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Office of Mental Health

Office of Mental Health (OMH) Clinic Rates Codes

OMH Clinic Rate Codes

Description Non hospital* Hospital Federally Qualified Health Center (FQHC)
Base Rate 1504 1516 4301
Off-site Base Rate (available for select children’s services and crisis-brief for both adults and children.) 1507 1519 Not applicable
Seriously Emotionally Disturbed (SED) Child Base Rate (Medicaid managed care SED children only) 1510 1522 4601
SED Child Off-site Base Rate (Medicaid managed care SED children only) 1513 1525 Not applicable
Health Services (e.g., Health Monitoring, Health Physicals) 1474  1588 Not applicable
SED Child Health Services (e.g., Health Monitoring, Health Physicals) (Medicaid managed care SED children only) 1477 1591 Not applicable
Crisis Intervention 1579 1576 Not applicable
SED Child Crisis Intervention (Medicaid managed care SED children only.) 1585 1582 Not applicable
Intensive Outpatient Program (IOP) 1042 1048 Not applicable
Intensive Outpatient Program (IOP) SED 1045 1051 Not applicable
Delivery System Reform Incentive Payment (DSRIP) 1106 1110 Not applicable
Delivery System Reform Incentive Payment (DSRIP) SED 1108 1112 Not applicable
Integrated Outpatient Services (IOS) 1480 1122 Not applicable
Integrated Outpatient Services (IOS) SED 1483 1124 Not applicable

*Non hospital includes Diagnostic & Treatment Center (D&TCs), Local Governmental Unit (LGUs), freestanding Art 31s, and state operated injections may be claimed using either the Health Services rate codes or the Clinic rate codes.

OMH Clinic Rate Codes Exempt from Utilization Threshold Counts

Description Non Hospital* Hospital
Off-site Base Rate (available for select children’s services and crisis-brief for both adults and children.) 1507 1519
SED Child Off-site Base Rate (Medicaid managed care SED children only) 1513 1525
Health Services (e.g., Health Monitoring, Health Physicals) 1474 1588
SED Child Health Services (e.g., Health Monitoring, Health Physicals) (Medicaid managed care SED children only) 1477 1591
Crisis Intervention 1579 1576
SED Child Crisis Intervention (Medicaid managed care SED children only) 1585 1582
Intensive Outpatient Program (IOP) 1042 1048
Intensive Outpatient Program (IOP) SED 1045 1051

Comments or questions about the information on this page can be directed to the Bureau of Financial Planning.