Examples of States222 Billing Codes for Mental Health Services, Publicly Funded ( As of August 2007; revised October 2010 ) Purpose and Background. This collection of examples of successful codes that states use to bill for mental health services is the outgrowth of a collaborative Federal project. The three agencies working together on this project include SAMHSA, CMS and HRSA. The project began in 2005 as a response to the President222s New Freedom Commission recommendations, and the ensuing Federal Action Agenda for carrying out those recommendations. One of the action steps was to address reimbursement barriers to payment of mental health services provided in primary care settings, particularly in the public sector. To that end, the three Federal ag encies consulted with key informants, convened a Forum of experts, wrote a literature review, White Paper, and Final report on Reimbursement of Mental Health Services in Primary Care Settings ( Kautz, C., Mauch, D., & Smith, S. A. Reimbursement of mental he alth services in primary care settings (HHS Pub. No.SMA - 08- 4324). Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2008, publication pending). The Forum of experts suggested, among other things, that collecting examples of what States and providers do now to bill for mental health services, and sharing that information via a simple, accessible document for the use of providers and States, would be very helpful. We hope you find this publication useful, and we welcome your feedback. A brief orientation to HCPCS codes In the public sector, both Medicare and Medicaid are billed using the Healthcare Common Procedure Coding System (HCPCS) codes. The HCPCS is primarily two separate and differen t sets of codes, referred to as Level I Current Procedural Terminology (223CPT codes224), and Level II (State codes). The Level I CPT codes were created and are maintained by the American Medicaid Association; while the Centers for Medicare and Medicaid Ser vices maintains the Level II State codes. The HCPCS (pronounced 223HIC PICS224) refers to both these Level I and II codes. There are some 223Level III224 codes, being phased out, which can be used in special situations, for infrequent local services that do not have a code, such as unanticipated emergency services in a unique situation like September 11 or Hurricane Katrina. The HIPAA legislation of 1996 specified that all medical coding systems in the future should be uniform and standardized nationally, and it projected phase - in dates, by 2003, which have been extended more than once for some Level II codes. HIPAA also required use of the ICD - 9 - DM (International Classification of Diseases) medical manual for diagnoses, which includes mental disorders, rat her than the use of the DSM (Diagnostic and Statistical Manual of Mental Disorders) that mental health clinicians had previously used for mental diagnoses. Introduction to Level I and Level II HCPCS Codes Level I Codes are the Current Procedural Terminolo gy or 223CPT224 codes and are owned and maintained by the American Medical Association, which initiated them in 1966. The CPT codes are 5 - digit numbers, for example, 90806. These codes are often used by providers billing Medicare or private insurance compani es. (Medicaid can also pay for some Level I CPT codes if the State decides to allow, as can State MH Agencies.) Level II are nationally standardized State codes, determined by the Centers for Medicare and Medicaid Services (CMS), and applied by each State. These codes are often used by providers billing the State Medicaid agency for services rendered to Medicaid beneficiaries. Level II codes are 5 - digit, and begin with a letter that is followed by a 4 - digit number, e.g., H4006. Medicare also pays for L evel II codes, but specifically excludes the codes beginning with 223H224 or 223T,224 which includes most mental health and substance abuse screening and treatment services. The Level II codes are used by many States and, under the Health Insurance Portability and A ccountability Act of 1996 (HIPA A), are required to be standardized nationally . The codes beginning with A through V are nationally the same; however, the codes W 226 Z vary from State to State . States are trying to switch to use only nationally standardi zed codes. HCPCS and the public sector: Medicare and Medicaid both use both Level I and II codes. Under Medicaid, the States specify what codes may be reimbursed. Each State is different. Under Medicare, the Level I CPT codes are most commonly used, but must be each approved by CMS for Medicare payment. Certain (but not all) Level II codes, the State codes, are allowed to be used under Medicare, and CMS is the decision maker for what codes are allowed in Medicare payment. Although HCPCS refers to bot h Level I and Level II codes, a point of confusion is that in common usage, often times the term 223HCPCS224 is used informally to refer principally to only Level II ( State) codes rather than both Levels I and II. Please see Table I for a summary of codes and payers. More Specifics Level I: C urrent Procedural Terminology CPT level I codes fall into several categories that are relevant to mental health billing. Level I HCPCS codes used for mental health services are in the Evaluation and Management (EM) a s well as the Medicine sections of the CPT manual. In the Medicine section, the two areas that apply specifically to mental health services are the Psychiatry codes (90801 226 90899) and the Health Behavioral Assessment and Intervention (HBAI) codes (96150 226 96155). CPT 5 - digit numeric codes include: Psychiatric codes (90801 226 90899), Health Behavioral Assessment & Intervention (223HBAI224 codes 96150 226 96155) Evaluation & Management (223EM224 codes 2275 categories): Office: 99201 226 99215; Consultation: 99241 226 99 255 ( CMS discontinued 2010); Home care: 99324 226 99340; and Preventive: 99381 226 99429 (99230 226 99440 are exclusively for newborn treatment). Telehealth 99441 226 99444 for MDs; 98966 226 98969 for non MDs Psychiatr y codes, 90801 226 90899 According to Medi care, the 223 psychiatry 224 CPT procedure codes 90801 - 90899 may be used by m ental health specialists: physicians , physician extenders (such as nurse practitioners, clinical nurse specialists, or physician assistants), and nonphysicians, such as clinical social workers (CSW) licensed by the State; and clinical psychologists, licensed by and subject to State criteria, operating within the scope of their practice as defined by the State . This range of Psychiatry procedure codes 90801- 90899 can be used to tre at patients with primary mental disorders that are identified by ICD - 9- CM diagnosis codes 290- 319. When submitting claims for outpatient mental health services under the Medicare program, the claim must contain an appropriate diagnosis code, procedure code an d a place of service code. State Medicaid offices specify what type of provider may use the Psychiatry codes; many states limit reimbursement for these codes to mental health specialists such as psychiatrists, advanced practice psychiatric nurses, clinical social workers, or psychologists. Although Medicare does not limit psychiatry CPT codes to be used only by physicians who are specialized in mental health, Medicare does, however, direct carriers billing for Medicare payment to evaluate the providers 222 qualifications and licensure or certification to perform mental health services, and to evaluate whether the physician is operating within the State scope of practice and the services are reasonable/ necessary. This may be a source of variable interpretation and payment variability, in that s tates may vary in specificity of provider type that they authorize to deliver specialized mental health services. HBAI and EM codes The use of HBAI CPT Codes requires a primary medical diagnosis from the ICD - 9- CM. The mental symptoms are a result of the physical or medical primary problem. HBAI codes used for a beneficiary with a mental health problem due to a primary physical illness are to be used by non- physicians such as clinical psychologists or MH speciali sts; however, CSWs may not bill Medicare using HBAI or EM codes. E/M services codes can be used with a primary diagnosis of either a physical or mental illness. E/M codes are most successfully used by physicians such as primary care MDs or physician exten ders. E/M codes are not recommended for use under Medicare by clinical psychologists. NOTE: As of January 1, 2010, the Centers for Medicare and Medicaid Services no longer recognize the E/M Consultation codes, except for telehealth consultation G codes and the 99441- series. CMS states to use E/M Office visit codes instead. They issued a CMS Manual System Pub 100- 04 Claims Processing for Medicare guidance, Transmittal #1875 downloadable at: http://www.cms.gov/transmittals/downloads/R1875CP.pdf . When billing Medicare, local carriers or fiscal sometimes reject a claim from a primary care provider using a mental diagnosis. Even when approved, Medicare reimbursement for a mental di agnosis may be at the 50% level, rather than the reimbursement level of 80% for primary non- mental physical illness. If billing Medicaid using an E/M procedure code, many states report that they allow use of mental disorders 290 226 319 from the ICD - 9- CM, s uch as 311 Depressive disorder, 300.00 Anxiety disorder, or 300.02 Generalized Anxiety Disorder. E/M Office Visit codes (CPT # 99201- 99215) are still recognized under Medicare and in fact the Relative Value Units ( RVUs) for New or Established patients ma y be increased with the 2010 rules. One can check CPT code viability at the AMA website: https://catalog.ama - assn.org/Catalog/cpt/cpt_search.jsp?locality=MD . CMS states that a ll E/M services shall follow the E/M documentation guidelines available on http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp . Telephone E/M provided by physician CPT codes as of 2008 include # 99441 226 99444; the same services given by qualified non - physicians are CPT # 98966 226 98969. ( downloaded 10/19/2010 at: http://www.cms.gov/Transmittals/downloads/R1423CP.pdf ) Level I I: State Codes Level II HCPCS codes beginning with letters A through V are national codes; however, there are certain codes that Medicare does not pay for, such as the H and T ( Mental Health and Substance Abuse codes); however, most Medicaid programs do allow many H and T codes. In addition, S - codes are not r ecognized by Medicare; however, they are used by other third party payers (e.g., Aetna, Blue Cross/Blue Shield, Department of Defense, Humana, etc.). Level II codes beginning with W, X, Y and Z are local State cod es, and may vary from State to State. St ates may specify which nationally standardized codes they allow (the A 226 V codes); some states also use some W 226 Z codes, such as Maine, which are specific to that individual state only. Newer codes : As of January 1, 2007, two 223H224 codes were approved and effective under Medicaid: H0049 (alcohol and /or drug screening) and H0050 (alcohol and/ or drug brief intervention, per 15 minutes), and so far, states are exploring use of them. As of January 1, 2008, Medicare will pay for the two new 223G224 codes, for assessment and brief intervention for alcohol and/or drug abuse services. G0396 (15 minutes) and G0397 (same services for 30 minutes) are the two new billable codes under Medicare, and they replicate the new Level I CPT codes numbering 99408 and 99409 f or private insurers. Updated 10- 19- 10 Shelagh Smith, MPH SAMHSA

2 H0003 Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs H0004 Behavioral health counseling and therapy, per 15 min. H0005 Alcohol and/or drug services; group counseling by a clinician H0006 Alcohol and/or drug services; case management H0007 Alcohol and/or drug services; crisis intervention (outpatient) H0008 Alcohol and/or drug services; sub - acute detoxification (hospital inpatient) H0009 Alcohol and/or drug services; acute detoxification (hospital inpatient) H0010 Alcohol and/or drug services; sub - acute detoxification (residential addiction program inpatient) H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) H0012 Alcohol and/or drug services; sub - acute detoxification (residential addiction program outpatient) H0013 Alcohol and/or drug ser vices; acute detoxification (residential addiction program outpatient) H0014 Alcohol and/or drug services; ambulatory detoxification 3 H0015 Alcohol and/or drug services; intensive outpatient treatment (treatment program that operates at least 3 hours/ day and a least 3 days/week and is based on an individualized treatment plan) including assessment, counseling, crisis intervention, and activity therapies or education H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulat ory setting) H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem H0018 Behavioral health; short - term residential (non - hospital residential treatment program) without room and board, per diem 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, per diem H0020 Alcohol and/or drug services; methadone administratio n and/or service (provision of the drug by a licensed program) H0021 Alcohol and/or drug training service (for staff and personnel not employed by providers) H0022 Alcohol and/or drug intervention service (planned facilitation) H0023 Behavioral he alth outreach service (planned approach to reach a targeted population) 4 H0024 Behavioral health prevention information dissemination service (one - way direct or non- direct contact with service audiences to affect knowledge and attitude) H0025 Behaviora l health prevention education service (delivery of services with target population to affect knowledge, attitude, and/or behavior) H0026 Alcohol and/or drug prevention process service, community - based (delivery of services to deliver skills of impactors ) H0027 Alcohol and/or drug prevention environmental service (broad range of external activities geared toward modifying systems in order to main stream prevention through policy and law) H0028 Alcohol and/or drug prevention problem identification an d referral service (e.g. student assistance and employee assistance programs), does not include assessment H0029 Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g. alcohol free soci al events) H0030 Behavioral health hotline service H0031 Mental health assessment by non - physician H0032 Mental health service plan development by non - physician H0033 Oral medication administration, direct observation H0034 Medication tra ining and support, per 15 min. 5 H0035 Mental health partial hospitalization treatment, less than 24 - hours H0036 Community psychiatric supportive treatment, face to face, per 15 min. H0037 Community psychiatric supportive treatment program, per diem H0038 Self - help/peer services per 15 min. H0039 Assertive community treatment, face - to - face, per 15 min. H0040 Assertive community treatment program, per diem H0041 Foster care, child, non - therapeutic, per diem H0042 Foster care, child, non - therapeutic, per month H0043 Supported housing, per diem H0044 Supported housing, per month H0045 Respite care services, not in the home, per diem H0046 Mental health services, not otherwise specified H0047 Alcohol and/or other drug abu se services, not otherwise specified 6 H0048 Alcohol and/or other drug testing: collection and handling only, specimens other than blood (Reworded) H2001 Rehabilitation program, per 275 day H2010 Comprehensive medication services, per 15 min. H 2011 Crisis intervention service, per 15 min. H2012 Behavioral health day treatment, per hour H2013 Psychiatric health facility service, per diem H2014 Skills training and development, per 15 min. H2015 Comprehensive community support servi ces, per 15 min. H2016 Comprehensive community support services, per diem H2017 Psychosocial rehabilitation services, per 15 min. H2018 Psychosocial rehabilitation services, per diem H2019 Therapeutic behavioral services, per 15 min. H 2020 Therapeutic behavioral services, per diem H2021 Community - based wrap - around services, per 15 min. 7 H2022 Community - based wrap - around services, per diem H2023 Supported employment, per 15 min. H2024 Supported employment, per diem H20 25 Ongoing support to maintain employment, per 15 min. H2026 Ongoing support to maintain employment, per diem H2027 Psycho - educational service, per 15 min. H2028 Sexual offender treatment service, per 15 min. H2029 Sexual offender treatmen t service, per diem H2030 Mental health clubhouse services, per 15 min. H2031 Mental health clubhouse services, per diem H2032 Activity therapy, per 15 min. H2033 Multisystemic therapy for juveniles, per 15 min. H2034 Alcohol and/or drug abuse halfway house services, per diem H2035 Alcohol and/or drug treatment program per hour H2036 Alcohol and/or drug treatment program, per diem 8 H2037 Developmental delay, prevention activities, dependent child of client, per 15 min. J12 30 Injection, methadone HCL, up to 10 mg M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders S0201 Partial hospitalization services, less t han 24 hours, per diem S5100 Day care services, adult; per 15 min. S5101 Day care services, adult; per half day S5102 Day care services, adult; per diem S5145 Foster care, child, per diem S5146 Foster care, child, per month S9475 Am bulatory setting substance abuse treatment or detoxification services, per diem S9480 Intensive outpatient psychiatric services, per diem 9 S9484 Crisis intervention mental health services, per hour S9485 Crisis intervention, mental health services , per diem (existing) S9976 Lodging, per diem, not otherwise specified T1006 Alcohol and/or substance abuse services, family/couple counseling T1007 Alcohol and/or substance abuse services, treatment plan development and/or modification T1008 Da y treatment for individual alcohol and/or substance abuse services T1009 Child sitting services for the children of the individual receiving alcohol and/or substance abuse T1010 Meals for individuals receiving alcohol and/or substance abuse services (when meals are not included in the program) T1011 Alcohol and/or substance abuse services, not otherwise classified T1012 Alcohol and/or substance abuse services, skills development T1013 Sign language or oral interpreter for alcohol and/or subs tance abuse services T1014 Identify/ track for telemedicine T1025 Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and 10 psychosocial impairments, per diem T1026 Intensive, e xtended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour T2010 Preadmission Screening and Resident Review (PASRR) Level I identification screening, per scre en T2011 Preadmission Screening and Resident Review (PASRR) Level II evaluation, per evaluation T2034 Crisis intervention waiver, per diem T2048 Behavioral health; long - term care residential (non - acute care in a residential treatment program whe re stay is typically longer than 30 days), with room and board, per diem 0900 Behavioral health treatment services; g eneral classification 0901 Behavioral health treatment services; electroshock treatment 0902 Behavioral health treatment servic es; milieu treatment 0903 Behavioral health treatment services; play therapy 0904 Behavioral health treatment services; activity therapy 0905 Behavioral health treatment services; intensive outpatient services - 11 psychiatric 0906 Behavioral healt h treatment services; intensive outpatient services - chemical dependency 0907 Behavioral health treatment services; community behavioral health program (day treatment) 0909 Behavioral health treatment services; other behavioral health treatment Revenue Code 091X Revenue Code 091X, originally 223Psychiatric/psychological services224, was renamed 223Behavioral health treatment/services224 1000 Behavioral health accommodation; general classification 1001 Behavioral health accommodation; reside ntial treatment (psychiatric) 1002 Behavioral health accommodation; residential treatment (chemical dependency) 1003 Behavioral health accommodation; supervised living 1004 Behavioral health accommodation; halfway house 1005 Behavioral health acc ommodation; group home Subcategory 4 Subcategory 4, 223Psychiatric224, was changed to 223Behavioral health224 for all other accommodation codes 12 CPT - 4 256 Codes 90801 Psychiatric diagnostic interview examination 90802 Interactive psychiatric diagnostic inter view examination using play equipment, physical devices, language interpreter, or other mechanisms of communication 90804 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approx. 20 to 30 min. face- to - face with the patient 90805 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility with medical evaluation and management services, approx. 20 to 30 min. face - to - face with th e patient 90806 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approx. 45 to 50 min. face- to - face with the patient 90807 Individual psychotherapy, insight oriented, behavior mod ifying and/or supportive, in an office or outpatient facility with medical evaluation and management services, approx. 45 to 50 min. face - to - face with the patient 90808 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approx. 75 to 80 min. face - to - face with the patient 13 90809 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility with medical evaluation and management serv ices, approx. 75 to 80 min. face - to - face with the patient 90810 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an office or outpatient facility, approx. 20 to 30 min. face- to - face with the patient 90811 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an office or outpatient facility with medical evaluation and management services, approx. 20 to 30 min. face - to - face with the patient 90812 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an offi ce or outpatient facility, approx. 45 to 50 min. face- to - face with the patient 90813 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an office or out patient facility with medical evaluation and management services, approx. 45 to 50 min. face - to - face with the patient 90814 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an office or outpatient facility, approx. 75 to 80 14 min. face - to - face with the patient 90815 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal comm unication, in an office or outpatient facility with medical evaluation and management services, approx. 75 to 80 min. face - to - face with the patient 90816 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approx. 20 to 30 min. face - to - face with the patient 90817 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential c are setting with medical evaluation and management services, approx. 20 to 30 min. face - to - face with the patient 90818 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or resid ential care setting, approx. 45 to 50 min. face - to - face with the patient 90819 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting with medical evaluation and management services, approx. 45 to 50 min. face - to - face with the patient 90821 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approx. 75 to 80 min. face - to - face with the patient 15 90822 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting with medical evaluation and management services, app rox. 75 to 80 min. face - to - face with the patient 90823 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential care setting, approx. 20 to 30 min. face - to - face with the patient 90824 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential care setting with medical evaluation and management services, approx. 20 to 30 min. face - to - face with the patient 90826 Individual psychotherapy, interactive, using play equipment, physical devices, language inte rpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential care setting, approx. 45 to 50 min. face - to - face with the patient 90827 Individual psychotherapy, interactive, using play equipment, ph ysical devices, language interpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential care setting with medical evaluation and management services, approx. 45 to 50 min. face - to - face with the patie nt 90828 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential 16 care setting, approx. 75 to 80 min. f ace - to - face with the patient 90829 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non- verbal communication, in an inpatient hospital, partial hospital or residential care setting with medical evaluation and management services, approx. 75 to 80 min. face - to - face with the patient 90845 Psychoanalysis 90846 Family psychotherapy (without the patient present) 90847 Family psychotherapy (conjoint psychotherapy) (with patient pre sent) 90849 Multiple - family group psychotherapy 90853 Group psychotherapy (other than of a multiple - family group) 90857 Interactive group psychotherapy 90862 Pharmacologic management, including prescription, use, and review of medication with n o more than minimal medical psychotherapy 90865 Narcosynthesis for psychiatric diagnostic and therapeutic purposes (e.g., sodium amobarbital (amytal) interview) 90870 Electroconvulsive therapy (includes necessary monitoring); single seizure 9087 1 Electroconvulsive therapy (includes necessary monitoring); multiple 18 0074T (Temporary; Official in July 2004) Online consultation between physician and patient MODIFIERS Description Code Set 1: Specialized Programs HA Child/adolescent program HB Adult program, non - geriatric HC Older adult program, geriatric HD Pregnant/parenting women222s program HE Mental health program HF Substance abuse program HG Opioid addiction treatment program HH Integrated me ntal health/substance abuse program HI Integrated mental health and mental retardation/developmental/disabilities program HJ Employee assistance program HK Specialized mental health programs for high - risk populations Code Set 2: Education level of treatment staff HL Intern HM Less than bachelor degree level HN Bachelors degree level HO Masters degree level HP Doctoral level Code Set 3: Treatment context HQ Group setting HR Family/couple with client present HS Fam ily/couple without client present UK Collateral Code Set 4: Multidisciplinary HT Multi - disciplinary team Code Set 5: Service funding/financing arrangement HU Funded by child welfare agency HV Funded by state addictions agenc y HW Funded by state mental health agency HX Funded by county/local agency HY Funded by juvenile justice agency HZ Funded by criminal justice agency Code Set 7: Court - ordered treatment H9 Court - ordered TF Intermediate level of care TG Complex/high - tech level of care TN Rural/out of service area TS Follow - up service U1 - U9 Medicaid level of care #, as defined by each State UA - UD Medicaid level of care #, as defined by each State CPT Modifiers CPT 2 2 Unusual procedural services CPT 52 Reduced services Other Modifiers QJ Services/items provided to a prisoner or patient in State or local custody, however the State or local government, as applicable, meets the requirements in 42 CFR 411.4 (B) TJ Program group, child and/or adolescent