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HCPC Code Chart and Documentation List

Over 3 months I have got my own place, improved my attitude, my life goals and choices to improve our life.
-Clare County

CMHCM Provider Service Documentation Requirements

For all service documentation, the interventions provided by support staff MUST be identified in the consumer’s Individualized Plan of Service and relate to a goal or objective. If you are currently maintaining documentation for the below services, please contact CMHCM Contracts to determine whether your documentation meets all necessary elements to be approved ongoing. If you have any questions regarding documentation, please speak with our Provider Network Specialist or Provider Network Manager.

All service documentation must:

  • Be sufficiently detailed to allow reconstruction of what transpired for each service billed
  • Be signed and dated by the individual providing the service
  • Have a start and stop time documented (for 15 minute unit services)

HCPC Code

HCPC Description

Required Documentation

H0031

Mental Health Assessment, by Non-Physician

Psychosocial Assessment

H0032

Mental Health Service Plan Development by Non-Physician

PCP Pre-Planning Note, Person/Family Centered Plan, Addendum to Person/Family Centered Plan (if completing an update), Action Notice (Medicaid), Action Notice (Non-Medicaid), PCP Training Record

H0043

CLS, Per Diem

CLS Progress Note

H2014

Skills Training and Development, per 15 min

Skill Building Note

H2015

Comprehensive Community Support Services, per 15 min

CLS Progress Note

H2016

Comprehensive Community Support Services, per Day

Option 1 “Specialized Residential Daily Data” and “Specialized Residential Progress note without Daily Data”

 

Option 2 “Specialized Residential Progress Note Form A”

 

Option 3 “Specialized Residential Progress Note Form B”

0364T U5 (First 30 mins)

0365T U5 (Addtl. 30 mins)

ABA Therapeutic Behavioral Services

ABA Therapeutic Behavioral Service Progress Note

H2023

Supported Employment, per 15 min

Supported Employment Progress Note

INDTR

Non-Emergency Transportation Services

Transportation Log

S5111 and 0370T U5

Home Care Training, Family; Per Session

CIGMMO Progress Note

S5116

Non-Family Training

CIGMMO Progress Note

T1016

Supports Coordination, Each 15 Minutes

CIGMMO Progress Note

T1017

Targeted Case Management, Each 15 Minutes

CIGMMO Progress Note

T1020

Personal Care Services, Per Diem, Not for an Inpatient

Option 1 “Specialized Residential Daily Data” and “Specialized Residential Progress note without Daily Data”

 

Option 2 “Specialized Residential Progress Note Form A”

 

Option 3 “Specialized Residential Progress Note Form B”

T2015

Pre-Vocational Services

Pre-Vocational Services Progress Note

T2023

Targeted Case Management Services - Child Waiver

CIGMMO Progress Note

 

 

Over 3 months I have got my own place, improved my attitude, my life goals and choices to improve our life.
-Clare County
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