MEDICAID/CMS BILLING CODES
INDIVIDUAL & FAMILY THERAPY - H2019-HR
Restrictions:
1. Billed in ¼-hour increments - 4 units (1 hour) maximum per day
2. Can involve client alone, family members alone, or both
3. Cannot be billed for consultation with school staff
4. Limited to 104 ¼-hour units (26 hours) per fiscal year (July 1-June 30) per client
5. Must be rendered by a “Master’s Level Practitioner”*
6. Cannot be billed in same day as TBOS, Day Treatment, or BHOS
*requires degree in social work, psychology, marriage & family therapy, or mental health counseling OR
other degree with 4 of the following graduate courses: human growth & development, diagnosis &
treatment of psychopathology, human sexuality, counseling theories & techniques, group theories &
practice, dynamics of marriage & family systems, individual evaluation & assessment, career & lifestyle
assessment, research & program evaluation, personality theories, social & cultural foundations,
counseling in community settings, substance use disorders
Definition:
Includes insight oriented, cognitive behavioral, or supportive therapy to an individual or family.
THERAPEUTIC BEHAVIORAL ON-SITE (TBOS)
TBOS-Therapy=H2019-HO (Master’s) or TBOS-Behavior Management=H2019-HN (Bachelor’s)
or TBOS-Therapeutic Supports=H2019-HM (non-degreed)
Restrictions:
1. Limited to clients under age 21 only
2. Must be provided in home or in school only
3. Client must be at risk of more intensive, restrictive behavioral health placement
4. Can involve family members alone (home only) or teacher alone (school only)
5. Billed in ¼-hour increments. Director approval needed for sessions longer than 1 hour.
6. Limited to 36 ¼-hour units (9 hours) per month, but restricted to what is authorized by
funder
7. TBOS-T: “Master’s Level Practitioner”* required; TBOS-B: Bachelor’s allowed if BCaBA
8. Cannot be billed in same day as Individual Therapy, Day Treatment, or BHOS
Definition:
Individual & family therapy, collaborative development of the formal aftercare plan
BRIEF BEHAVIORAL HEALTH STATUS EXAMINATION - H2010-HO
Restrictions:
1. Billed in ¼-hour increments
2. Medicaid limit is 2 billed units per day (but Adapt pays up to 3 units for LE)
3. May be billed up to 2 units in addition to Individual/Family on intake session by licensed
clinician
4. Required prior to the development of the treatment plan
5. Must be performed by a licensed practitioner
6. Must be performed face-to-face with client (not parents alone)
7. May not be billed in the same day as Bio-Psychosocial Evaluation
Definition:
Brief clinical, psychiatric, diagnostic, or evaluative interview to assess behavioral stability or
treatment status; must include purpose of exam, setting, mental status of the recipient,
findings, diagnostic formulation, and treatment recommendations.
Adapt Behavioral Services - Clinician Procedure Manual
Revised 08/14
GROUP THERAPY - H2019-HQ
Restrictions:
1. Billed in ¼-hour increments
2. Limited to 156 ¼-hour units (39 hours) per fiscal year (July 1-June 30)
3. May be rendered by a Bachelor’s-level practitioner
4. Total group size (both billed and not billed members) may not exceed 6
5. Can be billed for parent group without client present, as long as treatment to parent
group relates to each child’s treatment plan
6. Paid to staff as 1 unit per client per 1-hour session (4 clients=4 units=1 hour)
7. Cannot be billed in same day as TBOS, Day Treatment, or BHOS
Definition:
Includes cognitive behavioral, supportive therapy, or counseling
BIO-PSYCHOSOCIAL EVALUATION - H0031-HN
Restrictions:
1. Limited to one per year per client
2. Completed after the intake session
3. Cannot be billed on same date as intake session, Brief Behavioral Health Status, or InDepth Assessment
IN-DEPTH ASSESSMENT - H0031-HO
Restrictions:
1. Limited to one per year per client
2. Completed after the intake session
3. Cannot be billed on same date as intake session, Brief Behavioral Health Status, or BioPsychosocial
4. Client must meet one of the following criteria:
a. Documented need for more intense level of treatment (e.g., TBOS criteria met)
b. High risk (e.g., stepped down from or denied admission to inpatient setting)
c. Lack of significant progress after 6 months of intensive services
d. Client age 0-5 whose behavioral/emotional symptoms are atypical for that child’s
age and development
LIMITED FUNCTIONAL ASSESSMENT (CFARS OR FARS) - H0031
Restrictions:
1. Limited to 3 per year per client
2. Completed after intake session and every 6 months after intake
3. Completed after planned discharge session, and for administrative discharges within 3
weeks after last session
4. CFARS for clients age 0-17; FARS for clients age 18+
TREATMENT PLAN DEVELOPMENT - H0032
Restrictions:
1. Limited to one per agency per year (July 1-June 30)
2. Completed at the end of the intake session
TREATMENT PLAN REVIEW (TPR) - H0032-TS
Restrictions:
1. Limited to 4 per year per client
2. Provided every 3 months after intake
3. Also billed for signed Discharge Reviews (all HMO’s but not AHCA)
Adapt Behavioral Services - Clinician Procedure Manual
Revised 08/14