SALT LAKE COUNTY DIVISION OF SUBSTANCE ABUSE
RATE TABLE INSTRUCTIONS
Fiscal Year 2008
Treatment Program: Treatment Activity: Unit: Current Contract - Rate:
Enter the Treatment Program code, both the Code and Description, as follows: Enter the Treatment Activity, both the Description and the HCPCS Code, as follows This corresponds with the treatment activity Enter the currently used rate of the treatment service activity.
1 Youth 90801 MH/Medication Evaluation Per 15 minutes If there is more than one rate for a particular service activity, use
2 Women 96101 Psychological Testing Per hour a different level for each rate.
3 Women in Women/Children 90804 Individual  Therapy 20 to 30 minutes face-to-face Per session Current Contract - Units of Measurement:
4 Child in Women/Children 90806 Individual Therapy 45 to 50 minutes face-to-face Per session Enter 'H' for hour; 'D' for day; 'S' for session /test.
99 General 90808 Individual Therapy 75 to 80 minutes face-to-face Per session Current Contract - Number of Units Contract Serves:
    90846 Family Therapy without patient present Per 15 minutes Current number of units provided to County clients per contract year.
ASAM Level: 90847 Family Therapy with patient present Per 15 minutes  
Enter the ASAM level, both the Description and the Code, as follows: H2019 Individual Behavior Management Per 15 minutes Proposed Contract - Rate:
.5 Early Intervention 90853 Group Therapy Per 15 minutes Enter the proposed rate of the treatment service activity.
1.0 Outpatient H2017 Group Life Skills Development Services/Recreation Per 15 minutes If there is more than one rate for a particular service activity, use
2.1 Intensive Outpatient H2017U1 Intensive Skills Development Services Child Per 15 minutes a different level for each rate.
2.5 Day Treatment H2019HQ Group Behavioral Management (S/A Education) Per 15 minutes Proposed Contract - Units of Measurement:
3.0 Transitional Housing H0006 Client Advocacy/Targeted Case Management Per 15 minutes Enter 'H' for hour; 'D' for day; 'S' for session /test.
3.1 Low Intensity Residential 90862 Medication Management/MD Per session Proposed Contract - Number of Units Contract Serves:
3.2 Clinically Monitored Detox 90862TD Medication Management/RN Per session Proposed number of units provided to County clients per contract year.
3.3 Medium Intensity Residential H0003 Urine Analysis Per session  
3.5 High Intensity Residential H0020 Pharmacotherapy(Methadone) Per day  
4 Medically Managed Detox H0019 Residential Treatment Per day Net Change:
    T1008 Day Treatment Per day Increase or Decrease in cost from current contract to proposed contract
    H0006 Transitional Housing/Case Management Only Per 15 minutes  
E:\collage\DocConv\transactions\1183144661432_4\upload\[9844_58169.xls]FY08 Rate Table Instructions
6/29/2007 13:17