Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan Medicaid b or b3
Cardinal 90791 26
Vaya 90791 SR
Cardinal service description
Vaya service description to use in AlphaMCS
Medicaid b or b3
90832 22
90832 Z1
90791 26 Home Based Psychiatric Diagnostic Evaluation (90832 22 ‐ Specialty Therapy, 30 min l)
90791SR ‐ In‐Home Psychiatric Diagnostic Evaluation
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 SR
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 90832SR ‐ IN‐HOME PSYCHOTHERAPY 30 MN
Medicaid b or b3
90834 22
90834 Z1
90834 22 ‐ Specialty Therapy, 45 min
90834Z1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 45 MN
90832Z1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 30 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
90834 26
90834 SR
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
90834GTCRZ1 ‐ TF‐CBT ‐ PSYCHOTHERAPY 45 MN, telepsych, catastrophe related 90834GTCRZ2 ‐ PCIT PSYCHOTHERAPY 45 MN, telepsych, catastrophe related 90834SR ‐ IN‐HOME PSYCHOTHERAPY 45 MN
Medicaid b or b3
90837 22
90837 Z1
90837 22 ‐ Specialty Therapy, 60 min
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 SR
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 90837SR ‐ IN‐HOME 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 90846 26 Home Based Family Therapy w/o member
Medicaid b or b3
90846 26
90846 SR
Medicaid b or b3
90847 22
90847 Z1
Medicaid b or b3
90847 22
90847 Z2
90847 22 ‐ Family Therapy w/ patient, Specialty Child Service 90847 22 ‐ Family Therapy w/ patient, Specialty Child Service
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 90846SR ‐ In‐home Family Ther W/O PT 90847Z1 ‐ TF‐CBT ‐ FAMILY THER W/ PT 90847Z2 ‐ PCIT ‐ FAMILY THER W/ PT
Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan
Cardinal
Vaya
Medicaid b or b3
90847 22 GT CR
90847 GT CR Z1
Medicaid b or b3
90847 22 GT CR
90847 GT CR Z2
Cardinal service description
Vaya service description to use in AlphaMCS
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
90847GTCRZ1 ‐ TF‐CBT ‐ FAMILY THER W/ PT, telepsych, catastrophe related 90847GTCRZ2 ‐ PCIT ‐ FAMILY THER W/ PT, telepsych, catastrophe related 90847SR ‐ In‐home Family Ther W/ PT H0035HK ‐ ENH RATE MH PARTIAL HOSP
Medicaid b or b3
90847 26
90847 SR
Medicaid b or b3
H0035 HE
H0035 HK
Medicaid b or b3
H0036 HK GT CR
H0036 HA GT CR
H0035 HE Partial Hospitalization for Eating Disorder Low Intensity H0036 HK GT CR INTERCEPT, Telehealth
Medicaid b or b3
H0036 HK
H0036 HA
H0036 HK INTERCEPT
H0036HAGTCR ‐ Community Support, telepsych, catastrophe related H0036HA ‐ Community Support
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 TS
H0040 22
H0040 TS Assertive Comm Tx Team Encounter
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
H0045 HQ U4
H0045 HQ U4 HA
H0040 TS CR Assertive Community Treatment Team, Encounter, Telephonic H0040 TS GT CR Assertive Community Treatment Team, Encounter, Telehealth H0045 HQ U4 B3‐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 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 HF
H2011
H2011 HF Mobile Crisis Management (MH/SA)
H2011 ‐ CRISIS SERVICES
Medicaid b or b3
H2011 U4
H2011 U4 HI
Medicaid b or b3
H2016 HI U2 U4
H2016 HI U4 U2
H2011 U4 Crisis Intervention & Stabilization Supports B3 DI H2016 HI U2 U4 Residential Supports Level 4 ‐ AFL B3 DI
H2011U4HI ‐ DI Crisis Intervention and Stabilization Supports with Technical Amendment 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
H2021 U5
H2021 U5 TS
H2021 U5 High Fidelity Wraparound Encounter
H2021 U5 TS High Fidelity Wraparound, Encounter
Medicaid b or b3
H2023 HE U4
H2023 U4 HH
Medicaid b or b3
H2023 HE U4 CR
H2023 U4 HH CR
H2023 HE U4 B3‐Initial Indiv Supported Employment H2023U4HH ‐ MHSA Initial Individual Supported Employment MHSA H2023 HE U4 CR Initial Individual Supported Employment, H2023U4HHCR ‐ MHSA Initial Individual Supported Employment, MH/SUD, Telephonic catastrope related
H0045HQU4HA ‐ (B3) Child Group Respite
Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan
Cardinal
Vaya
Medicaid b or b3
H2023 HE U4 GT CR
H2023 U4 HH GT
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
H2033 U1
Medicaid b or b3
Cardinal service description
Vaya service description to use in AlphaMCS H2023U4HHGTCR ‐ MHSA Initial Individual Supported Employment, catastrophe/tele H2033HACR ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER, catastrophe/disaster related H2033HAGTCR ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER, telepsych
H2033 HA
H2023 HE U4 GT CR Initial Individual Supported Employment, MH/SUD, Telehealth H2033 U1 CR Multi‐systemic Therapy (MST) Weekly, Disaster H2033 U1 GT CR Multi‐systemic Therapy (MST) Weekly, Telehealth H2033 U1 Multi‐systemic Therapy (MST) Weekly
S5145 U5
S5145 Z3
S5145 U5 Rapid Response Home
S5145Z3 ‐ Rapid Response Therapeutic Foster Care (TFC)
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 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
H2016 HI U2 CR XU
H2016 HI XU CR
Medicaid c
H2016 U2 CR XU
H2016 XU CR U2
H2033HA ‐ (WEEKLY) MULTI‐SYSTEMIC‐THER
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 H2011 Crisis Intervention and Stabilization Supports H2011HI ‐ Crisis Intervention and Stabilization Supports with 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
Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan
Cardinal
Vaya
Cardinal service description H2025 CR XU Supported Employment, Retainer
Medicaid c
H2025 CR XU
H2025 XU CR
Medicaid c
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
T2013 TF HQ CR XU
T2013 TF HQ XU
Medicaid c
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
Vaya service description to use in AlphaMCS
H2025XUCR ‐ Supported Employment ‐ Ind, retainer pymt, disaster related 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 T2013TFXUCR ‐ Community Living and Supports, retainer pymt, T2013 TF CR XU Community Living and Support, 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 Agency with Choice T2041 U1 UB Community Navigator Start‐up Training for T2041 Community Navigator Employer of Record T2041 U6 Community Navigator Annual Information T2041 Community Navigator session on Self Direction
Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan
Cardinal
Vaya
Cardinal service description
Vaya service description to use in AlphaMCS
Medicaid c
T2041 U6 UA
T2041
T2041 U6 UA Community Navigator Annual Information session on Self Direction (AWC members)
T2041 Community Navigator
Medicaid c
T2041 U6 UB
T2041
T2041 U6 UB Community Navigator Annual Information session on Self Direction (EOR members)
T2041 Community Navigator
Medicaid c
T2041 UA
T2041
T2041 UA Community Navigator (AWC members)
T2041 Community Navigator
Medicaid c
T2041 UB
T2041
T2041 UB Community Navigator (EOR members)
T2041 Community Navigator
Medicaid c
T2041 UC
T2041
T2041 UC Community Navigator Annual Information session on Self Determination & Rights
T2041 Community Navigator
Medicaid c
T2041 UC UA
T2041
T2041 UC UA Community Navigator Annual Information session on Self Determination & Rights(AWC)
T2041 Community Navigator
Medicaid c
T2041 UC UB
T2041
T2041 UC UB Community Navigator Annual Information session on Self Determination & Rights(EOR)
T2041 Community Navigator
Non‐Medicaid
90791 26
90791 SR
90791SR ‐ In‐Home Psychiatric Diagnostic Evaluation
Non‐Medicaid
90832 26
90832 SR
90791 26 Home Based Psychiatric Diagnostic Evaluation (Non‐Medical) 90832 26 Home Based Psychotherapy, 30 min
Non‐Medicaid
90834 26
90834 SR
90834 26 Home Based Psychotherapy, 45 min
90834SR ‐ IN‐HOME PSYCHOTHERAPY 45 MN
90832SR ‐ IN‐HOME PSYCHOTHERAPY 30 MN
Non‐Medicaid
90837 26
90837 SR
90837 26 Home Based Psychotherapy, 60 min
90837SR ‐ IN‐HOME PSYCHOTHERAPY 60 MN
Non‐Medicaid
90846 26
90846 SR
90846 26 Home Based Family Therapy w/o member
90846SR ‐ In‐home Family Ther W/O PT
Non‐Medicaid
90847 26
90847 SR
90847 26 Home Based Family Therapy w member
90847SR ‐ In‐home 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 CR
H2011 CR
H0040 TS CR Assertive Community Treatment Team, Encounter, Telephonic H0040 TS GT CR Assertive Community Treatment Team, Encounter, Telehealth H2011 HF CR Mobile Crisis Management, Disaster
Non‐Medicaid
H2011 HF GT CR
H2011 GT CR
H2011 HF GT CR Mobile Crisis Management, Telehealth
H2011GTCR ‐ CRISIS SERVICES, telepsych
Non‐Medicaid
H2011 HF
H2011
H2011 HF Mobile Crisis Management (MH/SA)
H2011 ‐ CRISIS SERVICES
H2011CR ‐ CRISIS SERVICES, catastrophe/disaster related
Cardinal Innovations Healthcare to Vaya Health Benefit Plan Services Crosswalk Rev. 11/30/2021
Benefit Plan
Cardinal
Vaya
Non‐Medicaid
YA389 GT
YA389 GT CR
Non‐Medicaid
YA390 GT
YA390 GT CR
Non‐Medicaid
YP620 GT
Non‐Medicaid
YP630 GT
Cardinal service description
Vaya service description to use in AlphaMCS
YP620 GT CR
YA389 GT IDD Supported Employment, Long‐term Support, Telehealth YA390 GT IDD Supported Employment, Individual, Telehealth YP620 GT ADVP
YA389GTCR ‐ LONG‐TERM VOCATIONAL SUPPORT ‐ I/DD, telepsych, catastrophe related YA390GTCR ‐ SUPPORTED EMP IND ‐ I/DD, telepsych, catastrophe related YP620GTCR ‐ MR/MI ADVP, telepsych, catastrophe related
YP630 GT CR
YP630 GT Supported Employment, Individual, Telehealth
YP630GTCR ‐ Supported Employment, Individual, Telehealth