Oral Medication Administration Services - Connection

This is a friendly reminder about billing code H0033 Oral Medication Administration, direct observation; on premises, and billing code H0033-HK Oral Medication Administration, direct observation; off premises.

 

There appears to be confusion regarding billing for those two codes.  To assist in clearing the confusion, the following regulations and DBH guidance must be followed:

 

7 AAC 135.260. Medication administration services

 

Alaska Medicaid covers medication administration provided by medical personnel on the premises of the CBHS or off-premises at the recipient’s home, school, or any other appropriate community setting. Services must be authorized on the recipient’s behavioral health treatment plan.

 

CBHS agencies can administer medications if they are a part of their treatment plan and they are administered by medical personnel. 

 

7AAC135.990 (17) provides descriptions of  “medication administration services” and “medical personnel”.

 

(17) "medication administration services" means the administration, by medical personnel, of injectable or oral medications to a recipient, documentation of medication compliance, assessment and documentation of side effects, and evaluation and documentation regarding the effectiveness of the medication; in this paragraph, "medical personnel" means

(A) a physician;

(B) a physician assistant;

(C) an advanced practice registered nurse;

(D) a registered nurse supervised by a physician or advanced practice registered nurse; or

(E) a licensed practical nurse supervised by a physician or advanced practice registered nurse.

 

As it states in the regulation, it must be a licensed medical provider who administers the medication and if administered by an RN or an LPN, they must be supervised by a physician or an advanced practice register nurse.  Noticed the highlighted section. This is a medical intervention by the direction of a physician or APN and is closely observed for side effects, medication compliance and evaluation regarding the effectiveness of the medications.

 

This is not simply observation and documentation of a client taking medications (whether OTC’s or prescribed).  It requires direct administration by a medically licensed individual, provides medical oversight by medical personnel and is an integrated part of the recipient’s behavioral health treatment plan.

 

Please contact the MPASS unit at mpassunit@alaska.gov  with any questions.


 

 

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