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UNITED HEALTHCARE <br />W ASHINGTON MEDICAID AND WASHINL TaN BENEFIT PLANS FOR THE UNINSURED BEHAVIORAL HEALTH PROEESSIGNAL REIMBURSEMENT SCHEDULE <br />MY3 <br />iekpM1one Ewluatbn+rd xHrug•ned Semce Pmuitletl bya PAylrurs;El-3p MieanolMNtal Orstussbn <br />-fip <br />-Is <br />Nnl Tked <br />Not Pried <br />4g]4 <br />3 <br />]=kpAonr EnbatbrvaM Managmervs 6eMte RrnMed bya PAssiran; 2lid MinmssofMMkal nheussbn <br />0.MfIdP <br />'A.Og <br />Nol Preetl <br />Not Irked <br />59dg <br />a <br />TekpM1one Ewlun[bn>eq Marngemrnt genke Pl.- by. 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/>03]31 <br />Mepl4e behanoretreatmmnwiw pensQotmWllleatbn=mh]5 minutrs otterhnkbns'dmeruo-tebtes.ilh aparient,sequwnd <br />the ld6wb a <br />200p <br />1d6 <br />H.6 <br />14,6 <br />14.6 <br />31 <br />ptlaptiu behau�iartreNment dtA pratmoimudlikatiun, mrh l5 minutes oi[eebnkum'Nmefasrm-fitnwirAa Wrient. requulnI <br />she ralbwNr r s: +dminisrmtrm <br />0.Nquv <br />29d <br />lib <br />11.6 <br />lib <br />Odypixe behansior LCNmentwiN pmmcnf modlikannn, eacH lS minutes dteehnsiam'limelaetrake=wAh aprlient, rcgumn; <br />he blbwhr c ss: admkkuasim <br />2199911P <br />]d.6 <br />H6 <br />24,6 <br />246 <br />v3131 <br />r eelmenl wish Rrotao4motllfiration,eatM1]i mlmrtndtnhuiiaru'4mefxclo-krewi pa lent.•ryekirtg <br />es� ygm6rbva tlm <br />ZL99410P <br />21.6 <br />2q.b <br />2qG <br />24.6 <br />G0316 <br />Wdxgedhnpnlinp+tkmorowemtion eve rduatmnmd mmagemmismful+l heymtltke tnultmre babe munaryxssda <br />..oP <br />2174 <br />Noe Psked <br />Nor Prketl <br />U.74 <br />mll6 <br />Tdon}M hmplui'mpaticnl erebsemtim rare esuivation antlmmagemrntscrvimlV beyond the mNl¢'une br the prenary wssdce <br />o-SgfOP <br />ESM <br />Not Prketl <br />Nel Prietl <br />1;,g} <br />16 <br />P.dengcdhmpial bpatknlorobservation tare ndwunnand mmagemeMsemelN belena Ne btatx6nc brrAc prmary ursite <br />-Al <br />31.16 <br />nut PmeV <br />Nos Prketl <br />1]16 <br />Gv316 <br />yaplwllepalinl orabsrrvadm tare maluadorvantl management urrda.lsl bep me meltkne br N=mm•rvtcrvite <br />o-20fOP <br />1fl.03 <br />Nul Pried <br />Met Pasted <br />>B.W <br />G6316 <br />mdetlM1mp p MeruMnvanm tq.cr+alwmnandm na;emenlurWttNl bemntl the loraltmefor p ry r r <br />2199911P <br />1}.16 <br />Nn1lrrd <br />Ho[ nkry <br />1}.Sx <br />m31b <br />PrnlonyM bnplullup.rice! u•o6umtim rareevalua4en and mnnaymrntscrviarlsl heyond rM1e mvltime bribe ptmary semen <br />21991(NP <br />]g.09 <br />Nos Pried <br />Not Tied <br />IgA9 <br />]] <br />Prdongetl nu sin;fa+ilih ewlwnnn aM managemmtaewketslbryma Nete+d e6Pe b•Shr Pdmary seryrn <br />LLlv/IP <br />II.23 <br />Nes PrkN <br />Not Freed <br />Ili] <br />1] <br />P•abnYrd nuningfici6tYewlwrson atxl managemmturvknlsl beymd Ne msal rime br me prdnary...wr <br />0.}0(i]P <br />".]3 <br />Nos Pcnea <br />Not PrkM <br />}323 <br />G031} <br />i4 <br />bngea nursingfioGlY malmlien yM mm+gemmrunxelsl bryontl the mW Gene br the pnmaryserwe <br />21993fIP <br />1L23 <br />Nat TUN <br />Not Pried <br />Il.]] <br />M17 <br />TG <br />Pm6n6nd nursiedfacdh mlvalion-M managemenlurrelit bryondthe [oral nme for tlm primarysasce <br />rl99fNP <br />]1.13 <br />Not Nked <br />Ner PruN <br />Zl.]3 <br />1) <br />Pmbnged nusingfa1d4-1.0m aM mmagmnMseradais]bmodmemultlm=ser lhepdmary urvice <br />uI8/IP <br />22.]4 <br />tact Nicd <br />Nos Irked <br />} 1 14 <br />31] <br />Prpkngcd eursingficiry maluatim aM managenmses.+cqsibmod me wkilurre br Me prbnay scrvir <br />A68/GR <br />13.9E <br />Nol Need <br />Nos Prketl <br />219E <br />37 <br />WrgN nursing welNY nyluarim aM managementurwtel+l bryo .he teulrime wr she pamarysuwk <br />610;lp <br />l]]6 <br />Nul Teed <br />Not Prkrd <br />I1, 16 <br />03]] <br />Prulmltcd nunin66ci6tymalrutim and menagemMl xrrkdil MvmM demWrMe br the p4mary+mck <br />M1ia/m <br />1d.09 <br />Not Tketl <br />Ig,09 <br />PrpbngrA nursing ficldtyenluatim and managememeervielN bnyorrd the wu3rMebr qe primyryic+se <br />11499/IP <br />Not Nked <br />G031i <br />rmMd nursing faclhrymaluatien qnd m>eygemml xantelsl deyoM [Fe multlme br Ne n ma <br />]1999I0.° <br />lgA9 <br />Nnl Pried <br />Tkn{ <br />Ig.04 <br />YO <br />Profmged komeoraeaitlerie naluallnnandmm+gemens serukeshepntl Nelelgl !line brlM ary urvloe <br />o-2Wm <br />Ne{Print <br />Nm Pried <br />G0318 <br />IG <br />Pro1m6ed home nrresiderue ewluaum 4M rvan+mmuns urvkN bepntl tAe lelllrMe brtAe i <br />AZOlOA <br />SS.i6 <br />Nal Pried <br />4k=a <br />J1.)6 <br />1.Prolonged <br />Aame otmiltleue naluaGnnaud mariugemens seruka hryontl the te1411hnc brlho maryu <br />999fIP <br />Net Tint <br />Net %icd <br />Gdi18 <br />IG <br />longed home nraesiaene eualealenand managemens urNtN be d the renal l6ne brtpe pimary rry <br />11993IOP <br />11.i6 <br />Nat Prue <br />Lt.]fl <br />Prolonged home orresidenu maluauenand marudemens seruka beond 1Ae lel4 bnc brrAr pafmaryu>]81m <br />Net TiN <br />Nor Mk=tl <br />longeel M1eme eraeddmre entumionantl management urvke. beyond the wlal tune brshe pirmary sery <br />0.16lOP <br />S]Ag <br />NO Piked <br />W3Lg <br />Prdongtl M1eme or resrtlerue ewtuatiun and mam;emens semen h=ped tArmultkne br Ne plenary urvlce <br />62WIP <br />Nor Piked <br />Net Pried <br />I69T <br />onged M10 ualion+ntl management urviei beunb the tnl+l time br Ne pemary se <br />AIww <br />11.7E <br />Nml. <br />G0318 <br />Pldon9H home or resN=me mlualien+ntl managmem serum uevend lAr mlal time krthe pl-, urvke <br />99lIP <br />Not Piked <br />log} <br />- n+luallon mtl managumens urvkei beyond the tnull�ne bathe pumarys <br />2L999/OP <br />I).]] <br />vied <br />NIOLgI <br />NO Prketl <br />Sl.tl <br />Gg186 <br />OruS[en{shtlefmuwe, utddmglll drugitlmntrcation me Nods am=regent kdMdaaltlmR antl dlsdn;dth between+wcwnl <br />62gM <br />sfll-gn <br />OLgb <br />Ep1.84 <br />Gmo <br />h•44.de16rJNe, ulirhglll dugkmtlBudnn methedr able ry 6lendh Nd...-m ,. a'nnegdfi heMurtsvtrcmml <br />0.1616P <br />1O1g4 <br />G0 o <br />dug t=ulsl,defnllkm, ntirkdlN duSlaentifiraxon m=Shodr+Nero NanGly lntlblduaitlmgred antl�gdsh 6ctweerestmewml <br />9Mltp <br />IOLg1 <br />]OLgI <br />50194 <br />Ikugtnllsl.A+l6xru.utRrmglll Nugitlemificadonmethedsable ro iientlh intlbidsai deep red di.hegrdth beMeenzvucwml <br />11�99d/oP <br />101g9 <br />G0181 <br />Mugtntfsbdelulliv<,uldmgltl drugiaennfieaummethpdx ahem hiendh'mtlMdual tlrug aen n!•oeydsT <br />-Ap <br />134.3E <br />139.1E <br />139,3E <br />NvgentfsldefnxM1u, utdgngl Ll du;beniigradonm=theds ade m ilentih intlMauai drug eed N'•hegtwh hetwunzvuewnl <br />0.10fUP <br />139.3E <br />fA181 <br />tlrug[nlrl, delurltgs�,otdemglLl dugitlen3ifiutwnm=I'MsaGem HentlhlntlMdunl drug: xed r4s4nddsh between shmwnl <br />11-9591.1 <br />IlAI] <br />]39.J] <br />139,3E <br />N•W{nhsl.dnlbllgm,uti@Nglll tlrugben[ificadnn m=Ureas+Nem ilentlhIntliuidual dress yed drbngrmbbntweensvuo A <br />119WjQl <br />1-11 <br />131JI <br />G1111 <br />bngetl oNne1NP ubn each aJtlkknal l5min <br />0.MAP <br />L].]3] <br />Ma3Tied <br />rPrkrd <br />11.11E <br />G3111 <br />Irobngetl oNgelOP vllN each aJtlltcnall5mle <br />A2d{OP <br />Itoi fl'ncd <br />Nbs Pried <br />Gllll <br />need olfirzoP visit mdr =ddisiuprl l5nm <br />11993/IP <br />1].}1 <br />Nut Pried <br />xe[P.ied <br />11.1E <br />l2 <br />f4oh�egeaatr.>•Np s9dt wdrarbiriwul lS men <br />3L9991t]p <br />Ig,94 <br />Mot Pmetl <br />Not liked <br />1H 46 <br />It <br />Ndpneed xdhx or ntkrnupalian n'aluatireeW mmumnwmtse.ixtsl ls5uml eti:msmmmrNluiaed thrca[dspinmypn.mhar <br />o-2daP <br />3L9s <br />Net Psked <br />Not T'ietl <br />1149 <br />-2 <br />TG <br />NuhmpcJ urFinar n1lure�P�tiea nahuxm nJrwulmnrn[sysinyV Ae3nN de osvr6rmerquiwJ thruaftM1n p'rwr. pnuedee <br />A1WOP <br />3i,99 <br />Nol PtkeJ <br />Nor Pined <br />3].49 <br />bl]li <br />14 <br />NalungJ utGmur utlerwdpdiea melu+Arm and mpugmrrc srusigsl hnwrJ tk maonunnsel wmef - <br />dep•rm+rypnurhM <br />E1-949/1P <br />3199 <br />Nut Prad <br />Ne[PriN <br />1J.g9 <br />l2 <br />we�Jrd2r:eur viper riNPadM nnlrvdm nN muug I.micyrl 61soalrh erssuwnreluirvd [im:ef the priuw}Prrwahue <br />11 999/t]P <br />32,99 <br />Not Preetl <br />Not PrkM <br />3L99 <br />Gills <br />Rulonp_J olficur edv e�utmrl nahutiun aml numeemnYas'irgslhnnrd Vu mawrrtntrywrultku <br />A]gpP <br />lv,4G <br />Nos PAetl <br />Nul Pried <br />33,4b <br />..I <br />1lulrrngd olli.m db ualprtmm malwtinnnuluumgmmmt remtdslbnrml llinwx+krmn ml'dreirimu <br />AIgfOP <br />H,46 <br />Nes hied <br />.1 P-. <br />14,46 <br />,,-I <br />Vnrhul lml[h N•uY isYe <br />0.30AP <br />L6L59 <br />I61.59 <br />I6S.54 <br />I6L59 <br />F <br />V,wbJ ysltlt Nmg;ygw <br />A]WOP <br />I6L S9 <br />l6£SrJ <br />I6L59 <br />I.L. <br />HOfAi <br />.V.n[w1 <br />21-9M14P <br />1g1.39 <br />16139 <br />Ih1.59 <br />is- <br />HOOOf <br />.Varlml :Ynlskbnip.5s� <br />1L9 V9 <br />I6L89 <br />365.59 <br />I6LSs <br />I6LYl <br />HOWL <br />.Umtul irulOr nruv .... <br />0.JOAP <br />IG1.59 <br />361n <br />SbI.54 <br />I61.59 <br />ttP <br />:Vmhol .ird(i Aug.iascu <br />o-)ll/OP <br />56159 <br />F6159 <br />x6i.54 <br />16Lm <br />HOWI <br />HN <br />WecMIAM(M Wdg Mien <br />21-"Im <br />16L59 <br />1619J <br />1G L59 <br />MI A•ellpr Nugeiurs <br />119 1- <br />1- <br />Hg001 <br />N} <br />Nnpay[HewmlAsw,smrnl 1persenbn-mete open ihwtrsl <br />A}WIP <br />1-5 <br />11fl]5 <br />1-1 <br />mvrhswgfil Psscssmmllperussbn-un be up ttl 2 Rwm1 <br />-0- <br />]1b35 <br />1]fl36 <br />1-11 <br />H0901 <br />N} <br />&epsyclmsxvl Msessmerdlpersessbn-can he oven lhmrsl <br />2199WVP <br />-Is <br />11h]5 <br />17635 <br />Im041 <br />0] <br />6bpsythowdal Assnsmemlperuuioe nn be open 2hmesl <br />'J99fOP <br />1Xll <br />11635 <br />116]5 <br />1.31 <br />WrnMl Antl]d Nug Assess <br />0.1WN <br />]61,59 <br />161.59 <br />IIOOOI <br />HF <br />HtoAol AndMr qug Aasea <br />AIWAP <br />1G154 <br />16159 <br />kb159 <br />dnWd prop Aare» <br />11-999f1P <br />161,59 <br />kOGOI <br />HF <br />Altexd AntlflM Nog Arsna <br />1199WOP <br />k6154 <br />16159 <br />13].66 <br />S61 Sg <br />n4h ¢remring [odnermine N�ihi6ry br aJmtuin m rmasment pogrom <br />'ay" <br />ibOtrl <br />hry br admiakn mvmunnt muN>m <br />-10P <br />3].fl5 <br />tt131p1 <br />ft-ioral heakh-`. mderermine 041,11y <br />15391tP <br />I'M <br />3),65 <br />11.15 <br />ne sglgibily bradm'tvkn mne+tment mopam <br />Ll-99WOP <br />AiIi <br />3`S <br />31.65 <br />31. 65 <br />HOW3 <br />Akohd ntlfor duguruning; bbpraMbryanalnis nl spaimem ie•prnrncc of ahofiel mtl/ortlsu;a <br />AIDIIP <br />12 <br />ana/n Auyssranlny b6entprvanaWsb of specimens terpmsrnce of abNrd mtlfordmg <br />AL610P <br />ll <br />lI <br />ImW3 <br />Akohd angler drugureeeley Nbunbryanalysb of speumens lm•pmsesge of abofid mdlortlrugs <br />I-9MIrp <br />II <br />Sl <br />1S <br />anary•drugs..Ke�rr a: trlmmnryanatyzb of spetimeM brpmsemeoFabdrd mmfe. a.ugs <br />]4994loP <br />t] <br />