H0004 — Behavioral health counseling and therapy, per 15 minutes
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Baseline behavioral measurements of function;and
- Intensive in-home behavioral health services may be consideredmedically necessarywhenALLof the following selection criteria are met (A, B and C):
- There is documentation thatallof the followingSeverity of Illnesscriteria are met (1 through 7):Specific psychiatric symptoms or disturbances of mood or behavior, consistent with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases diagnosis listed, are linked to functional impairment and risk of serious harm;andThere are specific deficits directly related to the intensive in-home behavioral health services;andThe m [...]
- Specific psychiatric symptoms or disturbances of mood or behavior, consistent with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases diagnosis listed, are linked to functional impairment and risk of serious harm;and
- There are specific deficits directly related to the intensive in-home behavioral health services;and
- The member and significant others demonstrate motivation for treatment, are capable of benefiting from the treatment approach planned, and participate in treatment;and
1 Active Policy
ANTHEM-CG-BEH-14 — CG-BEH-14 Intensive In-home Behavioral Health Services
Related Codes
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