HCPC Code Chart & Documentation List

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 (now: Notification of Benefit Determination - Medicaid), Action Notice Non-Medicaid (now Notice of Benefit Determination - 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 with Daily Data Form A” Option 3 “Specialized Residential Progress Note with Daily Data Form B”
H2023	Supported Employment, per 15 min	Supported Employment Progress Note
INDTR	Non-Emergency Transportation Services	Transportation Log
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

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