Oregon Problem Gambling Services

Oregon Problem Gambling Services Procedure Codes and Rates for FY2016-17 Effective July 1, 2016

Code Description PGS Payment Amount Service Criteria

H0001 Gambling Assessment $139.70 Service provided by qualified counselor per OAR 309-019-0100. If assessment takes longer than 1 hour, service provider can encounter remaining time as H0004. T1023 Behavioral Health Screening per 15 $23.86 Screening to determine the min appropriateness of consideration of an individual for participation in A&D 81 services. This service deferens from a gambling assessment in that the activity may be delivered over the telephone and requires not only the evaluation of a client's treatment needs, but also an evaluation of available treatment options. Service can be provided 30 days prior to enrollment and encountered for, as long as service notes per occurrence are documented and included in individual record. H0004 Gambling Treatment counseling and $23.86 Service provided by qualified therapy, per 15 min counselor per OAR 309-019-0100 H0005 Gambling Treatment counseling, $9.90 Service provided by qualified group per 15 min counselor per OAR 309-019-0100 90846 Family Psychotherapy (without the $92.69 Service provided by LMP, LPC, patient present), per service LMFT, LCSW, Psychologist or QMHP. 90847 Family Psychotherapy (conjoint $115.49 Service provided by LMP, LPC, psychotherapy) with the patient LMFT, LCSW, Psychologist or present, per service QMHP. Family psychotherapy is covered when there is a need to observe the clients interaction with family members and/or where there is a need to assess the capabilities of and assist the family members in aiding in the management of the client. Individual and family therapy codes can be encountered on the same date of service if there are two separate counseling sessions- one with the client and one with the family member and patient present. Providers should not encounter an individual therapy code with the family therapy code if only one session of therapy is rendered. 90849 Multiple-family group $37.38 Service provided by LMP, LPC, psychotherapy, per service LMFT, LCSW, Psychologist or QMHP 90801 or 90791 Psychiatric Diagnostic Interview $131.44 Service provided by MD, Psychiatric Mental Health Nurse Practitioner, LPC, LMFT, LCSW, Psychologist or QMHP. 90792 Psychiatric Diagnostic Interview, $140.94 Service provided by MD or with medication services Psychiatric Mental Health Nurse Practitioner, LPC, LMFT, LCSW, Psychologist or QMHP. 90832 Psychotherapy, with patient and/or $66.53 Service provided by LMP, LPC, family member, per 30 minutes LMFT, LCSW, Psychologist or QMHP. Individual psychotherapy, insight oriented, behavioral modifying and/or supportive. Individual must be diagnosed with a gambling disorder and mental health disorder (dual diagnosed). Client must not have existing health insurance coverage. Goal is to get patient enrolled in Oregon Health Plan or connected to other health insurance options. 96101 Psychological Testing with $91.19 QHHP who is licensed Psychologist interpretation and report, per hour or a Psychology Intern supervised by a Licensed Psychologist 90862 or 90863 or 90832 Medication Management $70.47 Services provided by MD or GMED Psychotherapy (Formerly known as 65.72 Psychiatric Mental Health Nurse Medication Management), per 30 Practitioner. Scope of services minutes includes prescribing medication, is the initial evaluation of the patient’s needs for medication, and ongoing medication monitoring/evaluation related to the patients use of medication. Service provided by a LMP, LPC, LMFT, LCSW, Psychologist, or QMHP with patient and/or family member. Effective January 1, 2016. H2027 Individual counseling continuing $23.86 This activity may be delivered to care, per 15 min clients who have received AD81 services for up to one year following discharge. The function is of maintaining recovery and continued wellness and to prevent relapse. G2100 Continuing Care Group Services, $9.90 Services provided to clients who per 15 min for gambler and/or have completed problem gambling family member treatment within the past 12 months and are to be utilized to facilitate continued recovery or to avert a potential relapse. Services can be provided within an existing therapy or psycho-educational group being provided to current clients or to a group of previous clients meeting on a regular basis for aftercare. H0038 Peer Delivered Services, per 15 min $16.00 "Peer Delivered Services" means an array of agency or community-based services and support provided by peers, and peer support specialists, to individuals or family members with similar lived experience, that are designed to support the needs of individuals and families as applicable by current policy. "Peer Support Specialist" means a person providing peer delivered services to an individual or family member with similar life experiences, under the supervision of a qualified Clinical Supervisor. A Peer Support Specialist must complete an AMH approved training program and be: a self-identified person currently or formerly receiving mental health services; or a self-identified person in recovery from a substance use or gambling disorder, who meets the abstinence requirements for recovering staff in substance use disorders or gambling treatment programs; or a family member of an individual who is a current or former recipient of addictions or mental health services. This could can also be encountered for as an aftercare service (effective July 1, 2016). H0038G Peer Delivered Services- Group, per $5.28 Peer Delivered Services provided by 15 min Peer Support Specialist per definition provided under H0038 in a group setting. This could can also be encountered for as an aftercare service (effective July 1, 2016). H2010 Comprehensive medication services, $23.86 Services delivered by a licensed per 15 min registered nurse or QMHP related to the dispensing, administration and management of medications. H2013 Psychiatric health facility service, $350.23 Services provided in a licensed per diem mental health residential facility and intensively staffed 24-hours under a physician approved treatment plan for which treatment includes an appropriate mix and intensity of assessment, medication management, individual and group therapies and skills development to reduce or eliminate the acute symptoms of the disorder and restore the client's ability to function in a home or the community to the best possible level. 99368 Team conference/consultation with 22.00 Medical team conference with Interdisciplinary team, per 30 interdisciplinary team of non- minutes or more physician\health care professionals without client or family present. Can only be encountered for problem gambling treatment staff (s) that is present. Must consult on individual client for at least 30 minutes to encounter for service. G2013 Residential gambling treatment $175.00 Services provided in a licensed service, per diem Marion County $200.00 residential alcohol and drug Bridgeway Residential Program treatment facility designated as a Only residential gambling treatment program and intensively staffed 24- hour for which treatment includes an appropriate mix and intensity of assessment, medication management, individual and group therapies and skills development to reduce or eliminate the acute symptoms of the disorder and restore the client's ability to function in a home or the community to the best possible level. T1016 Case management, per 15 min $22.25 Services provided for coordinating access to and provision of services from multiple agencies, establishing service linkages, advocating for treatment needs, and providing assistance in obtaining entitlements based on mental or emotional disability, T1016P Case management, per 15 min $16.00 Peer Support Specialist services provided for coordinating access to and provision of services from multiple agencies, establishing service linkages, advocating for treatment and recovery needs, and providing assistance in obtaining entitlements based on mental or emotional disability. G2030 Financial counseling, per hour $89.00 Pressure relief counseling or other forms of counseling provided to individuals enrolled in A&D 81 services or their family members for the purpose of financial restitution of gambling debt. T1013 Sign language/oral interpreter $9.60 Sign language/oral interpreter service, per 15 min services necessary to ensure the provision of services for individuals with hearing impairments or in the primary language of non-English speaking individuals. Such interpreters shall be linguistically appropriate and be capable of communicating in English and the primary language of the individual and be able to translate clinical information effectively. Payment for interpreter services is only allowed when provided in conjunction with another service such as assessment, individual/family therapy, or group therapy, etc. whenever feasible, individuals should receive services from staff, who are able to provide sign and/or oral interpretive services. In this case, interpreter services cannot be billed in addition to the therapeutic service. 99203 Evaluation and management 82.56 Evaluation and management of a physical health visit, new patient, 30 new patient that requires a detailed minutes maximum length history, detailed examination and medical decision making of low complexity. Service provided by Nurse Practitioner, Naturopathic or other qualified medical professional. Counseling and/or consultation of care with other qualified health care professionals or agencies are provided consistent with the nature of the problems and the patients and/or family needs. Service should be provided when physical health conditions are impeding with gambling treatment. Must be face- to-face. Maximum of 2 visits per patient. Client must not have existing health insurance coverage. Goal is to get patient enrolled in Oregon Health Plan or connected to other health insurance options. 99213 Evaluation and management $55.53 Evaluation and management of an physical health visit, established established patient that requires an patient, 15 minutes maximum length expanded problem focused history, expanded problem focused examination and medical decision making of low complexity. Service provided by Nurse Practitioner, Naturopathic or other qualified medical professional. Counseling and/or consultation of care with other qualified health care professionals or agencies are provided consistent with the nature of the problems and the patients and/or family needs. Service should be provided when physical health conditions are impeding with gambling treatment. Must be face- to-face. Maximum of 3 visits per patient. Client must not have existing health insurance coverage. Goal is to get patient enrolled in Oregon Health Plan or connected to other health insurance options. G5000 Individual counseling, other $23.86 Services provided by qualified technologies, per 15 min counselor per current policy standards. Must meet current requirements for confidentiality with patient informed consent. G4000 Individual counseling, telephone, $23.86 Services provided by qualified per 15 min counselor per current policy standards. Must meet current requirements for confidentiality with patient informed consent. G30 Mileage Current US GSA rate Limited to: 1. Service provider's travel to and from primary site providing AD81 services and ancillary AD81 service site; 2. Mileage charges by program or case consultants; 3. Service provider’s travel bringing clients to the treatment site. 4. Service providers transportation costs to bring clients to and from the residential treatment site. 5. Client transportation costs 50A* Strategic Outreach Planning, per 15 $23.86 Time spent with development of a min Strategic Outreach/Referral Pathways Plan. Limited to maximum of 10% of A&D 81 allocations unless preauthorized by OHA Problem Gambling Services Manager. 50B* Referral Agreement Development, $23.86 Time spent with allied agencies to per 15 min develop and follow up on formal referral agreements. Limited to 8 hours per allied agency, unless preauthorized by OHA Problem Gambling Services Manager. Includes time spent preparing for meetings and development of presentation, process and paperwork. 50C* Presentations to Allied $23.86 Time spent delivering presentations Professionals, per 15 min to professionals in health/medicine/social services/legal/financial with the express intent to follow up with individual contacts in order to establish relationship, develop screening and referral agreements and protocols, etc. Limited to 8 hours per allied agency, unless preauthorized by OHA Problem Gambling Services Manager. Includes time spent preparing for meeting and developing presentations. 50D* Presentations to Targeted High Risk $23.86 Time spent delivering presentations Client Groups, per 15 min to targeted high risk clients groups, including but not limited to: Incarcerated individuals A/D clients (OP/Residential) MH clients (OP/Residential) CAF clients. These presentations shall be focused on signs and symptoms of disordered gambling, treatment options and how to access treatment. Code can be used to provide individual or group consultation/education with potential family member client(s) for the purpose of explaining importance of treatment and what can be expected, in hopes that family member will enroll. Includes time spent preparing and developing presentations. 50E* Treatment Advertising Actual Cost Treatment Ads (yellow pages, web- based ads, radio, TV, newspaper). Limited to maximum of 20% of AD81 allocations unless preauthorized by OHA Problem Gambling Services Manager. 50F* Exhibiting at Professional $23.86 Exhibiting at a conference or Conferences, per 15 min meeting of professionals that we know from experience are likely to have problem gamblers in their practices and are in a position to potentially refer (i.e., physicians, nurses, social services, corrections, legal, financial). This is in contrast to a conference for service organizations (i.e. Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4 hours) per exhibit, unless preauthorized by OHA Problem Gambling Manager. 50G* Other as Pre-authorized As Authorized Other as pre-authorized by OHA Problem Gambling Manager. FLEX Non-traditional Services or Actual Cost Examples include wraparound Activities (barrier removal) type services (travel vouchers for clients, childcare expenses, etc)., and workforce development needs of service provider. 50AP* Strategic Outreach Planning, per 15 $16.00 Peer Support Specialist time spent min with clinician staff participating in strategic outreach plan development. Limited to maximum of 10% of A&D 81 allocations unless preauthorized by OHA Problem Gambling Manager. 50CP* Presentations to allied professionals, $16.00 Peer Support Specialist time spent per 15 min delivering presentations to professionals in health/medicine/social services/legal/financial with the express intent to follow up with individual contacts in order to establish relationship, develop screening and referral agreements and protocols, etc. Limited to 8 hours per allied agency, unless preauthorized by OHA Problem Gambling Services Manager. 50DP* Presentations to targeted high risk $16.00 Peer Support Specialist time spent client groups, per 15 min delivering presentations to targeted high risk clients groups, including but not limited to: Incarcerated individuals A/D clients (OP/Residential) MH clients (OP/Residential) CAF clients. These presentations shall be focused on signs and symptoms of disordered gambling, treatment options and how to access treatment. Limited to 8 hours per allied agency, unless preauthorized by OHA Problem Gambling Services Manager. 50FP* Exhibiting at Professional $16.00 Peer Support Specialist time spend Conferences, per 15 min exhibiting at a conference or meeting of professionals with the intention of educating potential gambling treatment referral sources about problem gambling, recovery, treatment, screening tools, and available problem gambling help in Oregon. This is in contrast to a conference for service organizations (i.e. Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4 hours) per exhibit, unless preauthorized by OHA Problem Gambling Manager. *50A-50G codes, known as Referral Pathways Codes, have the primary purpose of getting problem gamblers and/or family members enrolled in services, geared specifically towards increasing the number of clients receiving treatment. It is targeted, generally involves repeated contacts and the development of a relationship with the provider. The provider is generally another professional and the goal is to increase the number of clients they assess and refer to your program. For Referral Pathways documentation requirement, please keep on file a copy of strategic outreach plan, referral agreements, documentation of meetings, outline of presentations, copy of ads, flight schedules of media, exhibitor confirmation letter, etc. *** Providers must bill at rates, based upon the cost of services determined through a cost allocation, not in excess of their usual and customary charge to the general public ** (OAR 309-016-0105 and OAR 309-016-0420) Note: Language in red font is updated or new language for fiscal year 2016-17.