| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Health Risk Assessment | Procedure Definition (Developed by CalMHSA) Administration and review/interpretation of findings related to health risk assessments. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR SUD Screening | Procedure Definition (Developed by CalMHSA) Screening to determine the appropriate services for an individual seeking treatment. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Alcohol and/or drug screening | Procedure Definition (Developed by CalMHSA) Used to document administration/review of alcohol and/or drug screening. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Alcohol and/or drug screening. Laboratory analysis | Procedure Definition (Developed by CalMHSA) Laboratory results review/interpretation/analysis related to an alcohol and/or drug screening. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Contingency Management | Procedure Definition (Developed by CalMHSA) This procedure must be used to submit claims for Contingency Management Services. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR SUD Crisis Intervention | Procedure Definition (Developed by CalMHSA) SUD Crisis Intervention Services consist of contacts with a beneficiary in crisis. A crisis means an actual relapse or an unforeseen event or circumstance, which presents to the beneficiary an imminent threat of relapse.�These services should focus on alleviating the crisis problem, be limited to the stabilization of the beneficiary�s immediate situation and be provided in the least intensive level of care that is medically necessary to treat their condition. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Group Counseling | Procedure Definition (Developed by CalMHSA) Group counseling related to alcohol and/or drug services. 15 minutes |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Acute Detox (hospital inpatient) | Procedure Definition (Developed by CalMHSA) This code falls under "Recovery Services". Used to document acute detoxification-related services in an inpatient hospital setting. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Sub-acute detox (hospital inpatient) | Procedure Definition (Developed by CalMHSA) This code falls under "Recovery Services". Used to document subacute detoxification-related services in an inpatient hospital setting. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Lab Specimen Collection | Procedure Definition (Developed by CalMHSA) Used to document administration of alcohol and/or other drug testing when collecting and handling specimens other than blood. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR AOD Treatment | Procedure Definition (Developed by CalMHSA) This code falls under "Recovery Services". Used to document alcohol and/or other drug treatment program services. Per hour |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Alcohol and/or substance (other than tobacco) abuse screening | Procedure Definition (Developed by CalMHSA) Completion of alcohol and/or substance abuse (other than tobacco) structural screening (AUDIT, DAST) and brief intervention (SBI). 99408: 15-30 minutes 99409: Greater than 30 minutes |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR ASAM or other structured SUD Assessment | Procedure Definition (Developed by CalMHSA) Documents determination of ASAM criteria and each code is for a different amount of time: G2011: 5-14 minutes G0396: 15-30 minutes G0397: 30+ minutes Can also be used for other structured SUD assessments. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Family/Couple Counseling | Procedure Definition (Developed by CalMHSA) Alcohol and/or substance abuse services provided with a family/couple. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Discharge Planning | Procedure Definition (Developed by CalMHSA) Utilized when developing discharge summaries and/or discharge plans and reviewing these documents with the beneficiary. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Application of On-body Injector for Timed Subcutaneous Injection | Procedure Definition (Developed by CalMHSA) Application of on-body injector (includes cannula insertion) for timed subcutaneous injection. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Assessment of aphasia | Procedure Definition (Developed by CalMHSA) Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report. Per hour |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Individual Counseling | Procedure Definition (Developed by CalMHSA) Individual Counseling consists of contacts with a beneficiary. Individual counseling can include contact with family members or other collaterals if the purpose of the collateral�s participation is to focus on the treatment needs of the beneficiary by supporting the achievement of the beneficiary's treatment goals. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Brief Emotional/Behavioral Assessment | Procedure Definition (Developed by CalMHSA) Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Care Management Services for Behavioral Health Conditions by Physician | Procedure Definition (Developed by CalMHSA) Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: *Initial assessment or follow-up monitoring, including the use of applicable validated rating scales, *Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, *Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and *Continuity of care with a designated member of the care team. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Caregiver Assessment Administration of Care-Giver Risk Assessmt | Procedure Definition (Developed by CalMHSA) Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Care Coordination Outside System of Care | Procedure Definition (Developed by CalMHSA) For SMHS: This service is designated by HCPCS code H2021 and refers to coordination of care between providers in the Mental Health System and providers who are outside the Mental Health system. H2021 can only be used to show that a delivery-system coordination of care has occurred. For other kinds of coordination, other service codes must be used. Per 15 minutes. For DMC & DMC-ODS: This service is designated by HCPCS code H2021 and refersto coordination of care between providers in the Drug Medi-Cal System and providers who are outside the Drug medi-Cal System. H2021 can only be used to show that a delivery-system coordination of care has occurred. For other kinds of coordination, other service codes must be used. Per 15 minutes. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Comprehensive Community Supports | Procedure Definition (Developed by CalMHSA) Services related to helping patients access needed medical, social, educational, and other health-related services. Per 15 minutes. For DMC-ODS this is a "Recovery Service" and for DMC this is a "Treatment Planning" service. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Comprehensive Multidisciplinary Evaluation | Procedure Definition (Developed by CalMHSA) Services related to the completion of a multidisciplinary evaluation (i.e. an evaluation that is administered and informed by professionals from various areas of expertise). 15 minutes |
| DMC State Plan Y | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Intervention | Procedure Definition (Developed by CalMHSA) A service, lasting less than 24 hours, to or on behalf of a beneficiary for a condition that requires more timely response than a regularly scheduled visit. Service activities include but are not limited to one or more of the following: assessment, collateral and therapy. Clinical providers who are providing crisis intervention should consider whether Psychotherapy for Crisis would be a more appropriate code for the service rendered. Per 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Developmental Screening | Procedure Definition (Developed by CalMHSA) Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Developmental Testing | Procedure Definition (Developed by CalMHSA) Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report. First hour |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR ECT | Procedure Definition (Developed by CalMHSA) Provision of electroconvulsive therapy inclusive of necessary monitoring related to the procedure. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Environmental intervention for medical mgmt purposes on a psych patient's b | Procedure Definition (Developed by CalMHSA) Working with agencies, employers, or institutions to address a patient's physical environment as a means to address psychiatric needs/care. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Family Therapy - client present | Procedure Definition (Developed by CalMHSA) "Family Therapy" services for the purposes of improving the beneficiary's functioning. The patient must be present for this service. Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary�s functioning and at which the beneficiary is present. 26-50 minutes |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Family Therapy - client not present | Procedure Definition (Developed by CalMHSA) "Family Therapy" services for the purposes of improving the beneficiary's functioning. The patient does not have to be present for this service. Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary�s functioning and at which the beneficiary is present. 26-50 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Group Therapy | Procedure Definition (Developed by CalMHSA) Documents provision of "typical" group therapy services that include multiple beneficiaries. Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary�s functioning and at which the beneficiary is present. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Health Behavior Intervention - with Family | Procedure Definition (Developed by CalMHSA) Includes supporting improvements in function, minimizing psychological and/or psychosocial barriers to recovery, and improved coping skills related to medical conditions. Patient is not present. 16-30 minutes |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Home Visit of a New Patient | Procedure Definition (Developed by CalMHSA) Evaluation & Management service of new patient provided in the individual's home. Procedures should be selected based on direct service time. "New Patient" = The individual has not received any professional services within the last three years from the physician, or another physician of the same specialty who belongs to the same group practice. 99341: 15-25 minutes, 99342: 26-35 minutes, 99343: 36-50 minutes, 99344: 51-65 minutes, 99345: 66-80 minutes |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Home Visit of an Established Patient | Procedure Definition (Developed by CalMHSA) Evaluation & Management service of new patient provided in the individual's home. Each CPT code includes an associated time. "Established Patient" = The individual has received professional services within the last three years from the physician, or another physician of the same specialty who belongs to the same group practice. 99347: 10-20 minutes, 99348: 21-35 minutes, 99349: 36-50 minutes, 99350: 51-70 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Hypnotherapy | Procedure Definition (Developed by CalMHSA) Documents provision of hypnotherapy services which include an artificially induced alteration of consciousness in which the patient is in a state of increased suggestibility. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR E&M Nursing Facility (professional fees) | Procedure Definition (Developed by CalMHSA) 99304: Initial nursing facility care visit involving evaluation and management (E/M). Straightforward or low medical decision making or at least 25 minutes of total time. 99305: Initial nursing facility care visit involving evaluation and management (E/M). Moderate medical decision making or at least 35 minutes of total time. 99306: Initial nursing facility care visit involving evaluation and management (E/M). High medical decision making or at least 45 minutes of total time. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Inpatient Med Support | Procedure Definition (Developed by CalMHSA) 99252: Inpatient or observation consultation involving evaluation and management (E/M). Straightforward level of medical decision making or at least 35 minutes of total time. 99253: Inpatient or observation consultation involving evaluation and management (E/M). Low level of medical decision making or at least 45 minutes of total time. 99254: Inpatient or observation consultation involving evaluation and management (E/M). Moderate level of medical decision making or at least 60 minutes of total time. 99255: Inpatient or observation consultation involving evaluation and management (E/M). High level of medical decision making or at least 80 minutes of total time. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Physician Consultation | Procedure Definition (Developed by CalMHSA) Utilized to document time spent by a consulting physician to access data/information via an EHR, telephone, internet, performing data review and/or analysis and concludes with completing a written report. 5-15 minutes. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Intravenous Infusion, for Therapy, Prophylaxis, or Diagnosis | Procedure Definition (Developed by CalMHSA) Utilized to document Intravenous infusion, for therapy, prophylaxis or diagnosis (specify substance or drug), initial, 1-60 minutes |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medical Team Conference, Participation by Physician. Pt and/or Family Not Pr | Procedure Definition (Developed by CalMHSA) Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medication Training and Support | Procedure Definition (Developed by CalMHSA) Medication education, training and support, monitoring/discussing/reviewing side effects. Per 15 minutes. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Multiple-Family Group Psychotherapy | Procedure Definition (Developed by CalMHSA) A group therapy code that allows for documentation of groups that include multiple families vs. a single family. Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary�s functioning and at which the beneficiary is present. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Nacrosynthesis for Psychiatric Diagnostic and Therapeutic Purposes | Procedure Definition (Developed by CalMHSA) Documents administration of a narcotic drug to induce a state that aids in the development of a psychiatric diagnosis and treatment. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Neurobehavioral Status Exam | Procedure Definition (Developed by CalMHSA) Neurobehavioral status exams include assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities). Includes both face-to-face time as well as time interpreting test results and preparing reports. First hour |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Neuropsychological Testing Evaluation | Procedure Definition (Developed by CalMHSA) Neuropsychological testing includes services such as interpreting/evaluating results of cognitive/neurological assessments, integrating data and planning for next steps in care. First hour |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Observation or Inpatient Hospital Care, Including Admit/Disc Same Date | Procedure Definition (Developed by CalMHSA) Hospital inpatient or observation care services that are provided to patients who are admitted and discharged on the same day. This requires two or more encounters on the same date of services with one being an initial admission encounter and the other being a discharge encounter. 99234: Straightforward or low level of medical decision making or at least 45 minutes of total time. 99235: Moderate level of medical decision making or at least 70 minutes of total time. 99236: High level of medical decision making or at least 85 minutes of total time. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Consults for New and Established Patients | Procedure Definition (Developed by CalMHSA) 99242: The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). Straightforward medical decision making or at least 21 minutes of total time. 99243: The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). Low level of medical decision making or at least 30 minutes of total time. 99244: The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). Moderate level of medical decision making or at least 40 minutes of total time. 99245: The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). High level of medical decision making or at least 55 minutes of total time. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medication Support Existing Client | Procedure Definition (Developed by CalMHSA) Used to document evaluation and management medication support services provided to established/existing patients who have had a visit in the last 3 years. This can also be used for services provided via audio & video together (video meetings). "Established/Existing Patient" = The individual has received professional services within the last three years from the physician, or another physician of the same specialty who belongs to the same group practice. 99212: 10-19 minutes, 99213: 20-29 minutes, 99214: 30-39 minutes, 99215: 40-54 minutes *These codes use the same psych note template and so previous data will be saved from the last note. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medication Support New Client | Procedure Definition (Developed by CalMHSA) Used to document evaluation and management medication support services provided to new patients where it has been greater than 3 years since their last visit. "New Patient" = The individual has not received any professional services within the last three years from the physician, or another physician of the same specialty who belongs to the same group practice. 99202: 15-29 minutes, 99203: 30-44 minutes, 99204: 45-59 minutes, 99205: 60-74 minutes *These codes use the same psych note template and so previous data will be saved from the last note. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medication Administration | Procedure Definition (Developed by CalMHSA) Administration of oral medication with direct observation. 15 minutes. This code is also used by LVNs/LPTs and Pharmacists to document the administration of injectable medications. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Prenatal Risk Assessment | Procedure Definition (Developed by CalMHSA) Administration of risk assessment related to prenatal care. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Report Generation for Care Coordination | Procedure Definition (Developed by CalMHSA) Utilized to document preparing reports for other individuals, agencies, etc. for the purposes of care coordination. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Assessment LPHA | Procedure Definition (Developed by CalMHSA) Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. Although physicians and other qualified medical staff are permitted to utilize this code, this procedure code is mainly utilized by non-physician clinical staff who are documenting services that would typically fall under the category of "Assessment". 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Assessment MD | Procedure Definition (Developed by CalMHSA) This procedure code is mainly utilized by physicians and other qualified healthcare providers to document "Psychiatric Evaluation" services, including determination of a diagnosis. Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Review of Hospital Records | Procedure Definition (Developed by CalMHSA) Review of records for psychiatric evaluation without direct patient contact. This may be accomplished at the request of an agency or peer review organization. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychoanalysis | Procedure Definition (Developed by CalMHSA) Therapy that places focus on unconscious and strengthening an individual's relationship with their unconscious. 15 minutes |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Psychoeducation | Procedure Definition (Developed by CalMHSA) Includes providing information regarding mental illness and substance abuse and teaches problem-solving, communication, and coping skills to support recovery and resilience. Per 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychological or Neuropsychological Test Administration | Procedure Definition (Developed by CalMHSA) Psychological or neurological test administration and scoring (by a physician or other qualified healthcare provider), two or more tests and any method. First 30 minutes |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Psychological Testing | Procedure Definition (Developed by CalMHSA) Administration, review, explanation of psychological testing instruments/tools. First hour. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Psychosocial Rehab - Individual | Procedure Definition (Developed by CalMHSA) For SMHS, "Rehabilitation� means a service activity which includes, but is not limited to assistance in improving, maintaining, or restoring a beneficiary�s or group of beneficiaries� functional skills, daily living skills, social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and support resources; and/or medication education. Per 15 minutes. For DMC-ODS, rehabilitation falls under "Recovery Services" and can document education related to mental health, substance abuse, independent living, social, coping and interpersonal skills, relapse prevention, etc. Per 15 minutes. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychotherapy for Crisis | Procedure Definition (Developed by CalMHSA) The individual must be present for all or part of the service. Urgent assessment and exploration of an individual in crisis. Includes mental status exam as well as a disposition and treatment includes therapy, mobilization of resources and implementation of interventions to address the crisis. 30-74 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Individual Therapy | Procedure Definition (Developed by CalMHSA) "Individual Therapy" services provided to a beneficiary focused primarily on symptom reduction and restoration of functioning as a means to improve coping and adaptation and reduce functional impairments. Therapeutic intervention includes the application of cognitive, affective, verbal or nonverbal strategies based on the principles of development, wellness, adjustment to impairment, recovery and resiliency to assist a beneficiary in acquiring greater personal, interpersonal and community functioning or to modify feelings, thought processes, conditions, attitudes or behaviors which are emotionally, intellectually, or socially ineffective. Each Psychotherapy with Patient CPT represents a specific length of time: 90832: 30 minutes, 90834: 45 minutes and 90837: 60 minutes. The beneficiary must be present for these services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychotherapy with Patient with an EM Service | Procedure Definition (Developed by CalMHSA) Utilized to document when psychotherapy services were provided as part of an evaluation and management service. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Client Education | Procedure Definition (Developed by CalMHSA) The DHCS billing manual states that this should be utilized to submit claims for Patient Education Services. Per 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Cognitive Testing | Procedure Definition (Developed by CalMHSA) Services that document the administration of standardized cognitive performance testing. Per hour |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Subcutaneous Infusion for Therapy or Prophylaxis, Initial | Procedure Definition (Developed by CalMHSA) Documents setting up of infusion pump, establishing a subcutaneous port site, and infusing a medication via the pump for a period up to one hour for prevention or therapeutic purposes. 15-60 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR TMS ongoing | Procedure Definition (Developed by CalMHSA) Subsequent delivery and management of therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; including cortical mapping, motor threshold determination, delivery and management. Per session. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR E&M Hospital Inpatient | Procedure Definition (Developed by CalMHSA) 99231: Subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). Straightforward or low level of medical decision making or at least 25 minutes of total time. 99232: Subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). Moderate level of medical decision making or at least 35 minutes of total time. 99233: Subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). High level of medical decision making or at least 50 minutes of total time. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR E&M Nursing Facility - Established Client | Procedure Definition (Developed by CalMHSA) The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the provider spends at least 10 minutes of total time. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR TCM/ICC | Procedure Definition (Developed by CalMHSA) Services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral; monitoring service delivery to ensure beneficiary access to service and the service delivery system; monitoring of the beneficiary�s progress; placement services; and plan development. Each 15 minutes. This is also the code utilized to capture Intensive Care Coordination (ICC) services. Targeted Case Management is a type of Care Coordination code that can be used by DMC-ODS providers. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Medication Support Telephone | Procedure Definition (Developed by CalMHSA) Evaluation & Management services provided by telephone. 99441: 5-10 minutes, 99442: 11-20 minutes 99443: 21-30 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR TBS | Procedure Definition (Developed by CalMHSA) Therapeutic Behavioral Services (TBS) is an adjunctive program that supports other services patients are currently receiving. TBS is an intensive, individualized, one-to-one behavioral health service available to children/youth with serious emotional challenges and their families, who are under 21 years old and have full-scope Medi-Cal. Per 15 minutes. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR TMS Initial | Procedure Definition (Developed by CalMHSA) Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management, per session. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Therapeutic, Prophylactic, or Diag Injection; Single or Initial Substance/D | Procedure Definition (Developed by CalMHSA) Intravenous push, single or initial substance/drug. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Medication Injection | Procedure Definition (Developed by CalMHSA) Utilized to document psychiatric medication intramuscular and subcutaneous injections. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Therapeutic, Prophylactic, or Diagnostic Injection; Intra-Arterial | Procedure Definition (Developed by CalMHSA) Utilized to document intra-arterial injections. 15 minutes |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR TMS Calibration | Procedure Definition (Developed by CalMHSA) Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; re-determination, including cortical mapping, motor threshold determination, delivery and management. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Transitional Care Management Svcs, Direct Communication within 14 calendar | Procedure Definition (Developed by CalMHSA) Services that support transition of patients from one care setting to another. Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge. Medical decision-making of at least moderate complexity during the service period. Includes a face-to-face visit, within 14 calendar days of discharge. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Transitional Care Management Svcs, Direct Communication within 7 calendar d | Procedure Definition (Developed by CalMHSA) Services that support transition of patients from one care setting to another. Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge. Medical decision-making of high complexity during the service period. Includes a face-to-face visit, within 7 calendar days of discharge. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychiatric Inpatient Day - Adult | Procedure Definition (Developed by CalMHSA) Utilized to document general inpatient psychiatric services provided to individuals 21 through 64. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR E&M Nursing Facility - New Client | Procedure Definition (Developed by CalMHSA) 99308: Subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 15 minutes of total time. 99309: Subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider spends at least 30 minutes of total time. 99310: Subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends at least 45 minutes of total time. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychiatric Inpatient Day - Youth | Procedure Definition (Developed by CalMHSA) Utilized to document general inpatient psychiatric services provided to individuals under 21 years of age. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Methadone - Day Service | Procedure Definition (Developed by CalMHSA) Methadone administration and/or service (provision of the drug by a licensed program) |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychiatric Inpatient Day - Older Adult | Procedure Definition (Developed by CalMHSA) Utilized to document general inpatient psychiatric services provided to individuals age 65 and older. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR General Inpatient - Admin Day | Procedure Definition (Developed by CalMHSA) Documentation of administrative days during a general inpatient hospitalization. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychiatric Hospital Inpatient Admin Day | Procedure Definition (Developed by CalMHSA) Documentation of administrative days during a psychiatric inpatient hospitalization. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Psychiatric Health Facility Day | Procedure Definition (Developed by CalMHSA) Inclusive of services provided within a psychiatric health facility (PHF) |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Therapeutic Foster Care | Procedure Definition (Developed by CalMHSA) Short-term, intensive, highly coordinated, trauma informed and individualized SMHS activities (plan development, rehabilitation and collateral) to children and youth up to age 21 who have complex emotional and behavioral needs and who are placed with trained, intensely supervised and supported TFC parents. The TFC parent serves as a key participant in the therapeutic treatment process of the child or youth. TFC is intended for children and youth who require intensive and frequent mental health support in a family environment. The TFC service model allows for the provision of certain SMHS activities (plan development, rehabilitation and collateral) available under the EPSDT benefit as a home-based alternative to high level care in institutional settings such as group homes and an alternative to Short Term Residential Therapeutic Programs (STRTPs |
| DMC State Plan Y | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Residential Day - Older Adult | Procedure Definition (Developed by CalMHSA) Children�s-Adult Crisis Residential: Geriatric services. |
| DMC State Plan Y | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Residential Day - Adult | Procedure Definition (Developed by CalMHSA) Children�s-Adult Crisis Residential: Non-Geriatric services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Residential Day - Youth | Procedure Definition (Developed by CalMHSA) Children�s-Adult Crisis Residential services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Adult Residential Day - Older Adult | Procedure Definition (Developed by CalMHSA) Adult Residential: Geriatric services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Adult Residential Day | Procedure Definition (Developed by CalMHSA) Adult Residential: Non-Geriatric services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Stabilization - Emergency Room Services | Procedure Definition (Developed by CalMHSA) Crisis Stabilization: Emergency Room services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Stabilization Unit | Procedure Definition (Developed by CalMHSA) Crisis Stabilization: Urgent Care services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Day Treatment Intensive - Half Day | Procedure Definition (Developed by CalMHSA) Half Day of Day Treatment Intensive services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Day Treatment Intensive - Full Day | Procedure Definition (Developed by CalMHSA) Full Day of Day Treatment Intensive services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Day Rehabilitation - Half Day | Procedure Definition (Developed by CalMHSA) Half Day of Day Rehabilitation services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Day Rehabilitation - Full Day | Procedure Definition (Developed by CalMHSA) Full Day of Day Rehabilitation services. |
| DMC State Plan N | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Psychosocial Rehabilitation Group | Procedure Definition (Developed by CalMHSA) For SMHS, "Rehabilitation� means a service activity which includes, but is not limited to assistance in improving, maintaining, or restoring a beneficiary�s or group of beneficiaries� functional skills, daily living skills, social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and support resources; and/or medication education. For DMC-ODS, rehabilitation falls under "Recovery Services" and can document education related to mental health, substance abuse, independent living, social, coping and interpersonal skills, relapse prevention, etc. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Care Coordination Outside System of Care Group | Procedure Definition (Developed by CalMHSA) For SMHS: This service is designated by HCPCS code H2021 and refers to coordination of care between providers in the Mental Health System and providers who are outside the Mental Health system. H2021 can only be used to show that a delivery-system coordination of care has occurred. For other kinds of coordination, other service codes must be used. Per 15 minutes. For DMC & DMC-ODS: This service is designated by HCPCS code H2021 and refers to coordination of care between providers in the Drug Medi-Cal System and providers who are outside the Drug medi-Cal System. H2021 can only be used to show that a delivery-system coordination of care has occurred. For other kinds of coordination, other service codes must be used. Per 15 minutes. |
| DMC State Plan Y | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Residential Treatment -Substance Use | Procedure Definition (Developed by CalMHSA) H0012: Alcohol and/or drug services: (residential addiction program outpatient). Subacute detoxification (DMC-ODS ONLY) H0019: Behavioral Health; Long Term Residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days) without room and board (Both DMC and DMC-ODS) |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR General Outreach | Procedure Definition (Developed by CalMHSA) An outreach activity not tied to a specific client. For example: running a mental health/behavioral health booth at a local fair. This would be used in conjunction with an Organizational Client. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Targeted Outreach | Procedure Definition (Developed by CalMHSA) An outreach activity tied to a specific client. For example: law enforcement has a list of high-risk individuals that county MH is reaching out to in order to get them into treatment. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Quality Improvement Activities | Procedure Definition (Developed by CalMHSA) Any type of Quality Improvement and/or administrative time, such as chart review, attending a QI-related meetings, etc. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Consults to External Providers (Non-billable) | Procedure Definition (Developed by CalMHSA) Documents consults with physical health care providers, primary care providers or other relevant healthcare providers. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Transportation | Procedure Definition (Developed by CalMHSA) Documents services that are strictly transportation-related. If a billable service was provided during the transport, the appropriate billable procedure code should be selected. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Client Non Billable Srvc Must Document | Procedure Definition (Developed by CalMHSA) Any other non-billable service that must be documented and is not better accounted for by other available non-billable procedure codes. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Initial hospital care, per day, for the evaluation and management of a patient | Procedure Definition (Developed by CalMHSA) Initial hospital inpatient or observation care for the evaluation and management of a patient. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev Prob Identification-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev Education-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev Community Based-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev Info Dissemination-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev Environ Strategy-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Prev-Alternatives-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded primary prevention activities using this strategy |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Quality Assurance-AOD | Procedure Definition (Developed by CalMHSA) Used to track SABG funded quality assurance activities |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Transportation Mileage | Procedure Definition (Developed by CalMHSA) Mobile Crisis Add On - Used when transporting a client to a treatment facility; measures mileage |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Transportation, Staff Time | Procedure Definition (Developed by CalMHSA) Mobile Crisis Add On - Used when transporting a client to a treatment facility OR when accompanying a client being transported by law enforcement, ambulance, or other valid transportation method; measures time spent during the transportation |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Inpatient Psychiatric Procedure | Procedure Definition (Developed by CalMHSA) Used to document a non-billable psychiatric procedure done in an inpatient unit |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Shift Summary | Procedure Definition (Developed by CalMHSA) Used to document a Shift Summary note when a client is in an inpatient or residential facility. This is a non-billable service, as the services will be bundled for these facilities. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Non-Billable Bed Procedure | Procedure Definition (Developed by CalMHSA) Used to track non-billable bed days or bed procedures not otherwise captured elsewhere for facilities that do bed management (IP/CSU/Res) |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Brief Contact Note | Procedure Definition (Developed by CalMHSA) Used to document a brief, non-treatment services contact with the client, such as confirming an appointment. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Ambulatory Withdrawal Management | Procedure Definition (Developed by CalMHSA) Alcohol and/or drug services; ambulatory detoxification. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Residential Daily Note | Procedure Definition (Developed by CalMHSA) Used to document your daily summary note for residential services. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Crisis Inquiry | Procedure Definition (Developed by CalMHSA) To be utilized in no-episode programs for crisis calls. This bills the same as Crisis Intervention. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Non-Billable Attempted Contact | Procedure Definition (Developed by CalMHSA) To be utilized when documenting attempts to contact a client but have been unsuccessful in reaching them. |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Residential Withdrawal Management | Procedure Definition (Developed by CalMHSA) SUD Residential Withdrawal Management day service |
| DMC State Plan N | DMC-ODS Y | MH N | Procedure Name Displayed in EHR Partial Hospitalization-Substance Use | Procedure Definition (Developed by CalMHSA) S0201: Partial Hospitalization Services; less than 24 hours, per diem (DMC-ODS ONLY). |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Attestation Note | Procedure Definition (Developed by CalMHSA) Used for attendings if they want to add any additional context to the original note by residents/NP. We recommend attaching this note to the original note written by the resident/NP. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Electronic Based Psych Assessment | Procedure Definition (Developed by CalMHSA) Used for automated testing and results for psychological/neuropsycholgoical testing. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Medical Non-Billable Note | Procedure Definition (Developed by CalMHSA) Used for documenting clinical and medical activity for which there is no existing code. (eg. reviewed, labs, charts, and messages without any patient or with other care providers interactions and/or when reviewing hospital records, it was not in conjunction with influencing the diagnosis). |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Legal Report Writing Note | Procedure Definition (Developed by CalMHSA) Used when writing reports or documentation for court or legal procedings, including LPS Conservatorship assessments, JV220s, or other court-related documents. This is also used for other reports, such as making CPS or APS reports, entering state reporting items, or writing grant-required reports for a specific client. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR CARE Act - Notice Activity | Procedure Definition (Developed by CalMHSA) Used when a staff member is drafting noticies for CARE Act processes, including all hearing and appearance notices, CARE Agreement notices, etc. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR CARE Act - Outreach and Engagement | Procedure Definition (Developed by CalMHSA) Used for documenting all outreach and engagement activities required to engage the respondent. Also used when developing a CARE Agreement with the respondent. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR CARE Act - Court Report Activity | Procedure Definition (Developed by CalMHSA) Used when a staff member is drafting needed reports for CARE Act processes, including CARE Agreement, Clinical Evaluation, CARE Plan, etc. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR CARE Act - Hearing Time | Procedure Definition (Developed by CalMHSA) Used to document activities that occur and time spent during CARE Act hearings. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Mobile Crisis Encounter | Procedure Definition (Developed by CalMHSA) Used when the Mobile Crisis Team is dispatched to a site to address a person's crisis. This is a bundled service and will bill a flat rate regardless of time indicated. It is recommended that staff continue to track the time spent on each encounter. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Mobile Crisis Dispatch Screening | Procedure Definition (Developed by CalMHSA) Used to document the screening provided to determine if the Mobile Crisis Team is dispatched to a location or not. |
| DMC State Plan Y | DMC-ODS Y | MH Y | Procedure Name Displayed in EHR Mobile Crisis Follow-Up | Procedure Definition (Developed by CalMHSA) Used to document required follow-ups for Mobile Crisis Encounter. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR CARE Act - Data Reporting | Procedure Definition (Developed by CalMHSA) Used for data reporting activities related to the CARE Act |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR PEI Outreach | Procedure Definition (Developed by CalMHSA) Used to track MHSA PEI outreach activities. This will often use a pseudo-client, as many are not targeted to a specific client, but rather community-held outreach events. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Room and Board | Procedure Definition (Developed by CalMHSA) Used to track Room and Board services. These aren't billable to Medi-Cal but may need to be tracked for other reimbursement or tracking purposes. |
| DMC State Plan - | DMC-ODS - | MH - | Procedure Name Displayed in EHR Bed Hold Day | Procedure Definition (Developed by CalMHSA) Non-billable code to use when you're holding a bed for a specific client, but they're currently not occupying that bed. |
| DMC State Plan N | DMC-ODS N | MH Y | Procedure Name Displayed in EHR Hospital discharge day management | Procedure Definition (Developed by CalMHSA) Hospital Discharge Day Management Services, CPT code 99238 or 99239 is a face-to-face evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay. Only the attending physician of record reports the discharge day management service. Physicians or qualified nonphysician practitioners, other than the attending physician, who have been managing concurrent health care problems not primarily managed by the attending physician, and who are not acting on behalf of the attending physician, shall use Subsequent Hospital Care (CPT code range 99231 � 99233) for a final visit. (CMS Pub 100-04) |
Updated 4/9/24