| Service |
HPCS
Code |
Rate |
Unit |
Service Type |
Authorizations
per 30 day |
Range |
Assessment-continuing
care ASI |
Z3333 |
$45.00 |
Unit |
Clinical |
1 |
day |
| Case Management |
Z3363 |
$48.00 |
hour |
Enhancement |
8 |
day |
| Enhanced Detox |
Z334E |
$416.00 |
Day |
Medical |
7 |
weekly |
| Medical Follow-up |
|
$42.00 |
visit |
Medical |
1 |
day |
| Methodone Maintenance |
Z3357 |
$4.25 |
Day |
Medical |
30 |
weekly |
Outpatient / Family
Conference |
Z3349 |
$35.00 |
Hour |
Clinical |
4 |
day |
Outpatient / Family
Counseling |
Z3348 |
$49.00 |
Hour |
Clinical |
4 |
day |
Outpatient /
Group Therapy |
Z3355 |
$23.00 |
Hour |
Clinical |
4 |
day |
Outpatient /
Individual Half |
Z3358 |
$26.00 |
Half Hour |
Clinical |
4 |
day |
Outpatient /
Individual Full |
Z3354 |
$49.00 |
Half Hour |
Clinical |
4 |
day |
Outpatient /
Intensive |
Z3346 |
$71.00 |
Day |
Clinical |
16 |
day |
Outpatient /
Partial Care |
Z3344 |
$84.00 |
Day |
Clinical |
20 |
day |
Outpatient /
Prescription Visit |
Z3353 |
$4.50 |
Visit |
Medical |
4 |
day |
| Physical Exam |
|
$144.00 |
visit |
Medical |
1 |
day |
| Recovery Mentor |
|
$30.00 |
hour |
Enhancement |
6 |
day |
Residential /
Halfway House |
Z3339 |
$57.00 |
Day |
Clinical |
30 |
weekly |
Residential /
Long Term (TC) |
Z3337 |
$68.00 |
Day |
Clinical |
30 |
weekly |
Residential /
Short Term (TC) |
Z3335 |
$147.00 |
Day |
Clinical |
30 |
weekly |
| Suboxone Maintenance |
|
2mg/0.5mg-
$7.25 |
Day |
Medical |
30 |
weekly |
| |
|
8mg/2mg-
$9.84 |
|
Medical |
30 |
weekly |
| |
|
Subutex 2mg-
$7.92 |
|
Medical |
30 |
weekly |
| |
|
Subutex 8mg-
$11.38 |
|
Medical |
30 |
weekly |
| Transportation |
|
$8.00 |
hour |
Enhancement |
2 |
day |
| Urine Drug Screen |
Z3359 |
$8.00 |
unit |
Medical |
8 |
day |
| |
|
|
|
|
|
|
| Co-occurring |
|
|
|
|
|
|
| Medication Monitoring |
90862 |
$42.00 |
Unit |
Co-occurring |
2 |
|
| Psychiatric Evaluation |
90801 |
$32.00 |
Unit |
Co-occurring |
6 |
|
| Family Therapy |
90846 |
$49.00 |
Hour |
Co-occurring |
4 |
|
| Individual Therapy |
90806 |
$49.00 |
Hour |
Co-occurring |
4 |
|
| Clinical Consultation |
90887 |
$25.00 |
Unit |
Co-occurring |
6 |
|
| Co-Occurring Assessment |
90801A |
$0.00 |
Unit |
Co-occurring |
1 |
|
