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NOTIFICATION: Weight Change for CPT Code 90882

OASAS Certified Part 822 Freestanding Chemical Dependence
Outpatient Clinics, Chemical Dependence Outpatient Rehabilitation Programs, Outpatient Youth
Programs and Opioid Treatment Providers

OASAS has received notification from NYS Department of Health that the APG weight for CPT code 90882-Complex Care Coordination is changing effective July 1, 2014.

Complex Care Coordination is an ancillary service, provided to a current patient when a critical event occurs or the patient's condition requires significant coordination with other service providers. Documentation must note the critical event or condition and the need for coordination and summarize the purpose of the coordination.

Complex Care Coordination is not routine care coordination activities.

The weight for CPT code 90882-Complex Care will be .0965 per unit effective July 1, 2014. OASAS requires a minimum of 45 minutes to bill for Complex Care Coordination as detailed in the APG Clinical and Billing Guidance manual. For each occurrence of Complex Care Coordination being provided to a client adhering to the requirements of the APG Clinical and Billing Guidance manual, providers will need to bill three (3) units on their claim to receive proper reimbursement. If any number of units other then three (3) is entered on the claim, the provider will be subject to audit and disallowance.

Complex Care Coordination is exempt from the two (2) billable services per day maximum rule. Complex Care coordination must occur within 5 working days of a clinical service. This could be 5 days prior or 5 days after the clinic service. However, programs may not bill for more than three (3) Complex Care Coordination visits per patient within an episode of care, unless clinical staff provides written clinical justification for additional complex care coordination services.

Note: Hospital-based Chemical Dependence Outpatient clinics, Chemical Dependence Outpatient Rehabilitation programs, and Opioid Treatment providers continue to be reimbursed the threshold/legacy amount.