Children CFTSS HCBS - Procedures Setup

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To set up Procedures for CFTSS services, complete the following:

1. Go to Administration 🡪 Procedures.
2. Complete required fields (highlighted yellow).
   • See NYS Children’s Health and Behavioral Health (BH) Services Children’s Medicaid System Transformation Billing and Coding Manual and the Children Family Treatment Support. Services Rate Summary for Coding information.
   • Multiple modifiers can be entered - Enter with no comma or spaces in between each modifier.
3. Complete optional fields - (highlighted orange) based on agencies business process.
4. CFTSS Billing Linked Offsite Procedure - (highlighted purple) NYS provides for additional claim submission (separate claim) if a base service is provided offsite. On the base procedure setup, link the base procedure to the corresponding offsite procedure. (Tip: set up offsite procedure first).
5. Procedure Restrictions Tab - (highlighted blue) is to define services that cannot be performed if this service is provided (if needed).
   • i.e. See NYS Allowable Billing Combinations Children’s Behavioral Health, Children and Family Treatment and Support Services and HCBS.
     
     
      

**Phased in rates

To set up the incremental bumped up CFTSS rates, complete the following:

1. Set up a procedure for each time frame, with the associated rate information.
2. Set up a visit type for each time frame.
3. Link the corresponding visit type to the procedure type.
4. Make the visit types active for only the permitted time frame.
   • On day one that a visit type is allowed: make the visit type active.
   • Upon confirming that all documentation has been completed for the retiring visit type: make the retiring visit type inactive (highlighted in pink above).
   • Example of set up a procedure for each time frame, with the associated rate information.
     • i.e. OLP Licensed Evaluation 0 – 6 months (HCPCS/CPT 90791, Rate Code 7901, Downstate 64.73, Unit 1.00, Max Units 4 – 15 Min); OLP Licensed Evaluation 6-12 months (HCPCS/CPT 90791, Rate Code 7901, Downstate 57.48, Unit 1.00, Max Units 4 – 15 Min);; OLP Licensed Evaluation 12+ months (HCPCS/CPT 90791, Rate Code 7901, Downstate 51.78, Unit 1.00, Max units 4 – 15 Min)
     • i.e. Offsite OLP Individual 0 – 6 months (HCPCS/CPT 90791, Rate Code 7920, Downstate 12.39, Unit 1.00, Max Units 4 – 15 min);; Offsite OLP Individual 6 – 12 months (HCPCS/CPT 90791, Rate Code 7920, Downstate 11.00, Unit 1.00, Max Units 4 – 15 Min.); Offsite OLP Individual 12+ months (HCPCS/CPT 90791, Rate Code 7920, Downstate 9.91, Unit 1.00, Max Units 4 – 15 Min)