Dear SAPC Providers,
The Department of Health Care Services’ (DHCS) group services billing formula has changed and is now based on the duration of the group session and no longer fluctuates based on the number of participants. Additionally, SAPC has updated the Rates and Standards Matrix to allow providers to submit claims for documentation time for group counseling sessions, provided it does not exceed the following standards and represents actual time documenting notes tailored to each participant:
- 2-4 participants one 15-minute unit;
- 5-8 participants up to two 15-minute units; and
- 9-12 participants up to three 15-minute units.
The number of minutes would be added to the total time submitted for the group session, but it must be clear what amount of time relates to the time spent conducting the group versus the time spent documenting individualized group session notes. See the attached document for examples or visit SAPC’s Network Providers page.
Other changes to the document include: (1) equalizing the room and board rate for ASAM 3.1, 3.3, and 3.5 to $46.96 and (2) removing physical exam as a reimbursable service, at least for now, given uncertainty about whether this service is permissible in outpatient settings and because this service is better reimbursed under fee-for-service Medi-Cal or by the patients’ primary care doctor.
If you have any questions please email SUDTransformation@ph.lacounty.gov.
Wesley L. Ford
Director, Substance Abuse Prevention and Control