90801 Psychiatric diagnostic interview examination 90802 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication. 90807 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, with medical evaluation and management services 45 to 50 minutes 90846 Family psychotherapy (without child present) 90847 Family psychotherapy (with child present) 96150 Health and behavior assessment utes 96151 Health and behavior re-assessment utes 96153 96154 96155 99510 G0154 Health and behavior intervention - 2 or more children Health and behavior intervention with family and child Health and behavior intervention with family without child Home visit for individual, family or marriage counseling Services of social worker in home health setting utes utes utes 96152 Health and behavior intervention (individual) utes Social Work & psychological services directly relating to and/or furthering the patient's G0409 rehabilitation goals H0002 Behavioral health screening to determine eligibility for admission to treatment program C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 1
H0004 Behavioral health counseling and therapy H0031 Mental health assessment by non-physician Mental health service plan development by H0032 non-physician H0046 Mental health svc not otherwise specified Family assessment by licensed health H1011 professional for state defined purposes H2014 Skills training and development H2019 Therapeutic behavioral services H2027 Psychoeducational services Developmental delay prevention activities, H2037 dependent child of client Co-visits Scheduled interdisciplinary conference professional G0175 N (minimum of three) with patient present Co-visits Co-visits Co-visits Developmental Evaluation professional professional T1024 T1025 professional T1026 N professional 96110 N N Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, psychosocial impairments Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, psychosocial impairments Developmental testing, limited, with interpretation & report Minimum of 3 disciplines Per diem 1 hour 1 hour C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 2
Developmental Evaluation professional 96111 Extended developmental testing (motor, language, social, affective, cognitive, by standardized instruments, with interpretation and report I hour Developmental Monitoring Family Training General visit Home visit Not Applicable T1023 professional T1027 N Screening to determine the appropriateness of considerartion of an individual for perticipation in a specified program, etc. Family training or counseling for child development professional T1015 N Clinic visit/ professional 99600 N Unlisted home visit service or procedure Nutritian Nutritian Group Nutritionist Nutritionist G0270 G0271 Medical nutrition therapy; re-assessment and subsequent intervention(s) following second referral in same year for change of diagnosis, medical condition or treatment regimen Medical nutrition group therapy; reassessment and subsequent intervention(s) following second referral in same year for change of diagnosis, medical condition or treatment regimen Nutrition Assessment Nutritionist 97802 Nutrition Therapy, initial assessment, consult utes Limit not designated Nutrition Assessment Nutritionist 97803 Nutrition re- assessment, consult utes Limit not designated Group Nutrition Therapy, initial assessment, Nutrition Assessment Nutritionist 97804 consult 30 minutes Limit not designated Therapist 97039 Unlisted Services & Procedures Unlisted Modality 30 min C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 3
Therapist 97110 Therapeutic Exercises utes Session limit 4 units Therapist 97112 Neuromuscular Reeducation utes Session limit 4 units Massage Therapy including effleurage, Therapist 97124 pertrissage, tapotement Session limit 4 units Traction Therapy, manual therapy techniques, Therapist 97140 manipulation. Prior authorization Therapist 97150 Group Therapeutic I unit per recipient Therapist 97530 Kinetic therapy Session limit 4 units Therapist 97532 Cognitive skills development Session limit 4 units Therapist 97533 Sensory Integration Session limit 4 units Therapist 97535 Activities of Daily Living utes Prior authorization Therapist 97542 Wheelchair Management/ propulsion utes Session limit 4 units Therapist 97755 Assistive Technology assessment utes With written report Therapist 97760 Orthotic Management and training utes Session limit 4 units Therapist H2014 Skills training and development Developmental delay prevention activities, Therapist H2037 dependent child of client Therapy 97003 Therapy Evaluation 1 per calendar yr C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 4
Therapy 97004 Therapy Re-evaluation 1 every 3 mos. Services of occupational therapist in home Therapy G0152 health setting PT/OT Assessment 97001 Physical Therapy Evaluation PT/OT Assessment 97002 Physical Therapy Re-evaluation 95831 Muscle and range of motion testing Hand, with or without comparison with 95832 normal side 95833 Total Evaluation of body, excluding hands 95834 Total Evaluation of body, including hands Range of motion measurements (not including 95851 hands) & report Range of motion measurements (including 95852 hands) & report 97110 Therapeutic Exercises utes Session limit 4 units 97112 Neuromuscular Reeducation utes Session limit 4 units 97116 Gait training Session limit 4 units 97124 Massage Therapy including effleurage, pertrissage, tapotement Session limit 4 units 97140 Joint mobilization/ manipulation Prior authorization 97530 Therapeutic Activities Session limit 4 units 97532 Cognitive skills development Session limit 4 units 97533 Sensory Integration Session limit 4 units C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 5
97535 Fitting, measuring, customizing, instructing for use of AT device utes Prior authorization 97750 Physical Performance test utes With written report 97755 Assistive Technology assessment utes With written report 97760 Orthotic Management and training utes Session limit 4 units 97762 Check out for Orthotic/ Prosthetic Use utes Session limit 4 units 97799 Unlisted Services and Procedures Not covered G0151 Services of physical therapy in home or health setting Not covered S8990 Physical or manipulative therapy performed for maintance rather than restoration Not covered Physical Therapy Physical Therapy S9131 Physical therapy in home per diem per diem Not covered V57.1 Other physical therapy Not covered V57.81 Orthotic Training Not covered Services of physical therapist in home health G0151 setting Developmental delay prevention activities, H2037 dependent child of client & Language 92506 Evaluation of speech, language, voice, communication and/or auditory processing I evaluation per calendar year C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 6
& Language 92507 & Language 92526 and Hearing G0153 and Hearing H2037 and Hearing Treatment of speech, language, voice, communication, &/or auditory processing disorder: individual Treatment of swallowing dysfunction and/or function for feeding Services of speech and language pathologist in home health setting Developmental delay prevention activities, dependent child of client Repair/modification of augmentative communicative system or device. (not hearring aide) Per event 4 procedures per day Procedure/ Limit 1 unit V5336 N and Hearing V5362 Screening and Hearing V5363 Language screening and Hearing V5364 Dysphsia screening and Language Diagnostic analysis of cochlear implant w/ 92601 programming, child under age 7 Under age 7 only and Language Diagnostic analysis of cochlear implant w/ 92602 programming, child under age 7 Under age 7 only Evaluation for prescription of non-speech and Language generating augmentative & alternative 92605 communication device. Limit not specified and Language 92606 Therapeutic service(s) for the use of nonspeech generating device, including programming and modification. Limit not specified and Language 92607 Evaluation for prescription for speechgenerating augmentative and alternative communication device, face to face, first hour 1st Hour C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 7
and Language and Language and Language and Language and Language 92608 92609 92610 Evaluation for prescription for speechgenerating augmentative and alternative communication device each additional 30 minutes Therapeutic services for the use of speechgenerating device, including programming and modification Evaluation of oral and pharyngeal swallowing function additional 30 minute increments Add on to 92607 97532 Cognitive skills development Session limit 4 units 97533 Sensory Integration Session limit 4 units C:\Documents and Settings\dackerman.SUNNOXFORD\Local Settings\Temporary Internet Files\OLKCD\Copy of ICD9 s_4 15_2011 4.xls Page 8