cardinal-innovations-to-vaya-health-benefit-plan-crosswalk by Vaya Health

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid b or b3

Cardinal Innovations 90791 26

90791 YA

Medicaid b or b3

90791 HK

Benefit Plan

Vaya

Cardinal Innovations Service Description 90791 26 Home Based Psychiatric Diagnostic Evaluation (Non‐Medical) 90791 HK Special Evaluation ‐ SAP

Vaya Service Description to Use in AlphaMCS 90791YA ‐ Mobile Engagement Psychiatric Diagnostic Evaluation

Medicaid b or b3

90832 22

90832 Z1

90832 22 ‐ Specialty Therapy, 30 min

90791HK ‐ Psychiatric Diagnostic Evaluation ‐ Special Evaluation ‐ SAP 90832Z1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 30 MN

Medicaid b or b3

90832 22

90832 Z2

90832 22 ‐ Specialty Therapy, 30 min

90832Z2 ‐ PCIT PSYCHOTHERAPY 30 MN

Medicaid b or b3

90832 22 GT CR

90832 GT CR Z1

Medicaid b or b3

90832 22 GT CR

90832 GT CR Z2

Medicaid b or b3

90832 26

90832 YA

90832 22 GT CR Specialty Child Therapy, 30 min, Telehealth 90832 22 GT CR Specialty Child Therapy, 30 min, Telehealth 90832 26 Home Based Psychotherapy, 30 min

90832GTCRZ1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 30 MN, telepsych, catastrophe related 90832GTCRZ2 ‐ PCIT PSYCHOTHERAPY 30 MN, telepsych, catastrophe related 90832YA ‐ Mobile Engagement PSYCHOTHERAPY 30 MN

Medicaid b or b3

90834 22

90834 Z1

90834 22 ‐ Specialty Therapy, 45 min

90834Z1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 45 MN

Medicaid b or b3

90834 22

90834 Z2

90834 22 ‐ Specialty Therapy, 45 min

90834Z2 ‐ PCIT PSYCHOTHERAPY 45 MN

Medicaid b or b3

90834 22 GT CR

90834 GT CR Z1

Medicaid b or b3

90834 22 GT CR

90834 GT CR Z2

Medicaid b or b3 Medicaid b or b3

90834 26 90837 22

90834 YA 90837 Z1

90834 22 GT CR Specialty Child Therapy, 45 min, Telehealth 90834 22 GT CR Specialty Child Therapy, 45 min, Telehealth 90834 26 Home Based Psychotherapy, 45 min 90837 22 ‐ Specialty Therapy, 60 min

90834GTCRZ1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 45 MN, telepsych, catastrophe related 90834GTCRZ2 ‐ PCIT PSYCHOTHERAPY 45 MN, telepsych, catastrophe related 90834YA ‐ Mobile Engagement PSYCHOTHERAPY 45 MN 90837Z1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 60 MN

Medicaid b or b3

90837 22

90837 Z2

90837 22 ‐ Specialty Therapy, 60 min

90837Z2 ‐ PCIT PSYCHOTHERAPY 60 MN

Medicaid b or b3

90837 22

90837 Z3

90837 22 ‐ Specialty Therapy, 60 min

90837Z3 ‐ DBT PSYCHOTHERAPY 60 MN

Medicaid b or b3

90837 22 GT CR

90837 GT CR Z1

Medicaid b or b3

90837 22 GT CR

90837 GT CR Z2

Medicaid b or b3

90837 26

90837 YA

90837 22 GT CR Specialty Child Therapy, 60 min, Telehealth 90837 22 GT CR Specialty Child Therapy, 60 min, Telehealth 90837 26 Home Based Psychotherapy, 60 min

90837GTCRZ1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 60 MN, telepsych, catastrophe related 90837GTCRZ2 ‐ PCIT PSYCHOTHERAPY 60 MN, telepsych, catastrophe related 90837YA ‐ Mobile Engagement PSYCHOTHERAPY 60 MN

Medicaid b or b3

90846 22

90846 Z1

90846Z1 ‐ TF‐CBT ‐ FAMILY THER W/O PT

Medicaid b or b3

90846 22

90846 Z2

Medicaid b or b3

90846 22 GT CR

90846 GT CR Z1

Medicaid b or b3

90846 22 GT CR

90846 GT CR Z2

90846 22 ‐ Family Therapy w/o patient, Specialty Child Service 90846 22 ‐ Family Therapy w/o patient, Specialty Child Service 90846 22 GT CR Family Therapy w/o patient, Specialty Child Service, Telehealth 90846 22 GT CR Family Therapy w/o patient, Specialty Child Service, Telehealth

90846Z2 ‐ PCIT ‐ FAMILY THER W/O PT 90846GTCRZ1 ‐ TF‐CBT ‐ FAMILY THER W/O PT, telepsych, catastrophe related 90846GTCRZ2 ‐ PCIT ‐ FAMILY THER W/O PT, telepsych, catastrophe related

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid b or b3

Cardinal Innovations 90847 22

90847 Z1

Medicaid b or b3

90847 22

90847 Z2

Medicaid b or b3

90847 22 GT CR

90847 GT CR Z1

Medicaid b or b3

90847 22 GT CR

90847 GT CR Z2

Medicaid b or b3

90847 26

90847 YA

Medicaid b or b3

G2012 CR

Medicaid b or b3

H0018 HA

Medicaid b or b3

Benefit Plan

Vaya

Cardinal Innovations Service Description 90847 22 ‐ Family Therapy w/ patient, Specialty Child Service 90847 22 ‐ Family Therapy w/ patient, Specialty Child Service 90847 22 GT CR Family Therapy w/ patient, Specialty Child Service, Telehealth 90847 22 GT CR Family Therapy w/ patient, Specialty Child Service, Telehealth 90847 26 Home Based Family Therapy w member

Vaya Service Description to Use in AlphaMCS 90847Z1 ‐ TF‐CBT ‐ FAMILY THER W/ PT 90847Z2 ‐ PCIT ‐ FAMILY THER W/ PT 90847GTCRZ1 ‐ TF‐CBT ‐ FAMILY THER W/ PT, telepsych, catastrophe related 90847GTCRZ2 ‐ PCIT ‐ FAMILY THER W/ PT, telepsych, catastrophe related 90847YA ‐ Mobile Engagement FAMILY THER W/ PT G2012CR ‐ Brief Virtual Check‐in by Prescriber, 5‐10 minutes

H0018 HA

G2012 CR Brief Virtual Check‐in by Prescriber, 5‐10 minutes H0018 HA Complex Residential Treatment, Child

H0018 HB

H0018 HB Complex Residential Treatment, Adult

H0018HB ‐ Complex Residential Treatment, Adult

Medicaid b or b3

H0019 UR

H0019 UR Residential Level IV (5+ Beds)

H0019UR ‐ Residential Level IV (5+ Beds)

Medicaid b or b3

H0035 HE

H0035 HK

H0035HK ‐ ENH RATE MH PARTIAL HOSP

Medicaid b or b3

H0036 HK

H0036 HA

H0035 HE Partial Hospitalization for Eating Disorder Low Intensity H0036 HK INTERCEPT

Medicaid b or b3

H0036 HK GT CR

H0036 HA GT CR

H0036 HK GT CR INTERCEPT, Telehealth

Medicaid b or b3

H0036 HK U5

H0036 HK U5 Family Centered Treatment

Medicaid b or b3

H0038 HK U4

H0038 YA

H0038 HK U4 Peer Bridger

H0038YA ‐ Post‐Discharge Peer Supports – Individual

Medicaid b or b3

H0040 HA U5 TS

Medicaid b or b3

H0040 HA U5 U1

Medicaid b or b3

H0040 TS

H0040 22

H0040 HA U5 TS Child Focused Assertive Community Treatment Team (ACTT), Encounter H0040 HA U5 U1 Child Focused Assertive Community Treatment Team (ACTT) H0040 TS Assertive Comm Tx Team Encounter

H0040HAU5TS ‐ Child Focused Assertive Community Treatment Team (ACTT), Encounter H0040HAU5U1 ‐ Child Focused Assertive Community Treatment Team (ACTT) H004022 ‐ ACTT > 4 events per month

Medicaid b or b3

H0040 TS CR

H0040 22 CR

Medicaid b or b3

H0040 TS GT CR

H0040 22 GT CR

H004022CR ‐ ACTT > 4 events per month, catastrophe/disaster related H004022GTCR ‐ ACTT > 4 events per month, telepsych

Medicaid b or b3

H0040 U5

Medicaid b or b3

H0040 U5 CR

H0040 TS CR Assertive Community Treatment Team, Encounter, Telephonic H0040 TS GT CR Assertive Community Treatment Team, Encounter, Telehealth H0040 U5 Assertve Community Treatment Team (ACTT), Step‐Down H0040 U5 CR Assertive Community Treatment Team, Step Down, Telephonic

H0018HA ‐ Complex Residential Treatment, Child

H0036HA ‐ Community Support H0036HAGTCR ‐ Community Support, telepsych, catastrophe related H0036HKU5 ‐ Special Use Family Centered Treatment

H0040U5 ‐ Step Down Assertive Community Treatment Team (ACTT) H0040U5CR ‐ Step Down Assertive Community Treatment Team (ACTT), catastrophe

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid b or b3

Cardinal Innovations H0040 U5 GT CR

H0040 U5 GT CR

Medicaid b or b3

H0045 HQ U4

H0045 HQ U4 HA

H0040 U5 GT CR Assertive Community Treatment Team, Step Down, Telehealth H0045 HQ U4 B3‐Group Respite

Benefit Plan

Vaya

Cardinal Innovations Service Description

Vaya Service Description to Use in AlphaMCS H0040U5GTCR ‐ Step Down Assertive Community Treatment Team (ACTT), catastrophe, tele H0045HQU4HA ‐ (B3) Child Group Respite

Medicaid b or b3

H0045 HQ U4

H0045 HQ U4 HB

H0045 HQ U4 B3‐Group Respite

H0045HQU4HB ‐ (B3) Adult Group Respite

Medicaid b or b3

H0045 U4

H0045 U4 HA

H0045 U4 B3‐Individual Respite

H0045U4HA ‐ (B3) Child Individual Respite

Medicaid b or b3

H0045 U4

H0045 U4 HB

H0045 U4 B3‐Individual Respite

H0045U4HB ‐ (B3) Adult Individual Respite

Medicaid b or b3

H2011 HF

H2011

H2011 HF Mobile Crisis Management (MH/SA)

H2011 ‐ CRISIS SERVICES

Medicaid b or b3

H2011 HF CR

H2011 CR

H2011 HF CR Mobile Crisis Management, Disaster

H2011CR ‐ CRISIS SERVICES, catastrophe/disaster related

Medicaid b or b3

H2011 HF GT CR

H2011 GT CR

H2011 HF GT CR Mobile Crisis Management, Telehealth

H2011GTCR ‐ CRISIS SERVICES, telepsych

Medicaid b or b3

H2011 U4

H2011 U4 HI

Medicaid b or b3

H2011 U5 U1

H2011 U4 Crisis Intervention & Stabilization Supports B3 DI H2011 U5 U1 Enhanced Crisis Response (ECR)

H2011U4HI ‐ DI Crisis Intervention and Stabilization Supports with Technical Amendment H2011U5U1 ‐ Enhanced Crisis Response (ECR)

Medicaid b or b3

H2016 HI U2 U4

H2016 HI U4 U2

H2016 HI U2 U4 Residential Supports Level 4 ‐ AFL B3 DI

H2016HIU4U2 ‐ DI Level 4 AFL‐Residential Supports

Medicaid b or b3

H2016 U2 U4

H2016 U4 U2

H2016 U2 U4 Residential Supports Level 1 ‐ AFL B3 DI

H2016U4U2 ‐ DI Level 1 AFL Residential Supports

Medicaid b or b3

H2022 HE U5

H2022 HE U5 In Home Therapy Services (IHTS)

H2022HEU5 ‐ In Home Therapy Services (IHTS)

Medicaid b or b3

H2023 HE U4 CR

Medicaid b or b3 Medicaid b or b3

H2023 HE U4 GT CR H2023 U4 HH GT CR H2033 U1 H2033 HA

H2022 HE U5 GT CR In Home Therapy Services (IHTS), Telehealth H2023 HE U4 B3‐Initial Indiv Supported Employment MHSA H2023 HE U4 CR Initial Individual Supported Employment, MH/SUD, Telephonic H2023 HE U4 GT CR Initial Individual Supported Employment, MH/SUD, Telehealth H2033 U1 Multi‐systemic Therapy (MST) Weekly

H2022HEU5GTCR ‐ In Home Therapy Services (IHTS)

Medicaid b or b3

H2022 HE U5 GT CR H2022 HE U5 GT CR H2023 HE U4 H2023 U4 HH

Medicaid b or b3

H2033 U1 CR

H2033 HA CR

Medicaid b or b3

H2033 U1 GT CR

H2033 HA GT CR

Medicaid b or b3

S5145 HI

Medicaid b or b3

S5145 HI CR

H2023 U4 HH CR

H2023U4HH ‐ MHSA Initial Individual Supported Employment H2023U4HHCR ‐ MHSA Initial Individual Supported Employment, catastrope related H2023U4HHGTCR ‐ MHSA Initial Individual Supported Employment, catastrophe/tele H2033HA ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER

H2033 U1 CR Multi‐systemic Therapy (MST) Weekly, Disaster H2033 U1 GT CR Multi‐systemic Therapy (MST) Weekly, Telehealth S5145 HI Residential Level II Family Type MH/IDD

H2033HACR ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER, catastrophe/disaster related H2033HAGTCR ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER, telepsych S5145HI ‐ Family Type MH/IDD CTSP Residential Level II

S5145 HI CR Therapeutic Foster Care, Family Type MH/IDD, Disaster

S5145HICR ‐ Family Type MH/IDD CTSP Residential Level II, catastrophe related

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid b or b3

Cardinal Innovations S5145 U2

S5145 U2

S5145 U2 Therapeutic Foster Care ‐ Monthly

S5145U2 ‐ Monthly Therapeutic Foster Care

Medicaid b or b3

S5145 U5

S5145 Z3

S5145 U5 Rapid Response Home

S5145Z3 ‐ Rapid Response Therapeutic Foster Care (TFC)

Medicaid b or b3

S9480 HK U5

S9480 HK U5 Rapid Care Services High

S9480HKU5 ‐ Rapid Care Services High

Medicaid b or b3

S9480 U5

S9480 U5 Rapid Care Services Low

S9480U5 ‐ Rapid Care Services Low

Medicaid b or b3

T2014 U2 U4

T2014 U4 U2

T2014 U2 U4 Residential Supports AFL Level 2 B3 DI

T2014U4U2 ‐ DI Level 2 AFL ‐ Residential Supports

Medicaid b or b3

T2020 U2 U4

T2020 U4 U2

T2020 U2 U4 Residential Supports AFL Level 3 B3 DI

T2020U4U2 ‐ DI Level 3 AFL ‐ Residential Supports

Medicaid b or b3

T2041 U4

T2041 U4 U5

T2041 U4 Community Navigator B3

T2041U4U5 ‐ B‐3 Community Guide ‐ Monthly

Medicaid b or b3

T2041 U4 UA

T2041 U4

T2041 U4 UA Community Navigator AWC Member B3

T2041U4 ‐ B‐3 DI Community Navigator ‐ Monthly

Medicaid b or b3

T2041 U6 U4

T2041 U4

T2041U4 ‐ B‐3 DI Community Navigator ‐ Monthly

Medicaid b or b3

T2041 U6 U4 UA

T2041 U4

Medicaid b or b3

T2041 UC U4

T2041 U4

T2041 U6 U4 Community Navigator Annual Information session on Self Direction B3 T2041 U6 U4 UA Community Navigator Annual Information session on Self Direction AWC B3 T2041 UC U4 Community Navigator Annual Information session on Self Determination & Rights B3

Medicaid b or b3

T2041 UC U4 UA

T2041 U4

Medicaid c

H2011

H2011 HI

Medicaid c

H2015 CR XU

H2015 XU CR

Medicaid c

H2015 HQ CR XU

H2015 HQ XU CR

Medicaid c

H2016 CR XU

H2016 XU CR

Medicaid c

H2016 HI CR XU

H2016 HI XU CR

Medicaid c Medicaid c

H2016 HI U2 CR XU H2016 HI XU CR U2 H2016 U2 CR XU H2016 XU CR U2

Medicaid c

H2025 CR XU

Benefit Plan

Vaya

H2025 XU CR

Cardinal Innovations Service Description

Vaya Service Description to Use in AlphaMCS

T2041U4 ‐ B‐3 DI Community Navigator ‐ Monthly T2041U4 ‐ B‐3 DI Community Navigator ‐ Monthly

T2041 UC U4 UA Community Navigator Annual T2041U4 ‐ B‐3 DI Community Navigator ‐ Monthly Information session on Self Determination & Rights AWC B3 H2011HI ‐ Crisis Intervention and Stabilization Supports with H2011 Crisis Intervention and Stabilization Supports Technical Amendment H2015 CR XU Community Networking, Individual, Retainer H2015XUCR ‐ Community Networking Service ‐ Ind, retainer pymt, disaster related H2015 HQ CR XU Community Networking, Group, Retainer H2015HQXUCR ‐ Community Networking Group, retainer pymt, disaster related H2016 CR XU Residential Supports, Level 1, Retainer H2016XUCR ‐ Level 1‐Residential Supports, retainer pymt, disaster related H2016 HI CR XU Residential Supports, Level 4, Retainer H2016HIXUCR ‐ Level 4‐Residential Supports, retainer pymt, disaster related H2016 HI U2 CR XU Residential Supports, AFL Level 4, H2016HIXUCRU2 ‐ Level 4 AFL‐Residential Supports, retainer Retainer pymt, disaster related H2016 U2 CR XU Residential Supports, AFL Level 1, H2016XUCRU2 ‐ Level 1 AFL Residential Supports, retainer pymt, Retainer disaster related H2025 CR XU Supported Employment, Retainer H2025XUCR ‐ Supported Employment ‐ Ind, retainer pymt, disaster related

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid c

Cardinal Innovations H2025 HQ CR XU

H2025 HQ XU CR

Medicaid c

H2025 TS CR XU

H2025 TS XU CR

Medicaid c

T2013 TF CR XU

T2013 TF XU CR

Medicaid c Medicaid c

T2013 TF HQ CR XU T2013 TF HQ XU CR T2014 CR XU T2014 XU CR

Medicaid c

T2014 U2 CR XU

T2014 XU CR U2

Medicaid c

T2020 CR XU

T2020 XU CR

Medicaid c

T2020 U2 CR XU

T2020 XU CR U2

Medicaid c

T2021 CR XU

T2021 XU CR

Medicaid c

T2021 HQ CR XU

T2021 HQ XU CR

Medicaid c

T2027 CR XU

T2027 XU CR

Medicaid c

T2033 CR XU

T2033 XU CR

Medicaid c

T2033 HI CR XU

T2033 HI XU CR

Medicaid c

T2033 TF CR XU

T2033 TF XU CR

Medicaid c

T2033 U1 CR XU

T2033 U1 XU CR

Medicaid c

T2041 U1 UA

T2041

Medicaid c

T2041 U1 UB

T2041

Medicaid c

T2041 U6

T2041

Medicaid c

T2041 U6 UA

T2041

Benefit Plan

Vaya

Cardinal Innovations Service Description

Vaya Service Description to Use in AlphaMCS

H2025 HQ CR XU Supported Employment, Group, Retainer H2025HQXUCR ‐ Supported Employment Group, retainer pymt, disaster related H2025 TS CR XU Supported Employment, Long Term H2025TSXUCR ‐ Supported Employment – Long Term Follow‐up, Follow‐up, Retainer retainer pymt, disaster related T2013 TF CR XU Community Living and Support, T2013TFXUCR ‐ Community Living and Supports, retainer pymt, Individual, Retainer disaster related T2013 TF HQ CR XU Community Living and Support, T2013TFHQXUCR ‐ Community Living and Supports‐ Group, Group, Retainer retainer pymt, disaster related T2014 CR XU Residential Supports, Level 2, Retainer T2014XUCR ‐ Level 2 ‐ Residential Supports, retainer pymt, disaster related T2014 U2 CR XU Residential Supports, AFL Level 2, T2014XUCRU2 ‐ Level 2 AFL ‐ Residential Supports, retainer pymt, Retainer disaster related T2020 CR XU Residential Supports, Level 3, Retainer T2020XUCR ‐ Level 3 ‐ Residential Supports, retainer pymt, disaster related T2020 U2 CR XU Residential Supports, AFL Level 3, T2020XUCRU2 ‐ Level 3 AFL ‐ Residential Supports, retainer pymt, Retainer disaster related T2021 CR XU Day Supports, Individual, Retainer T2021XUCR ‐ Day Support ‐ Individual, retainer pymt, disaster related T2021 HQ CR XU Day Supports, Group, Retainer T2021HQXUCR ‐ Day Support Group, retainer pymt, disaster related T2027 CR XU Day Supports, Developmental Day, Retainer T2027XUCR ‐ Day Supports: Developmental Day, retainer pymt, disaster related T2033 CR XU Supported Living, Level 1, Retainer T2033XUCR ‐ Supported Living – Level 1, retainer pymt, disaster related T2033 HI CR XU Supported Living, Level 2, Retainer T2033HIXUCR ‐ Supported Living – Level 2, retainer pymt, disaster related T2033 TF CR XU Supported Living, Level 3, Retainer T2033TFXUCR ‐ Supported Living – Level 3, retainer pymt, disaster related T2033 U1 CR XU Supported Living, Periodic, Retainer T2033U1XUCR ‐ Supported Living ‐ Periodic, retainer pymt, disaster related T2041 U1 UA Community Navigator Start‐up Training for T2041 ‐ Community Navigator: Monthly Agency with Choice T2041 U1 UB Community Navigator Start‐up Training for T2041 ‐ Community Navigator: Monthly Employer of Record T2041 U6 Community Navigator Annual Information T2041 ‐ Community Navigator: Monthly session on Self Direction T2041 U6 UA Community Navigator Annual Information T2041 ‐ Community Navigator: Monthly session on Self Direction (AWC members)

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Medicaid c

Cardinal Innovations T2041 U6 UB

T2041

T2041 U6 UB Community Navigator Annual Information session on Self Direction (EOR members)

T2041 ‐ Community Navigator: Monthly

Medicaid c

T2041 UA

T2041

T2041 UA Community Navigator (AWC members)

T2041 ‐ Community Navigator: Monthly

Medicaid c

T2041 UB

T2041

T2041 UB Community Navigator (EOR members)

T2041 ‐ Community Navigator: Monthly

Medicaid c

T2041 UC

T2041

T2041 UC Community Navigator Annual Information session on Self Determination & Rights

T2041 ‐ Community Navigator: Monthly

Medicaid c

T2041 UC UA

T2041

T2041 UC UA Community Navigator Annual Information session on Self Determination & Rights(AWC)

T2041 ‐ Community Navigator: Monthly

Medicaid c

T2041 UC UB

T2041

T2041 UC UB Community Navigator Annual Information session on Self Determination & Rights(EOR)

T2041 ‐ Community Navigator: Monthly

Non‐Medicaid

90791 26

90791 YA

90791YA ‐ Mobile Engagement Psychiatric Diagnostic Evaluation

Non‐Medicaid

90832 26

90832 YA

90791 26 Home Based Psychiatric Diagnostic Evaluation (Non‐Medical) 90832 26 Home Based Psychotherapy, 30 min

Non‐Medicaid

90834 26

90834 YA

90834 26 Home Based Psychotherapy, 45 min

90834YA ‐ Mobile Engagement PSYCHOTHERAPY 45 MN

Non‐Medicaid

90837 26

90837 YA

90837 26 Home Based Psychotherapy, 60 min

90837YA ‐ Mobile Engagement PSYCHOTHERAPY 60 MN

Non‐Medicaid

90847 26

90847 YA

90847 26 Home Based Family Therapy w member

90847YA ‐ Mobile Engagement FAMILY THER W/ PT

Non‐Medicaid

H0040 TS

H0040 22

H0040 TS Assertive Comm Tx Team Encounter

H004022 ‐ ACTT > 4 events per month

Non‐Medicaid

H0040 TS CR

H0040 22 CR

Non‐Medicaid

H0040 TS GT CR

H0040 22 GT CR

H004022CR ‐ ACTT > 4 events per month, catastrophe/disaster related H004022GTCR ‐ ACTT > 4 events per month, telepsych

Non‐Medicaid

H2011 HF

H2011

H0040 TS CR Assertive Community Treatment Team, Encounter, Telephonic H0040 TS GT CR Assertive Community Treatment Team, Encounter, Telehealth H2011 HF Mobile Crisis Management (MH/SA)

Non‐Medicaid

H2011 HF CR

H2011 CR

H2011 HF CR Mobile Crisis Management, Disaster

H2011CR ‐ CRISIS SERVICES, catastrophe/disaster related

Non‐Medicaid

H2011 HF GT CR

H2011 GT CR

H2011 HF GT CR Mobile Crisis Management, Telehealth

H2011GTCR ‐ CRISIS SERVICES, telepsych

Benefit Plan

Vaya

Cardinal Innovations Service Description

Vaya Service Description to Use in AlphaMCS

90832YA ‐ Mobile Engagement PSYCHOTHERAPY 30 MN

H2011 ‐ CRISIS SERVICES

Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk (includes services new to Vaya) Rev. 01/04/2022

Non‐Medicaid

Cardinal Innovations T2016 U8

T2016 U8

Non‐Medicaid

YA341

YA341 ‐ Assertive Engagement

Non‐Medicaid

YA389 GT

YA389 GT CR

Non‐Medicaid

YA390 GT

YA390 GT CR

Non‐Medicaid

YA403

YA389 GT IDD Supported Employment, Long‐term Support, Telehealth YA390 GT IDD Supported Employment, Individual, Telehealth YA403 Comprehensive Clinical Support, Disaster

YA389GTCR ‐ LONG‐TERM VOCATIONAL SUPPORT ‐ I/DD, telepsych, catastrophe related YA390GTCR ‐ SUPPORTED EMP IND ‐ I/DD, telepsych, catastrophe related YA403 Comprehensive Clinical Support, Disaster

Non‐Medicaid

YM850

YM850 Residential Supports

YM850 ‐ Residential Supports

Non‐Medicaid

YP610

YP610 Developmental Day

YP610 ‐ Developmental Day

Non‐Medicaid

YP620 GT

YP620 GT CR

YP620 GT ADVP

YP620GTCR ‐ MR/MI ADVP, telepsych, catastrophe related

Non‐Medicaid

YP630 CR

YP630 CR Supported Employment, Individual, Disaster

YP630CR ‐ Supported Employment, Individual, catastrophe related

Non‐Medicaid

YP630 GT

YP630 GT CR

YP630 GT Supported Employment, Individual, Telehealth

YP630GTCR ‐ Supported Employment, Individual, Telehealth

Non‐Medicaid

YP790

YP790 Detox ‐ Social Setting

YP790 ‐ Detox ‐ Social Setting

Benefit Plan

Vaya

Cardinal Innovations Service Description T2016 U8 Behavioral Health Urgent Care, Observation

Vaya Service Description to Use in AlphaMCS T2016U8 ‐ Behavioral Health Urgent Care ‐ Observation