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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

 

 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 Beds076223 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 Benefit395 

 Inmate/Prisoner Services

 

 

 Inpatient Care - Children and Adolescents

 

 

 Inpatient Care - Adults

0124/0134

 

 Inpatient Care - State Facility0100 

 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