Protocols and Care Criteria

Current Service Selection Guidelines and Clinical Protocols for the Access Alliance of Michigan affiliation, including contracted providers. For current procedure (HCPCS) and Service Activity Codes, please click here.

Medical Necessity Criteria and service selection guidelines issued by the Michigan Department of Community Health govern all services.

Please contact our Access Manager with questions, comments, or concerns about these documents or the AAM Clinical Protocols.

Current Service Selection Guidelines and Clinical Protocols

SERVICE OR PROTOCOL TITLE	PROCEDURE CODE	REVISION DATE/NOTES
Assertive Community Treatment	H0039
Assessment	H0031
Behavior Management Committee	H2000	CMHSP's Only
Case Management Services - Adults
Case Management Services - Children
Clinical Certification	See Protocol
Equipment, Adaptive	See Protocol
Environmental Modification	S5165
Housing Assistance	T2038
Medical Supplies	See Protocol
Private Duty Nursing	S9123
Community Living Supports - Support Staff	H2016
Crisis Residential Services	H0018
Crisis Stabilization Services	S9484
Emergency (Crisis Intervention) Services	H2011
Enhanced Dental Services	See Protocol
Enhanced Pharmacy Services
Extended Observation Beds	0762	23 Hours Max
Family Skills Development Services	S5111
Family Therapy Services	90847	See Document
Group Therapy Services		See Document1 and Document2
Home Based Services Age 0 - 3 Age 4 - 17	See Protocol
Hospital Based Observation	0762
Indigent Pharmacy Benefit	395
Inmate/Prisoner Services
Inpatient Care - Children and Adolescents
Inpatient Care - Adults	0124/0134
Inpatient Care - State Facility	0100
Interpreter Services	560
Jail Diversion		CMHSP's Only
Laboratory and Diagnostic Services	See Codebook
Medication Administration	90782
Medication Review - Physician	90862
Medication Review - Nurse/Physician Assistant
Non-Emergency Ambulance Transportation
Nursing Home Mental Health Monitoring	T1017
Nutritional Assessment	S9470
Nutritional Services	97803
Occupational Therapy Assessment	97003
Occupational Therapy Services	97530
Outpatient Therapy - Adult	See Protocol	See Document
Outpatient Therapy - Children and Adolescents		See Document
Partial Hospitalization - Adults	0912
Partial Hospitalization - Children and Adolescents
Patient Education
Peer Directed and Operated Services	H0038
Physical Therapy Assessment	97001
Physical Therapy Services	97003
Pre-Admission Screening		CMHSP's Only
Prevention Services	H0025
Pre-Vocational Services	T2015
Psychiatric Assessment - Outpatient	90801/99222
Psychiatric Assessment - Inpatient	See Protocol
Psychiatric Assessment - Med/Surg Floor	See Protocol
Psychiatric Follow-Up (Inpatient)	99231
Psychological Testing	96100
Psychosocial Rehabilitation (Clubhouse)
Residential Care (Community Living Supports and Personal Care Services in a Licensed Residential setting)
Respite Services	See Protocol
RN Health Assessment	T1001
RN Health Services	T1002
Skill Building Assistance	H2014
Speech and Language Assessment	92506
Speech and Language Services	92507
Supported Employment Services	H2023
Supports Coordination Services	T1016
Transportation Services	See Protocol
Treatment Planning	H0032
Wraparound Services	H2022

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Access Alliance of Michigan
A Division of Bay-Arenac Behavioral Health
5455 Hampton Place
Saginaw, MI 48604
989-497-1302

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Last Update: 10/11/07