Does H0036 require prior authorization?

No, H0036 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for H0036?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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