Académique Documents
Professionnel Documents
Culture Documents
Description
PGS Payment
Amount
Service Criteria
H0001
Gambling Assessment
$139.70
T1023
$22.25
$23.86
H0004
$22.25
$23.86
$7.42
$9.90
$131.44
$140.94
$89.00
$91.19
$65.72
$22.25
$23.86
$7.42
$9.90
This activity may be delivered to clients who have received AD81 services for up to
one year following discharge. The function is of maintaining recovery and continued
wellness and to prevent relapse.
Services provided to clients who have completed problem gambling treatment
within the past 12 months and are to be utilized to facilitate continued recovery or to
avert a potential relapse. Services can be provided within an existing therapy or
psycho-educational group being provided to current clients or to a group of previous
clients meeting on a regular basis for aftercare.
H0005
90801 or
90791
90792
96101
90862 or
90863
H2027
G2100
H0038
$16.00
H0038G
$5.28
H2010
H2013
$22.25
$23.86
$260.52
$350.23
99368
Team conference/consultation
with Interdisciplinary team, per 30
minutes or more
22.00
G2013
$175.00
T1016
$22.25
T1016P
$16.00
G2030
$89.00
T1013
$7.42
$9.60
99203
82.56
99213
$55.53
Peer Support Specialist services provided for coordinating access to and provision of
services from multiple agencies, establishing service linkages, advocating for
treatment and recovery needs, and providing assistance in obtaining entitlements
based on mental or emotional disability.
Pressure relief counseling or other forms of counseling provided to individuals
enrolled in A&D 81 services or their family members for the purpose of financial
restitution of gambling debt.
Sign language/oral interpreter services necessary to ensure the provision of services
for individuals with hearing impairments or in the primary language of non-English
speaking individuals. Such interpreters shall be linguistically appropriate and be
capable of communicating in English and the primary language of the individual and
be able to translate clinical information effectively.
Payment for interpreter services is only allowed when provided in conjunction with
another service such as assessment, individual/family therapy, or group therapy, etc.
whenever feasible, individuals should receive services from staff, who are able to
provide sign and/or oral interpretive services. In this case, interpreter services cannot
be billed in addition to the therapeutic service.
Evaluation and management of a new patient that requires a detailed history, detailed
examination and medical decision making of low complexity. Service provided by
Nurse Practitioner, Naturopathic or other qualified medical professional.
Counseling and/or consultation of care with other qualified health care professionals
or agencies are provided consistent with the nature of the problems and the patients
and/or family needs. Service should be provided when physical health conditions
are impeding with gambling treatment. Must be face-to-face. Maximum of 2 visits
per patient. Client must not have existing health insurance coverage. Goal is to get
patient enrolled in Oregon Health Plan or connected to other health insurance
options.
Evaluation and management of an established patient that requires an expanded
problem gocused history, expanded problem focused examination and medical
decision making of low complexity. Service provided by Nurse Practitioner,
Naturopathic or other qualified medical professional. Counseling and/or consultation
of care with other qualified health care professionals or agencies are provided
consistent with the nature of the problems and the patients and/or family needs.
Service should be provided when physical health conditions are impeding with
gambling treatment. Must be face-to-face. Maximum of 3 visits per patient. Client
must not have existing health insurance coverage. Goal is to get patient enrolled in
G5000
$22.25
$23.86
Services provided by qualified counselor per current policy standards. Must meet
current requirements for confidentiality with patient informed consent.
G4000
$22.25
$23.86
Services provided by qualified counselor per current policy standards. Must meet
current requirements for confidentiality with patient informed consent.
G30
Mileage
50A*
50B*
50C*
50D*
Current US Limited to: 1. Service provider's travel to and from primary site providing AD81
GSA rate services and ancillary AD81 service site; 2. Mileage charges by program or case
consultants; 3. Service providers travel bringing clients to the treatment site. 4.
Service providers transportation costs to bring clients to and from the residential
treatment site. 5. Client transportation costs
Strategic Outreach Planning, per
$22.25
Time spent with development of a Strategic Outreach/Referral Pathways Plan.
15 min
$23.86
Limited to maximum of 10% of A&D 81 allocations unless preauthorized by OHA
Problem Gambling Services Manager.
Referral Agreement Development,
$22.25
Time spent with allied agencies to develop and follow up on formal referral
per 15 min
$23.86
agreements. Limited to 8 hours per allied agency, unless preauthorized by OHA
Problem Gambling Services Manager. Includes time spent preparing for meetings
and development of presentation, process and paperwork.
Presentations to Allied
$22.25
Time spent delivering presentations to professionals in health/medicine/social
Professionals, per 15 min
$23.86
services/legal/financial with the express intent to follow up with individual contacts
in order to establish relationship, develop screening and referral agreements and
protocols, etc. Limited to 8 hours per allied agency, unless preauthorized by OHA
Problem Gambling Services Manager. Includes time spent preparing for meeting
and developing presentations.
Presentations to Targeted High
$22.25
Time spent delivering presentations to targeted high risk clients groups, including
Risk Client Groups, per 15 min
$23.86
but not limited to: Incarcerated individuals A/D clients (OP/Residential) MH clients
(OP/Residential) CAF clients. These presentations shall be focused on signs and
symptoms of disordered gambling, treatment options and how to access treatment.
Code can be used to provide individual or group consultation/education with
potential family member client(s) for the purpose of explaining importance of
treatment and what can be expected, in hopes that family member will enroll.
Includes time spent preparing and developing presentations.
50E*
Treatment Advertising
Actual Cost Treatment Ads (yellow pages, web-based ads, radio, TV, newspaper). Limited to
maximum of 20% of AD81 allocations unless preauthorized by OHA Problem
Gambling Services Manager.
50F*
Exhibiting at Professional
$22.25
Exhibiting at a conference or meeting of professionals that we know from
Conferences, per 15 min
$23.86
experience are likely to have problem gamblers in their practices and are in a
position to potentially refer (i.e., physicians, nurses, social services, corrections,
legal, financial). This is in contrast to a conference for service organizations (i.e.
Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4 hours) per exhibit,
unless preauthorized by OHA Problem Gambling Manager.
50G*
Other as Pre-authorized
As AuthorizedOther as pre-authorized by OHA Problem Gambling Manager.
FLEX
Non-traditional Services or
Actual Cost Examples include wraparound (barrier removal) type services (travel vouchers for
Activities
clients, childcare expenses, etc)., and workforce development needs of service
provider.
50AP*
Strategic Outreach Planning, per
$16.00
Peer Support Specialist time spent with clinician staff participating in strategic
15 min
outreach plan development. Limited to maximum of 10% of A&D 81 allocations
unless preauthorized by OHA Problem Gambling Manager.
50CP*
Presentations to allied
$16.00
Peer Support Specialist time spent delivering presentations to professionals in
professionals, per 15 min
health/medicine/social services/legal/financial with the express intent to follow up
with individual contacts in order to establish relationship, develop screening and
referral agreements and protocols, etc. Limited to 8 hours per allied agency, unless
preauthorized by OHA Problem Gambling Services Manager.
50DP*
Presentations to targeted high risk
$16.00
Peer Support Specialist time spent delivering presentations to targeted high risk
client groups, per 15 min
clients groups, including but not limited to: Incarcerated individuals A/D clients
(OP/Residential) MH clients (OP/Residential) CAF clients. These presentations shall
be focused on signs and symptoms of disordered gambling, treatment options and
how to access treatment. Limited to 8 hours per allied agency, unless preauthorized
by OHA Problem Gambling Services Manager.
50FP*
Exhibiting at Professional
$16.00
Peer Support Specialist time spend exhibiting at a conference or meeting of
Conferences, per 15 min
professionals with the intention of educating potential gambling treatment referral
sources about problem gambling, recovery, treatment, screening tools, and available
problem gambling help in Oregon. This is in contrast to a conference for service
organizations (i.e. Kiwanis, Elks), schools, PTAs and health fairs. Limited to (4
hours) per exhibit, unless preauthorized by OHA Problem Gambling Manager.
*50A-50G codes, known as Referral Pathways Codes, have the primary purpose of getting problem gamblers and/or family members enrolled in
services, geared specifically towards increasing the number of clients receiving treatment. It is targeted, generally involves repeated contacts and
the development of a relationship with the provider. The provider is generally another professional and the goal is to increase the number of clients
they assess and refer to your program.
For Referral Pathways documentation requirement, please keep on file a copy of strategic outreach plan, referral agreements, documentation of
meetings, outline of presentations, copy of ads, flight schedules of media, exhibitor confirmation letter, etc.
*** Providers must bill at rates, based upon the cost of services determined through a cost allocation, not in excess of their usual and customary
charge to the general public ** (OAR 309-016-0105 and OAR 309-016-0420)
Note: Language in red font is updated or new language for fiscal year 2015-16.