Children's Therapeutic Services and Supports (CTSS)

Coverage Policy

PROPRIETARY INFORMATION OF UCARE | Page 1 of 4

Policy Number: CP-IFP222-030A Effective Date: January 1, 2024

Children’s Therapeutic Services and Supports (CTSS)

The purpose of this policy is to provide clarity and specificity for coverage of Children’s

therapeutic services and supports (CTSS), a site-based, structured mental health treatment

program. It consists of psychotherapy and skills training services.

The CTSS program is excluded from coverage for IFP.

CTSS services are only covered under Medicaid/PMAP contracts.

DISCLAIMER

Coverage Policies are developed to assist in identifying coverage for UCare benefits under UCare’s health

plans. They are intended to serve only as a general reference regarding UCare’s administration of health

benefits and are not intended to address all issues related to coverage for health services provided to

UCare members.

These services may or may not be covered by all UCare products (refer to product section of individual

coverage policy for product-specific detail). Providers are encouraged to have their UCare patient refer

to their UCare plan documents (Evidence of Coverage/Member Handbook/Member Contract) for specific

coverage information. If there is a conflict between a coverage policy and the UCare plan documents,

the UCare plan documents prevail.

Coverage Policies do not constitute medical advice. Providers are responsible for submission of accurate

and compliant claims

Product Summary

This coverage policy applies to the following UCare products:

UCare product Applies to

UCare Individual & Family Plans (IFP), UCare IFP with M Health Fairview



UCare Medicare Plans, UCare Medicare with M Health Fairview & North

Memorial Health, UCare Advocate Plus (HMO I-SNP), EssentiaCare

UCare’s Minnesota Senior Health Options (MSHO) (HMO D-SNP)

UCare Connect + Medicare (HMO D-SNP)

UCare Connect (SNBC)

Prepaid Medical Assistance Program (PMAP), MinnesotaCare

Minnesota Senior Care Plus (MSC+)

Benefit category:

Exclusions-Services not covered

Coverage Policy

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Definitions or summary

CTSS is a combination of mental health services for children who require varying therapeutic

and rehabilitative levels of intervention to treat a diagnosed emotional disturbance.

• Combines therapy with skills training to support children in reaching their appropriate

developmental and social functioning levels.

• Provides varying levels of intervention services in their homes or elsewhere in the

community.

• Range of mental health and rehabilitation services for children and youth (birth – 21

years) that focuses on the emotional conditions that impair the ability to function

independently

Mental Health Services for IFP members provided independent of a site-based,

structured mental health treatment CTSS Program include:

• Day treatment in a licensed program

• Diagnostic assessment

• Individual, group, and family therapy

• Intensive outpatient services

• Medication management

• Mental health crisis intervention

• Partial hospital program in a hospital or community mental health center

• Psychological and neuropsychological testing by a qualified licensed psychologist

Coverage policy

CTSS Programs and related services are excluded from coverage for IFP members.

The services that are not covered include, but may not be limited to the following:

• CTSS programs

• Skills training

• Crisis assistance

• Treatment plan development

• Mental Health Behavioral Aide

Coverage Policy

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CPT/ HCPCS/ICD-10 Codes

*Note: If available, codes are listed below for informational purposes only, and do not guarantee

member coverage or provider reimbursement. This list may not be all-inclusive.

CPT®,

HCPCS or

ICD-10

CODES

Modifier Narrative Description

H2012 UA HK Behavioral Health Day Treatment

H2012 UA HK U6 Behavioral Health Day Treatment

H2014 UA Skills training and development, individual

H2014 UA HQ Skills training and development, group

H2014 UA HR Skills training and development, family

H2015 UA Comp community support services – crisis assistance

H2019 UA Therapeutic behavioral services- Level I MHBA

H2019 UA HM Therapeutic behavioral services- Level II MHBA

H2019 UA HE Therapeutic behavioral services- direction of MHBA

H0031 UA CTSS administration and reporting standardized measures

H0032 UA

CTSS Service plan development; treatment plan development

and review

90832 UA Psychotherapy (with patient or family member or both)

90834 UA Psychotherapy (with patient or family member or both)

90837 UA Psychotherapy (with patient or family member or both)

90833

E/M with psychotherapy add-on (with patient or family

member or both)

90836

E/M with psychotherapy add-on (with patient or family

member or both)

90838

E/M with psychotherapy add-on (with patient or family

member or both)

90875

Individual psychophysiological therapy incorporating

biofeedback, with psychotherapy

90876

Individual psychophysiological therapy incorporating

biofeedback, with psychotherapy

90846

Family psychotherapy without patient present

90847

Family psychotherapy with patient present

90849

Multiple family group psychotherapy

90853

Group psychotherapy

90839

Psychotherapy for crisis

90840

Psychotherapy for crisis, clinical trainee

*CPT is a registered trademark of the American Medical Association.

Coverage Policy

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Prior authorization

Prior authorization for Children’s Therapeutic Services and Supports (CTSS) is not required

for members covered under IFP because the program is excluded from coverage

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