Protocols & Care Criteria

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Protocols & Care Criteria
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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	6/2008
Assessment	H0031	6/2008
Behavior Management Committee	H2000	CMHSP's Only
Case Management Services - Adults		5/2008
Case Management Services - Children		5/2008
Clinical Certification	See Protocol
Equipment, Adaptive	See Protocol
Environmental Modification	S5165
Housing Assistance	T2038	12/1/2008
Medical Supplies	See Protocol
Private Duty Nursing	S9123
Community Living Supports - Support Staff	H2016
Crisis Residential Services	H0018	6/2008
Crisis Stabilization Services	S9484	5/20/2008
Emergency (Crisis Intervention) Services	H2011	6/4/2008
Enhanced Dental Services	See Protocol
Enhanced Pharmacy Services
Extended Observation Beds	0762	23 Hours Max
Family Skills Development Services	S5111	11/16/07
Family Therapy Services	90847	6/2008
Group Therapy Services		6/2008
Home Based Services Age 0 - 3 Age 4 - 17	H0036	6/3/2008
Housing Assistance	T2038	12/1/2008
Indigent Pharmacy Benefit	395	5/2008
Inpatient Care - Children and Adolescents	0124/0134	5/13/2008
Inpatient Care - Adults	0124/0134	5/13/2008
Inpatient Care - State Facility	0100
Interpreter Services	560	12/2008
Jail Diversion		CMHSP's Only
Laboratory and Diagnostic Services	See Codebook	5/2008
Medication Administration	90782	5/2008
Medication Review - Physician	90862	5/2008
Nursing Home Mental Health Monitoring	T1017	5/20/2008
Nutritional Assessment	S9470	2/1/2000
Nutritional Services	97803	12/1/2008
Occupational Therapy Evaluation	97003	9/2008
Occupational Therapy Services	97530	9/2008
Outpatient Therapy - Adult	See Protocol	See Document
Outpatient Therapy - Children and Adolescents		See Document
Partial Hospitalization - Adults	0912	6/2008
Partial Hospitalization - Children and Adolescents		6/2008
Patient Education
Peer Delivered and Operated Services	H0038	12/1/2008
Physical Therapy Assessment	97001	9/2008
Physical Therapy Services	97110	9/2008
Pre-Admission Screening		CMHSP's Only
Prevention Services	H0025	12/1/2008
Pre-Vocational Services	T2015	12/1/2008
Psychiatric Assessment - Outpatient	90801/99222	2/2008
Psychiatric Assessment - Inpatient	See Protocol	2/2008
Psychiatric Assessment - Med/Surg Floor	See Protocol	6/3/2008
Psychiatric Follow-Up (Inpatient)	99231	6/3/2008
Psychological Testing	96100	1/2008
Psychosocial Rehabilitation (Clubhouse)	H2030	6/4/2008
Residential Care (Community Living Supports and Personal Care Services in a Licensed Residential setting)		4/1/2007
Respite Services	See Protocol
RN Health Assessment	T1001
RN Health Services	T1002	2008
Skill Building Assistance	H2014	12/1/2008
Speech Evaluation	92506	9/2008
Speech Therapy Services	92507	9/2008
Supported Employment Services	H2023	5/2008
Supports Coordination Services	T1016	7/1/2008
Transportation Services	See Protocol	5/29/2008
Treatment Planning	H0032	5/7/2008
Wraparound Services	H2022	12/1/2008

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Access Alliance of Michigan
A Division of Bay-Arenac Behavioral Health
201 Mulholland
Bay City, MI 48708
989-497-1302

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