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Referral Definition

Revised: 07-29-2010

Definition of a Referral

A referral for C&TC reporting purposes indicates that the child needs to be seen again for further assessment, diagnosis or treatment of a problem or a concern which was identified during the C&TC screening. The referral can be made to the screening provider or to another provider

HIPAA C&TC Referral Coding Information

All C&TC claim lines must list the appropriate HIPAA compliant referral code to be recognized as a C&TC claim and paid with the MHCP C&TC payment methodology.

  • • Use only one C&TC referral code per claim
  • • Use the same referral code on all lines of the claim
  • Two-Character C&TC Referral Codes and HIPAA Definitions

    Use the most appropriate referral code from the table below

    Use this referral code for billing when a C&TC screening results in:

    Referral code

    No referral(s) made (“NU”)

    NU

    One or more referrals were made (“ST”)

    ST (new diagnosis or treatment service requested)

    One or more referrals were made (“ST”), and the patient refused one or more of the referrals (“AV”), and the patient is currently under treatment for a diagnostic or corrective health problem(s) (“S2”)

    AV

    One or more referral(s) were made (“ST”), and the patient is currently under treatment for a diagnostic or corrective health problem(s) (“S2”). If the referral is a new referral, that does not pertain to the current treatment the patient is receiving, use (“ST”)

    ST (new diagnosis or treatment service requested)

    One or more referrals were made (“ST”), and the patient is currently under treatment for a diagnostic or corrective health problem(s) (“S2”) and the referral is not a new referral but pertains to the current treatment the patient is receiving, use (“S2”)

    S2 (continue current services/treatment)

    No referrals were made (“NU”), and the patient is currently under treatment for a diagnostic or corrective health problems(s) (“S2”)

    S2 (continue current services/treatment)

    One or more referrals were made (“ST”), and the patient refused one or more of the referrals (“AV”)

    AV

    A verbal dental referral was made for preventive dental health care

    NU

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