Clinical Edition Codes Survey - Procentive Customer Success

Mental Health - Employee Assistance Program
Select ONLY the codes that you will use for this type of service
Mental Health - Employee Assistance Program*
Select the codes you use.
- 90832 HJ - Individual Therapy: 16-37 Min
- 90834 HJ - Individual Therapy: 38-52 Min
- 90837 HJ - Individual Therapy: 53+ Min
- 90846 HJ - Family Therapy without Patient
- 90847 HJ - Family Therapy with Patient
- 99404 - Cigna EAP
- Other

Housing Stabilization
Select ONLY the codes that you will use for this type of service
EIDBI Codes*
Select the codes you use.
- H0043 U5 - Supplemental Services
- H2015 U8 - Housing Transition
- H2015 U8 TS - Housing Sustaining
- T2024 U8 - Housing Consultation
- Other

Code 1
Code*
Code Number Modifier (if applicable) Revenue Code Code Name
Allow override of time/units ratio?*
- No - use fixed time/unit ratio above
- Yes - allow staff to change time and units
- Always 1 Unit
If you answered no above please list the Hours/Minutes per unit here:
Hours Minutes
Inpatient*
- Yes
- No
Is this code used for Group Services?*
- Yes
- No
Is there a Default Place of Service for this code? If no put N/A.*
Do you have more codes to enter?*
- Yes
- No

Code 2
Code*
Code Number Modifier (if applicable) Revenue Code Code Name
Allow override of time/units ratio?*
- No - use fixed time/unit ratio above
- Yes - allow staff to change time and units
- Always 1 Unit
If you answered no above please list the Hours/Minutes per unit here:
Hours Minutes
Inpatient*
- Yes
- No
Is this code used for Group Services?*
- Yes
- No
Is there a Default Place of Service for this code? If no put N/A.*
Do you have more codes to enter?*
- Yes
- No

Code 3
Code*
Code Number Modifier (if applicable) Revenue Code Code Name
Allow override of time/units ratio?*
- No - use fixed time/unit ratio above
- Yes - allow staff to change time and units
- Always 1 Unit
If you answered no above please list the Hours/Minutes per unit here:
Hours Minutes
Inpatient*
- Yes
- No
Is this code used for Group Services?*
- Yes
- No
Is there a Default Place of Service for this code? If no put N/A.*
Do you have more codes to enter?*
- Yes
- No

Code 4
Code*
Code Number Modifier (if applicable) Revenue Code Code Name
Allow override of time/units ratio?*
- No - use fixed time/unit ratio above
- Yes - allow staff to change time and units
- Always 1 Unit
If you answered no above please list the Hours/Minutes per unit here:
Hours Minutes
Inpatient*
- Yes
- No
Is this code used for Group Services?*
- Yes
- No
Is there a Default Place of Service for this code? If no put N/A.*
Do you have more codes to enter?*
- Yes
- No

Code 5
Code*
Code Number Modifier (if applicable) Revenue Code Code Name
Allow override of time/units ratio?*
- No - use fixed time/unit ratio above
- Yes - allow staff to change time and units
- Always 1 Unit
If you answered no above please list the Hours/Minutes per unit here:
Hours Minutes
Inpatient*
- Yes
- No
Is this code used for Group Services?*
- Yes
- No
Is there a Default Place of Service for this code? If no put N/A.*

Codes Survey