique items captured in each form that are not captured in the other
Some of the data is required for State reporting requirementsE.g., MH PPS for mental health services, vice versaCo-occurring disorders are extremely prevalent in our populationIt is critical to provide uniform data on all our clients and is consistent with best practices for clients with co-occurring mental health and addictive disorders
Some of the data from the Demographics form carries forward to the Admissions
form, which then carries forward to the PPS General form
8Slide9
How often should the bundle be collected?
At intake, discharge, and every 6 months as applicable
Example 1: 22 month length of stayExample 2: 4 month length of stay
9Slide10
The Forms
: Some Horribly Important Considerations
Throughout this presentation, required items, regardless of their text color are denoted with a red starWe ask that you fill out all the items on the forms to the best of your ability. Although some of these items may not be required for submission of PPS data to the state, they are vitally important to BHD internal evaluation processes
,
including assessment of the performance of agencies which contract with BHD.
Other items on these forms are used to update the client’s basic demographic and financial information in Avatar
10Slide11
The Forms in the Bundle
11Slide12
The Demographics and CARS Client Change/Update Forms (Update Form)
12Slide13
The Demographics and Update Forms
As noted above, you must complete the Demographics and Update forms if there are changes to any of the following variables
If there are no changes to any of the variables below, you may simply review and submit the Demographics and Update forms
– your data from the Admissions form in Avatar will pre-fill the PPS General form
1.
Name
2. DOB
3. Gender
4. SS#
5. Street
Address
6. City
7. Zip
8. State
9. County
10. Phone #
11. Education
12. Employment
13. Financial Eligibility
13Slide14
The Demographics Form
Please make any necessary updates to these fields. If there are no updates, you may submit the form as is. The Demographics form should be pre-populated.
Pay special attention to these fields. It is critical that you update these fields if there are changes to them. These fields will carry forward to the PPS General Form and are used in our outcomes reporting.
14Slide15
The Update Form
Please make any necessary updates to this form. If you check “Yes” to any of the items below, it will enable the text/number boxes associated with these items. If there are no changes, simply review and submit.
15Slide16
The Demographics and Update Forms
T
he Demographics and Update forms must be completed and submitted before opening any other PPS forms in the bundleThis is because some of the data from the Demographics form updates data in the Admission form in Avatar
Thus, if you complete your updates to the Demographics and Update forms, you will not have to re-enter this specific data in the PPS General form
16Slide17
Demographics and Update Forms –
Relationship to Other FormsSlide18
The Demographics and Update Forms
Completing the Demographics and Update forms will enable providers to provide client demographic updates to BHD
without having to print out, fill out, and submit the paper version of the “CARS Client Change/Update Form” to the Fiscal Dept. via fax
Which will hopefully make things more efficient for you!!!
All the data required to update demographic and fiscal data will be obtained from the Demographics, Update, and PPS General forms
18Slide19
The State of Wisconsin PPS General Form
19Slide20
PPS Forms: Some Horribly Important Considerations
Any time you complete a PPS form, you must “ADD” a new form. The only time you will “EDIT” an existing PPS form is when you are completing a PPS form you began, but did not complete.
WITHIN EPISODES, all PPS data will “carry forward,” or pre-populate the new PPS form that you add. However, you will need to review the pre-populated data and update any fields that reflect a change in the client’s status.
20Slide21
PPS Forms: Some Horribly Important Considerations
The PPS forms must completed based on your knowledge of the client’s status during your last contact with her/him
If you have not had enough contact with a client subsequent to her/his admission to your services, please utilize one of the “Unknown” response options or refer to the data collected during the CARS intake process (the CARS Comprehensive Assessment, the CARS Comprehensive Assessment Results and Placement form, etc.)
21Slide22
The State of Wisconsin General PPS Module
This will be the date you completed the PPS assessment. So, if you assess the client at intake and complete the PPS data set a week later, use the intake date. This is particularly important for any PPS data sets you are completing retrospectively.
You will not need to enter this
Please make sure to complete these
Please refer to CARS Referral Form
Remember, some of these fields will be pre-filled from the demographics form. Make sure to review all for accuracy
22Slide23
Race
For Race, you may enter up to 5
According to the MH Handbook for PPS, “American Indian or Alaskan Native” should be used for “All persons having origins in any of the original people of North, South, and Central America”; “White” should be used for “All persons having origins in any of the original peoples of Europe, North Africa or the Middle East
.”
Please be sure to further designate if they are “Hispanic/Latino”, which is reserved for “All persons of Mexican, Puerto Rican, Cuban, Central or South American, or another Spanish culture or origin, regardless of race.”
Thus, a client who is from Mexico and considers himself Latino, but who traces his ancestors back to Spain, would be coded as “White” for Race and “Yes” for Hispanic/Latino
23Slide24
Employment – Some Clarifications
9 Not
in the labor force - jail, correctional or other institutional facilityIncludes inpatient facility, Mental Health Institutions (e.g., Winnebago), and nursing homes as “other institutional facilities
”
10 Not
in the labor force - sheltered non-competitive
employment
Remunerative employment or other occupational rehabilitating activity of an educational or therapeutic
nature (e.g., Goodwill)
12 Supported
competitive
employment
Competitive employment with ongoing long-term support to structure the job or work environment
(e.g.,
the consumer and their employer are actively supported by a CSP
team, Clubhouse Employment).
24Slide25
Employment, More Clarifications and Stuff
In order for a client to be classified as “unemployed – looking for work,” they need to have been seeking employment in the last 30 days
Clients who may be able to work but who have not been looking for work within the last 30 days should be categorized with one of the “Not in Labor Force” designationsIf a client has multiple types of employment, they should be prioritized in the following order:1.
Employment
2.
Unemployed
(but looking for work)
3.
Not
in the labor force
25Slide26
Living Arrangement – Some Clarifications
Private residence or household (Adults
only)Includes adults living alone or with others without supervision in a house or apartment; includes persons age 18 and older living with parents.
Supported
residence (Adults
only)
A
dult
clients living in a house, apartment, or other similar dwelling and are heavily dependent on others for daily living
assistance (e.g., a supported apartment, but not a CBRF).
Supervised
licensed residential
facilityThis level of care may include a group home, therapeutic group home, board and care, residential treatment, rehabilitation center, or agency‐operated residential care
facilities (e.g., an AODA residential treatment center, MH CBRF).
26Slide27
Living Arrangement – Some Clarifications
Crisis stabilization home/center
A time‐limited residential (24 hours/day) stabilization program that delivers services for acute symptom reduction and restores clients to a pre‐crisis level of functioning (e.g., Crisis Respite House).
Institution setting, hospital, or nursing home
As above in Employment section, includes
inpatient facility, Mental Health Institutions (e.g., Winnebago), and nursing homes as “other institutional facilities”
27Slide28
A Quick Word About SPC Codes
O
n the bottom of both the MH and AODA PPS forms is a section entitled, “SPC Codes”It is vitally important that you select the appropriate SPC code for the services you are providing in this sectionPlease submit all potential SPC codes you might use for a given episode of care, even if you don’t provide all those services in that episode.
Leaving this section blank will result in an underreporting to the State of the services Milwaukee County is providing
A CPT to SPC Code crosswalk is provided for every service at the
end of this PowerPoint
More information about how to complete the SPC Code section is provided at the end of the MH and AODA PPS sections, respectively
28Slide29
CCS – A Special Case
Because all CCS agencies use 510.10 as an SPC Code, only the Care Coordination agency which provides service facilitation services should complete the PPS Bundle for a CCS client
If, for example, a provider is supplying individual counseling as part of CCS, then unless that provider is also the Care Coordinator for that CCS client, she/he should not complete the PPS Bundle for that clientHowever, any individual counseling services supplied by that provider to any clients who are
not
CCS clients will necessitate a PPS Bundle for each client
29Slide30
The State of Wisconsin PPS MH Form
30Slide31
The State of Wisconsin MH PPS Module
Date the episode was opened.
Date the Referral form was started. Should be the same date as the start date of the CARS episode.
If the BRC Target Population is “High Intensity” or “Low Intensity” then the Report Date is required. The Report Date is “The date on which the Consumer Status outcomes and functional indicators are assessed with the consumer”.
The BRC Target Population Update is required every 6 month update and/or discharge
These fields are not required for successful PPS submission, but are required for CARS evaluation purposes
31Slide32
The State of Wisconsin MH PPS Module
Please refer to the CPT-SPC code crosswalk at the end of this PowerPoint to determine the SPC Code(s) applicable to the services you provide
The date the first and last SPC-
codeable
service provided, respectively
This field is not required for successful PPS submission, but is required for CARS evaluation purposes
These need to be completed at the discharge from a given SPC service
32
Only required at dischargeSlide33
The State of Wisconsin MH PPS Module
BRC Target Population (Blue Ribbon Commission)
This is an overall clinical assessment of client’s current service needsRequired as part of the Governor’s Blue Ribbon Commission Report and Federal Mental Health Block Grants
H – Persons
in need of ongoing, high intensity, comprehensive services
L – Persons
in need of ongoing, low intensity services
S – Persons
in need of short-term situational services
33Slide34
BRC Code Crosswalk from SAIL to Wiser Choice
BRC Code
Possible Top ASAM
Domain 8 Only
Score
Potential Level of Care – SAIL
Potential Level of Care – WC
H: Persons in need of ongoing, high intensity, comprehensive services
2.5-4.0
Community Based Residential Facility
Community Support Program
Comprehensive Community Services
Community Recovery Services
Targeted Case Management (Level I)
Recovery Support Coordination
L: Persons in need of ongoing, low intensity services
1.0-2.5
Comprehensive Community Services
Targeted Case Management (Level II and AODA)
Recovery Support Coordination
Case Management
S: Persons in need of short-term situational services
0.0-1.5
Targeted Case Management (Level II
)
Treatment Services
Case
Management
Treatment
Services
Please click
here
for a more extensive description of these BRC Codes
34Slide35
The State of Wisconsin MH PPS Module
Other Considerations
Only one Client Characteristic needs to be selected, but you are encouraged to select up to three, in descending order of need/relevance
Most of these characteristics are self-explanatory, but more in-depth explanations of all the codes can be found on page 48 of the PPS MH Module Handbook
Only one
Presenting Problem
needs to be selected, but you are encouraged to select up to three, in descending order of need/relevance
35Slide36
The State of Wisconsin MH PPS Module
Other Considerations
Commitment StatusInvoluntary civil - a person committed for a non-criminal proceeding whether for purposes of examination and observation or for treatment, either by a physician’s certificate, a court proceeding, or police or related
agencies
Involuntary criminal
- a person committed pursuant to one of the following:
charges
and/or convictions pending, determination of
competency
to stand
trial
found
“not guilty by reason of insanity” or “guilty but insane”
transfers
from correctional
institutions
36Slide37
The State of Wisconsin MH PPS Module
Psychosocial and Environmental Stressors -
Current problems that may affect the diagnosis, treatment and prognosis of mental disorders
Code
Label
Acute Events
Enduring Circumstances
1
None
No acute events that may be relevant to the disorder.
No enduring circumstances that may be relevant to the disorder.
2
Mild
Such as broke up with boy or girlfriend; started or graduated from school; child left home.
Such as family arguments; job dissatisfaction; residence in high crime neighborhood.
3
Moderate
Such as marriage; marital separation; loss of job; retirement; miscarriage.
Such as marital discord; serious financial problems; trouble with boss; being a single parent.
4
Severe
Such as divorce; birth of first child; trauma victim; witnessing violence (community or domestic).
Such as unemployment; poverty.
5
Extreme
Such as death of spouse; serious physical illness diagnosed; victim of rape.
Such as serious chronic illness in self or child; ongoing physical or sexual abuse.
6
Catastrophic
Such as death of child; suicide of spouse; devastating natural disaster.
Such as captivity as hostage; concentration camp experience.
0
Inadequate
Information
37Slide38
The State of Wisconsin MH PPS
Module – Health Status
Health Status – Refers to current physical health
s
tatus
Stable Health Condition:
Minimal
medical interventions are needed. No hospitalizations or emergency room use. Medications and treatments are effective in managing or alleviating symptoms.
Unstable
Health
Conditions:
Frequent
medical interventions are needed. Person may have periodic hospitalizations and emergency room use. Medications may change often in an attempt to stabilize medical condition(s). If more than one health condition, may result in complex medical treatments
.
New Symptoms:
N
ew
symptoms not related to currently diagnosed health conditions. Code
Label
Description1No Health Condition
2
Stable/ Capable
Person is capable of seeking medical attention and is independent in management of health condition.
3
Stable/ Incapable
Person is incapable or unwilling to seek medical attention and cannot manage health condition independently.
4
Unstable/ Capable
Person is capable of seeking medical attention and is independent in management of health condition.
5
Unstable/ Incapable
Person is incapable or unwilling to seek medical attention and cannot manage health condition independently.
6
New
Sxs
/ Capable
Person is capable of seeking medical attention and independently follows through with recommendations.
7
New
Sxs
/ Incapable
Person is incapable or unwilling to seek medical attention and does not follow through with recommendation.
9
Unknown
38Slide39
The State of Wisconsin MH PPS
Module – Daily Activities
This includes educational activities, but does not include employment activities. You must enter one and may enter up to three codes.
Code
Label
Description
1
No educational, social, or planned activity
Not in job training, not in school
2
Part-time educational activity
Part-time appropriate to the type of school (elementary, high school, college, technical)
3
Full-time educational activity
Full-time appropriate to the type of school (elementary, high school, college, technical)
4
Meaningful social activity
Socializing, support network, routine
5
Volunteer or planned formal activities
Clubs, drop-in
6
Other activities
Activities of homemaking, caregiving
7
Unknown
Information not available
39Slide40
The State of Wisconsin MH PPS
Module – Suicide Risk
Code
Label
Description
1
No risk factors
2
Presence of risk factors
Presence of risk factors, but no immediate risk. Risk factors include:
• Family history of mental or substance abuse disorder
• Family history of suicide
• Firearm in the home
• Incarceration
• Adverse life events/major personal loss
• Family violence, including physical or sexual abuse
3
High potential for suicide
Has at least one of these risk factors:
• Development of suicidal plan, acquiring the means, rehearsal behavior, setting a time for an attempt
• Severe hopelessness
• Presence of a suicide note
• Contemplation or use of a violent or especially lethal method
• Affirmation of intent to kill self
• Making out a will or giving away favorite possessions
• Inappropriately saying goodbye
• Explicit statements of suicidal ideation or feelings
9
Unknown
Information not available
40Slide41
The State of Wisconsin MH PPS Module
Incarceration/Involvement with Criminal Justice System –
Must enter at least 1, and may enter up to 4Jailed/Imprisoned - Means county jails, state prisons, federal prisons, or forensic units of state hospitals. Also includes the Huber facility
.
41Slide42
The State of Wisconsin MH PPS
Module – Episode End Reason
IF THE TREATMENT EPISODE WAS FULLY COMPLETED: 01 Completed service - major improvement 02 Completed service - moderate improvement 03 Completed service - no change
This is the first code that should be used, even if the client is being transferred to a lower level of care
For example, if a client successfully completes a TCM level of care and receives a planned referral to a mental health outpatient level of care, the improvement codes should be used first
42Slide43
The State of Wisconsin MH PPS Module – Episode End
Reason (Continued…)
If the client decompensated at a given level of care and needed to be transferred to a higher level of care, the “Formally transferred to another community based resource” or “Referred” designations should be used“Formally transferred to another community based resource” should be used when the provider knows the client’s referral destination (e.g., client has been transferred from TCM to CSP and transition occurred before client was discharged from TCM)
“Referred” should be used when the provider does not know the referral destination (e.g., client was encouraged to contact an outpatient therapist in her/his insurance network)
43Slide44
SPC End Reason
The “SPC End Reason” follows the same format and definitions as the “Episode End Reason”
The main difference is that an SPC service may be closed or discontinued, even though the Episode of care may remain open (e.g., Individual Outpatient AODA services 507.10 may remain open, even though Group Outpatient AODA 507.30 services may have ended)
44Slide45
The State of Wisconsin PPS AODA Form
45Slide46
The State of
Wisconsin AODA PPS
Module
If “Target Group” is coded as 74, “Family
member/other of AODA client (codependent
)”, then the item “Codependent Collateral” must be coded as “Yes”
Please see MH Module above for definition of this item.
Please see this
slide
to determine if the service being provided is a brief service
Please note that age of first use is defined as “intoxication” for alcohol, and first use of any drug, regardless of
amount
These are limited to support groups with a focus on AODA issues
46Slide47
Co-Dependent Collateral
”Y” should be used if individual is seeking services due to problem arising from her/his relationship with someone with AODA issues
“Y” should also be used if the individual seeking services does not have a current AODA issue of her/his own
47Slide48
The State of Wisconsin AODA PPS Module
Brief Services
This field may be checked YES if any of the following Group 2* standard program categories are the sole SPCs to be provided in an
episode
of care:
301 Court intake studies
501 Crisis intervention
501.10 Crisis Intervention
507.80
Suboxone
601 Outreach
602 Information and referral
603 Intake assessment
507.50 Outpatient, emergency regular
507.61 Antabuse
507.62 Other Medical
507.64 Urinalysis Tests
507.65 Medication Management
101 Child day care
104 Supportive home care 104.10 Supportive Home Care 106 Housing assistance 107 Transportation 108 Work-related services 110 Daily living skills training 112 Interpreter 112.55 Specialized medical supplies 604 Case management 606 Health screening
615 Supported employment *Please see page 24 of the AODA PPS Module handbook for a full listing of the SPC Code Groups
48Slide49
The State of
Wisconsin AODA PPS
Module
Date episode last SPC service ends and episode is closed
These are conceptually the same as the MH Module above with regards to completed service/improvement and deterioration. Please refer to the PPS AODA Handbook for more detail.
As with MH Module, please refer to CPT-SPC crosswalk slides at the end of this PowerPoint for your specific service(s)
49Slide50
The PPS/NOMS Supplemental Form
50Slide51
Some Additional Guidance
For any numerically coded items
(e.g., How many days in the past 30 did you experience serious depression…?) for which the answer is unknown and cannot be determined from any available source (CARS Comprehensive Assessment, progress notes, etc.), please use:“99”
51Slide52
PPS/NOMS Supplemental
Date the form is completed
This should be pre-filled from the PPS General form
52
This should include all drugs (
including
abuse/misuse of prescription drugs)
This is the date you assess (or should have assessed) the client. It should correspond to the SAME DATE you entered at the top of the PPS General Form. Again, this is the date the assessment did, or should have, occurred, not the date you complete the PPS forms.Slide53
PPS/NOMS Supplemental
Please include all emergency and inpatient service utilization in these categories, not just BHD operated services.
These should be pre-filled from the PPS General form
“Did not keep” refers to a scheduled health care appointment that was missed.
“Refused services” refers to a client who declined the service entirely.
53Slide54
PPS/NOMS Supplemental
This refers to recovery from mental or addiction issues (or both)
This section will be pre-filled if your client is “primary mental health”. If not, you will have to complete this section. Please refer to earlier slides on the MH PPS for guidance.
54Slide55
PPS/NOMS Supplemental
This section will be pre-filled if your client is “primary AODA”. If not, you will have to complete this section. Please refer to earlier slides on the AODA PPS for guidance.
Please note that if your client does not have any substance abuse issues, you may leave these items blank
55Slide56
PPS/NOMS Supplemental
For greater accuracy, we separated “Closing Reason” and “Level of Improvement” in the PPS/NOMS, as they are two separate constructs
Please select a closing reason and then elaborate upon this closing reason in the sections below. For example, if you select “Incarcerated” as a closing reason, this will
both enable and require
a response in the “Incarcerated, explain” section here. Most of the closing reasons have an option to provide greater detail.
56Slide57
REMEMBER:
THE PPS FORMS MUST BE COMPLETED IN PROVIDER CONNECT!!!
57Slide58
CPT to SPC Code Crosswalk
Reference Guide
= Clinical Service = Ancillary Service
C
A
58Slide59
Crisis Case Management and TCM: CPT to SPC
PROGRAM
TYPE
CPT ODE
CPT
CODE DESCRIPTION
SPC CODE
CRISIS
CASE MANAGEMENT
NMS001
NON COVERED SERVICE
501
CRISIS
CASE MANAGEMENT
S9484A
CRISIS ASSESSMENT AND PLANNING
501
CRISIS
CASE MANAGEMENT
S9484L
CRISIS LINKAGE + FOLLOW UP
50
1.20
CRISIS
CASE MANAGEMENT
S9484S
CRISIS STABILIZATION
501
TARGETED CASE MANAGEMENT
NMS001
NON COVERED SERVICE
604
TARGETED CASE MANAGEMENT
T1017U1
TARGETED CASE MGT-ASSESSMENT
604
TARGETED CASE MANAGEMENT
T1017U2
TARGETED CASE MGT-CASE PLANNING
604
TARGETED CASE MANAGEMENT
T1017U3
TARGETED CASE MGT-ONGOING MONITORING
604
TARGETED CASE MANAGEMENT
T1017U4
TARGETED CASE MGT-DISCHARGE PLANNING
604
C
59Slide60
Community Options Program: CPT to SPC
PROGRAM
TYPE
CPT ODE
CPT
CODE DESCRIPTION
SPC CODE
COP
T1017U1U5
TARGETED CASE MANAGEMENT- ASSESSMENT
604.00
COP
T1017U2U5
TARGETED CASE MANAGEMENT-CASE PLANNING
604.00
COP
T1017U3U5
TARGETED CASE MANGEMENT-ONGOING MONITOR
604.00
COP
T1017U4U5
TARGETED CASE MAGENEMENT-DISCHARGE PLAN
604.00
C
60Slide61
Adult Family Home: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
ADULT FAMILY HOME
S5140
ADULT FAMILY HOME
202.00
ADULT FAMILY HOME
T1019
COMPANION SERVICE
104.00
ADULT FAMILY HOME
SC2303
ROOM AND BOARD
202.00
C
61Slide62
AODA Case Management: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CASE MGMT & AFTER CARE SUPPORT
H0006CM
CASE MANAGEMENT
604
CASE MGMT & AFTER CARE SUPPORT
T1016U1
CASE MGT-ASSESSMENT
604
CASE MGMT & AFTER CARE SUPPORT
T1016U2
CASE MGT-CASE PLANNING
604
CASE MGMT & AFTER CARE SUPPORT
T1016U3
CASE MGT-DISCHARGE PLANNING
604
CASE MGMT & AFTER CARE SUPPORT
T1016U4
CASE MGT-DISCHARGE PLANNING
604
C
62Slide63
Community Based Residential Facilities:
CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CBRF
H0019
CBRF CARE AND MAINTENANCE
506.00
CBRF
S5125
ATTENDANT CARE SERVICES, PER 15 MINUTES
506.00
CBRF
S5126
SUPERVISED APARTMENT
506.00
CBRF
S5130
HOMEMAKER SERVICE
506.00
CBRF
S5170
HOME DELIVERED MEALS
506.00
CBRF
SC2303
ROOM
AND BOARD
506.00
CBRF
T1019
COMPANION SERVICE
104.00
C
63Slide64
Comprehensive Community Services: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CCS
NMS001
NON COVERED
SERVICE
510.10
CCS
NMS002
CCS PRE-ADMISSION
SERVICE
510.10
CCS
H2017A
SCREENING AND ASSESSMENT
510.10
CCS
H2017D
DIAGNOSTIC EVALUATION
510.10
CSS
H2017E
EMPLOYMENT RELATED SKILL TRAINING
510.10
CCS
H2017F
SERVICE FACILITATION
510.10
CCS
H2017H
PHYSICAL HEALTH MONITORING
510.10
CCS
H2017M
MEDICATION MANGEMENT
510.10
CCS
H2017P
PEER SUPPORTS
510.10
C
64Slide65
Comprehensive Community Services: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CCS
H2017PE
INDIVIDUAL AND/OR FAMILY PSYCHOEDUCATION
510.10
CSS
H2017PEGRP
INDIVIDUAL/FAMILY PSYCHOEDUCATION, GROUP
510.10
CCS
H2017S
INDIVIDUAL SKILLS DEV AND ENHANCEMENTS
510.10
CSS
H2017SA
SUBSTANCE ABUSE SERVICES
510.10
CSS
H2017SGRP
INDIVIDUAL SKILL DEV AND ENHANCE, GROUP
510.10
CCS
H2017SP
SERVICE PLANNING
510.10
CCS
H2017T
PSYCHOTHERAPY
510.10
CSS
H2017TGRP
PSYCHOTHERAPY, GROUP
510.10
CCS
99199
Travel, Individual/Group
510.10
CCS
H2017W
WELLNESS MGMT AND RECOVERY SUPP SRVS
510.10
C
65Slide66
CRS: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CRS
H0043U9
SUPPORTED HOUSING, PER DIEM
511.10
CRS
H2023
SUPPORTED
EMPLOYMENT
511
CRS
H0038
SELF HELP/PEER SERVICES
511
C
66Slide67
CLASP: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
CLASP
S9484L
CRISIS LINKAGE + FOLLOW UP
501.20
CLASP
S9484S
CRISIS STABILIZATION
501.00
CLASP
S9485
CRISIS PER DIEM
501.10
C
67Slide68
Community Support Program: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
COMMUNITY SUPPORT PROGRAM
NMS001
NON COVERED SERVICE
509.00
COMMUNITY SUPPORT PROGRAM
H0039
COMMUNITY SUPPORT PROGRAM SUPPORT
509.00
COMMUNITY SUPPORT PROGRAM
H0039GRP
COMMUNITY SUPPORT PROGRAM GROUP
509.00
C
68Slide69
AODA Day Treatment: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
DAY TREATMENT (75.12)
H0003U
URINALYSIS
507.64
DAY TREATMENT (75.12)
H2012AODA
AODA DAY TREATMENT
704.10
C
69Slide70
Mental Health Day Treatment: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
DAY TREATMENT (61.75)
NMS001
NON COVERED
SERVICE
704.00
DAY TREATMENT (61.75)
H2012A
DAY TREATMENT FUNCTIONAL ASSESSMENT
704.00
DAY TREATMENT (61.75)
H2012
DAY TREATMENT
704.00
DAY TREATMENT (61.75)
H2012GRP
DAY TREATMENT GROUP
704.00
C
70Slide71
Detoxification: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
DETOXIFICATION (75.07)
H0010
DETOXIFICATION-LEVEL 2
703.20
DETOXIFICATION (75.07)
H0011
DETOXIFICATION-LEVEL 1
703.20
DETOXIFICATION (75.09)
H0013
DETOXIFICATION-SOBER UP
705.10
DETOXIFICATION (75.07)
S2125
MAT - VIVITROL
507.65
C
71Slide72
AODA Medically Monitored Residential: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
MED. MONITOR RESIDENTL (75.11)
H0003U
URINALYSIS
507.64
MED. MONITOR RESIDENTL (75.11)
H0018M
BUNDLED RESIDENTIAL MED MONITOR
506.10
C
72Slide73
Medication Assisted Treatment: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
MEDICATION ASSISTED TREATMENT
H0003M
MAT LAB
507.65
MEDICATION ASSISTED TREATMENT
H0003U
URINALYSIS
507.64
MEDICATION ASSISTED TREATMENT
S2125
MAT - VIVITROL
507.65
MEDICATION ASSISTED TREATMENT
SC2126
SUBOXONE
507.80
MEDICATION ASSISTED TREATMENT
T1015
MAT
– H&P
507.65
C
73Slide74
AODA Outpatient: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
OUTPATIENT 75.13
H0003U
URINALYSIS
507.64
OUTPATIENT 75.13
H0005
ALCOHOL/SUBSTANCE ABUSE SERVICE-GROUP
507.30
OUTPATIENT 75.13
H0047
ALCOHOL/SUBSTANCE ABUSE SERVICES, NOS
507.10
OUTPATIENT 75.13
T1006
ALCOHOL/SUBSTANCE ABUSE SERVICES, FAMILY
507.20
C
74Slide75
Mental Health Outpatient: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
OUTPATIENT-MH
90832
PSYCHOTHERAPY 30 MIN
507.20
OUTPATIENT-MH
90834
PSYCHOTHERAPY 45 MIN
507.20
OUTPATIENT-MH
90837
PSYCHOTHERAPY 60 MIN
507.20
OUTPATIENT-MH
90847
FAMILY PSYCHOTHERAPY WITH PATIENT
507.40
OUTPATIENT-MH
90853
GROUP PSYCHOTHERAPY
507.30
C
75Slide76
Recovery House Plus: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
RECOVERY HOUSE PLUS OP/DT
H0047
ALCOHOL/SUBSTANCE ABUSE SERVICES, IND
507.10
RECOVERY HOUSE PLUS OP/DT
T1006
ALCOHOL/SUBSTANCE ABUSE SERVICES, FAMILY
507.20
RECOVERY HOUSE PLUS OP/DT
H2012AODA
AODA DAY TREATMENT
704.10
RECOVERY HOUSE PLUS OP/DT
H0005
ALCOHOL/SUBSTANCE ABUSE SERVICE-GROUP
507.30
RECOVERY HOUSE PLUS OP/DT
H0043R
RECOVERY HOUSE
205
C
76Slide77
Recovery Support Coordination: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
RECOVERY SUPPORT COORDINATION
H0006RSC
RECOV SUPP COORDINATION-GENERAL
604
RECOVERY SUPPORT COORDINATION
H0006RSCF
RECOV SUPP COORDINATION-FAMILY
604
RECOVERY SUPPORT COORDINATION
T1016U1
CASE MGT-ASSESSMENT
604
RECOVERY SUPPORT COORDINATION
T1016U2
CASE MGT-CASE PLANNING
604
RECOVERY SUPPORT COORDINATION
T1016U3
CASE MGT-DISCHARGE PLANNING
604
RECOVERY SUPPORT COORDINATION
T1016U4
CASE MGT-DISCHARGE PLANNING
604
RECOVERY SUPPORT COORDINATION
T1016U5
CASE MGT-TEAM MEETING
604.00
C
77Slide78
Recovery Support Services – Part 1: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
RSS-EMPLOYMENT
H2025E
COMMUNITY EMPLOYMENT PROGRAM
615
RSS-EMPLOYMENT
H2025W
WORK ADJUSTMENT TRAINING
615
RSS-FAMILY
H0045D
RESPITE CARE - DAILY
103.10
RSS-FAMILY
H0045H
RESPITE CARE - HOURLY
103.00
RSS-FAMILY
T1009
CHILD CARE, HOURLY
101
RSS-FAMILY
T1009D
CHILD CARE, DAILY
101
RSS-FAMILY
T1027PA
PARENT ASSISTANCE
110
RSS-FAMILY
T1027PC
PARENTING CLASS
110
RSS-FAMILY
T1005
RESPITE CARE SERVICES UP TO 15 MINS
103.00
RSS-HOUSING
H0043B
BRIDGE HOUSING INDIVIDUAL
205
RSS-HOUSING
H0043BF
BRIDGE HOUSING FAMILY
205
RSS-HOUSING
SC2024
ROOM AND BOARD
205
RSS-HOUSING
SC2032
HOUSING ASSISTANCE
106.00
A
78Slide79
Recovery Support Services – Part 2: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
RSS-PSYCH. SELF MGMT
H0004
ANGER MANAGEMENT
507.00
RSS-PSYCH. SELF MGMT
H0004F
ANGER MANAGEMENT - FAMILY
507.00
RSS-PSYCH. SELF MGMT
H0004GRP
ANGER MANAGEMENT - GROUP
507.00
RSS-PSYCH. SELF MGMT
H0047DV
DOMESTIC VIOLENCE VICTIM
507.10
RSS-PSYCH. SELF MGMT
H0047DVB
DOMESTIC VIOLENCE BATTERER
507.10
RSS-PSYCH. SELF MGMT
H2014G
DAILY LIVING SKILLS - GROUP
110.00
RSS-PSYCH. SELF MGMT
H2014I
DAILY LIVING SKILLS - INDIVIDUAL
110.00
RSS-PSYCH. SELF MGMT
A0160
TRANSPORTATION SERVICES
107.00
RSS-PSYCH. SELF MGMT
T1013
INTERPRETER SERVICES
112.00
RSS-SCHOOL AND TRAINING
T1012
EDUCATION/ACADEMIC SKILLS
110
RSS-SPIRITUAL
H0047SF
SPIRITUAL SUPPORT - FAMILY
507.20
RSS-SPIRITUAL
H0047SG
SPIRITUAL SUPPORT - GROUP
507.30
RSS-SPIRITUAL
H0047SI
SPIRITUAL SUPPORT - INDIVIDUAL
507.10
A
79Slide80
SBIRT: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
SBIRT
H0049
SBIRT SCREEN
507.10
SBIRT
H0050
SBIRT SERVICE
507.10
C
80Slide81
Transitional Residential: CPT to SPC
PROGRAM
TYPE
CPT CODE
CPT
CODE DESCRIPTION
SPC CODE
TRANSITIONAL RESIDENTIAL (75.14)
H0003U
URINALYSIS
507.64
TRANSITIONAL RESIDENTIAL (75.14)
H0018
RESIDENTIAL - TRANSITIONAL
506.20
C
81Slide82
Questions?
Please contact CARS at 414-257-8085 and ask for:
Matt DrymalskiMichael NunleyChuck SigurdsonJustin HellerPam Harris
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