Login

Fillable Printable Form 320E

Fillable Printable Form 320E

Form 320E

Form 320E

320-10
CHAPTER300
MEDICAL POLICY FOR AHCCCSCOVERED SERVICES
POLICY 320
SERVICES WITH SPECIAL CIRCUMSTANCES
ARIZONAHEALTH CARECOST CONTAINMENTSYSTEM
AHCCCS MEDICAL POLICYMANUAL
320-E
HEALTH AND BEHAVIOR INTERVENTION
REVISIONDATES: 03/01/14, 10/01/13, 05/01/07
INITIAL
EFFECTIVEDATE:
10/01/2006
DESCRIPTION
Health and behavioralassessment procedures (CPTcodes 96150-96155) are used to
identifyand treat the psychological, behavioral, emotional, cognitive and social factors
important tothe prevention, treatment and management of physical health problems. The
focus of theassessment is not on mental health, but on thestresses, expectations, lifestyle
and perceptions that are associated with the underlyingmedical condition. Codes 96150 -
96155 describe services offered to members who present with primaryphysical illnesses,
diagnosis or symptoms and may benefit from assessments and interventions that focus on
thebiopsychosocial factors related tothe member's health. These services do not
represent preventative medicine counseling and risk factor reduction interventions.
Therefore, evaluation and management services codes (including preventative medicine,
individual counseling codes 99401-99404 and preventative medicine, group counseling
codes 99411- 99412) should not be reported on the same day.
AMOUNT,DURATIONANDSCOPE
AHCCCS covers medicallynecessary health and behavioral assessment procedures (CPT
codes 96150-96155). The focus of the assessment/interventions is noton mental health
but the biopsychosocial factors important tophysical health problems and treatment. The
focus of the intervention is to improve the member's health and well-being utilizing
cognitive, behavioral, social, and/or psychophysiological procedures designed to
ameliorate specific disease-related problems.
Individuals requiringtheservice(s) described abovemust not be referred to the Integrated
Regional Behavioral Health Authorities (Integrated RBHAs) or Regional Behavioral
Health Authorities (RBHAs).
CODES
96150- Health and behavior assessment (e.g.health-focused clinical interview,behavioral
observations, psychophysiological monitoring,health-oriented questionnaires),
each 15 minutes face-to-face with the patient; initial assessment.
96151 - Re-assessment
96152 - Health and behavior intervention, each 15 minutes, face-to-face; individual
96153 - Group (two or more patients)
96154 - Family (with the patient present)
96155 - Family (without the patient present)
320-11
CHAPTER300
MEDICAL POLICY FOR AHCCCSCOVERED SERVICES
POLICY 320
SERVICES WITH SPECIAL CIRCUMSTANCES
ARIZONAHEALTH CARECOST CONTAINMENTSYSTEM
AHCCCS MEDICAL POLICYMANUAL
The followingprofessionals are approved byAHCCCS to provide health and behavioral
assessments/interventions:
1.Psychologist
2.Licensed clinical social worker
3.Licensed marriage and family therapist
4.Licensed professional counselor, and
5.Psychiatric nurse practitioner
Health and behavior intervention services may be performed in the following places of
service:
1.FederallyQualified Health Clinic (FQHC)
2.Rural Health Clinic
3.Provider Office
4.The member‘s home
5.Indian Health Service (IHS) Freestanding Facility
6.IHS Provider Based Facility
7.Tribal 638 FreestandingFacility, and
8.Tribal 638 Provider Based Facility.
9.Integrated Behavioral Health Residential Facility
LIMITATIONS
1.Services are limited to48 units annually (unit is equal to 15 minutes).
Members with mental health treatment needs exceeding the scope or duration of
services described (which are medical codes for behavioral health interventions)
should be appropriately referred for behavioral health services that willrequire
the specific use of behavioral health codes.
2.Services are limited to the providers and settingslisted above.
Login to HandyPDF
Tips: Editig or filling the file you need via PC is much more easier!
By logging in, you indicate that you have read and agree our Terms and Privacy Policy.