Complex Care Coordination Guidance

Effective August 8, 2023, changes were implemented for OASAS complex care management provided in Part 822 outpatient programs billing under APGs.

• Complex Care Coordination (CCM) is provided to a patient in treatment when the individual’s condition requires coordination with other service providers.
• CCM may be used to facilitate level of care changes that require care coordination to resolve social determinants of health issues or when there are issues presenting barriers to placement.
• CCM must be provided by clinical staff, not administrative staff.

April 1, 2023 Changes to Complex Care Management

Procedure code 90882

• Billing will continue to be under APGs using procedure code 90882. Billed in 5-minute units. Maximum 4 units per day (20 min) with 12 unit (1 hour) per week limit.
• Maximum units billable per day will remain at four (4), meaning a drop in the maximum billable time from one hour to 20 minutes. The maximum units billable in a week will be twelve (12), with a week being defined as Monday thru Sunday.
• There is no longer a requirement that CCM must occur within 14 days after counseling.

The following are examples of allowable and non-allowable complex care management services.

Allowable

• Referrals to housing, treatment, legal or entitlement programs
• Communication with landlords, employers, foster care agencies, foster parents, or biological parents only when contact is exceptional or directly tied to care coordination
• Coordination with primary care providers or other service providers
• Completion of housing applications (e.g. HRA) or SPOA applications when required to access services
• Updated psychosocial assessments for placement or residential referrals
• Referrals to higher level of care
• Letters or calls required to obtain benefits or services
   

Non-allowable

• Mandated CPS/ACS hotline reports
• Routine or standing contacts with foster care agencies, foster parents or biological parents
• Documentation required solely for AOT orders (OMH only)
• Standard administrative or billing paperwork (e.g. routine case notes, internal documentation)
• Internal discussion among supervisors, clinical, or billing staff

If a service is not listed as an allowable service, it should be considered non-allowable.

There are no APG grouper-pricer changes tied to this policy update. This is strictly an expansion of what may be counted as complex care management activities.

Please email any questions to [email protected].