Home Behavioral Healthcare Services
Number: 0730
Table Of Contents
PolicyApplicable CPT / HCPCS / ICD-10 Codes
Background
References
Policy
Scope of Policy
This Clinical Policy Bulletin addresses home behavioral healthcare services.
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Medical Necessity
Subject to applicable benefit plan terms and limitations, Aetna considers provision of skilled behavioral health services in the home medically necessary when all of the following criteria are met:
- The services are ordered by a physician or independently licensed behavioral health professional (BHP) (e.g., psychiatrist, psychologist, and social worker or professional counselor licensed to practice without supervison in their State) and are directly related to an active treatment plan of care established by the physician or licensed BHP; and
- The skilled behavioral health care is appropriate for the active treatment of a condition, illness or disease; and
- The skilled behavioral health care is intermittent or hourly in natureFootnotes for Intermittent or part-time skilled home behavioral health care*; and
- The skilled behavioral health care is provided under the supervision of an independently licensed BHP; and
- The services are provided in lieu of a continued hospitalization, confinement in a residential treatment facility (RTF), or receiving outpatient services outside of the home; and
- The treatment provided is appropriate for the member's condition including the amount of time spent providing the service as well as the frequency, type and duration of the services; and
- The behavioral health services provided are not primarily for the comfort or convenience of the member or family or custodial in natureFootnotes for Custodial care **.
Footnotes for Intermittent or part-time skilled home behavioral health care * Intermittent or part-time skilled home behavioral health care is defined as a visit of up to 1 hour in duration.
Footnotes for Custodial care** Custodial care is defined as services and supplies furnished to a person mainly to help him or her with activities of daily living. Custodial care includes services and supplies:
- Furnished mainly to train or assist the insured family member in personal hygiene and other activities of daily living rather than to provide therapeutic treatment; or
- That can be safely and adequately provided by persons without the technical skills of a health care provider (e.g., nurse).
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Policy Limitations and Exclusions
Note: Skilled home behavioral healthcare services are covered under the member’s behavioral healthcare benefit. Please check benefit plan descriptions.
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Related Policies
Code | Code Description |
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Other CPT codes related to the CPB: |
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99341 | Home visit for the evaluation and management of a new patient, which requires these three key components: - A problem focused history; - A problem focused examination; and - Straightforward medical decision making. |
99342 | Home visit for the evaluation and management of a new patient, which requires these three key components: - An expanded problem focused history; An expanded problem focused examination; and - Medical decision making of low complexity. |
99344 | Home visit for the evaluation and management of a new patient, which requires these three key components: - A comprehensive history; A comprehensive examination; and - Medical decision making of moderate complexity. |
99345 | Home visit for the evaluation and management of a new patient, which requires these three key components: - A comprehensive history; A comprehensive examination; and - Medical decision making of high complexity. |
99347 | Home visit for the evaluation and management of an established patient, which requires these three key components: - A problem focused interval history; - A problem focused examination; and - Straightforward medical decision making. |
99348 | Home visit for the evaluation and management of an established patient, which requires these three key components: - An expanded problem focused interval history; An expanded problem focused examination; and - Medical decision making of low complexity. |
99349 | Home visit for the evaluation and management of an established patient, which requires these three key components: - A detailed interval history; A detailed examination; and - Medical decision making of moderate complexity. |
99350 | Home visit for the evaluation and management of an established patient, which requires these three key components: - A detailed interval history; A detailed examination; and - Medical decision making of high complexity. |
Other HCPCS codes related to the CPB: |
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G0155 | Services of clinical social worker in home health or hospice settings, each 15 minutes |
G0177 | Training and educational services related to the care and treatment of patients disabling mental health problems per session (45 minutes or more) |
G0299 | Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes |
G0300 | Direct skilled nursing services of a license practical nurse (LPN) in the home health or hospice setting, each 15 minutes |
H0002 | Behavioral health screening to determine eligibility for admission to treatment program |
H0004 | Behavioral health counseling and therapy, per 15 minutes |
H0023 | Behavioral health outreach service (planned approach to reach a targeted population) |
H0031 | Mental health assessment, by non-physician |
H0032 | Mental health service plan development by non-physician |
H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes |
H0037 | Community psychiatric supportive treatment program, per diem |
H0046 | Mental health services, not otherwise specified |
H2019 | Therapeutic behavioral services, per 15 minutes |
H2020 | Therapeutic behavioral services, per diem |
H2021 | Community-based wrap-around services, per 15 minutes |
H2022 | Community-based wrap-around services, per diem |
H2030 | Mental health clubhouse services, per 15 minutes |
H2031 | Mental health clubhouse services, per diem |
S0273 | Physician visit at member's home, outside of a capitation arrangement |
S0274 | Nurse practitioner visit at member's home, outside of a capitation arrangement |
S9127 | Social work visit, in the home, per diem |
S9482 | Family stabilization services, per 15 minutes |
S9484 | Crisis intervention mental health services, per hour |
S9485 | Crisis intervention mental health services, per diem |
ICD-10 codes covered if selection criteria are met: |
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F01.50 - F99 | Mental and behavioral disorders |
Background
Skilled home behavioral health care is the provision of intermittent skilled services for treatment of behavioral disorders in the home. These services are rendered in lieu of hospitalization, confinement in an extended care facility, or going outside of the home for the service.
References
The above policy is based on the following references:
- Bruce ML, Van Citters AD, Bartels SJ. Evidence-based mental health services for home and community. Psychiatr Clin North Am. 2005;28(4):1039-1060.
- Burns T, Knapp M, Catty J, et al. Home treatment for mental health problems: A systematic review. Health Technol Assess. 2001;5(15):1-139.
- Farran CJ, Horton-Deutsch SL, Fiedler R, Scott C. Psychiatric home care for the elderly. Home Health Care Serv Q. 1997;16(1-2):77-92.
- Kohn R, Goldsmith E, Sedgwick TW. Treatment of homebound mentally ill elderly patients: The multidisciplinary psychiatric mobile team. Am J Geriatr Psychiatry. 2002;10(4):469-475.
- Malaysian Health Technology Assessment Unit (MHTAU). Home care nursing. Systematic review. Kuala Lumpur, Malaysia: Malaysian Health Technology Assessment Unit (MHTAU); 2001.
- Zeltzer BB, Kohn R. Mental health services for homebound elders from home health nursing agencies and home care agencies. Psychiatr Serv. 2006;57(4):567-569.