Crisis Intervention (H0036) Service Definition and Eligibility Requirements

Service Definition

Crisis intervention shall provide immediate mental health care, to assist individuals who are experiencing acute psychiatric dysfunction requiring immediate clinical attention. Crisis intervention services must be available 24 hours a day, seven days per week.

Medical Necessity Criteria

The service-specific provider intake, as defined at 12VAC30-50-130, shall document the individual's behavior and describe how the individual meets criteria for this service. Assessment time is allowed to document the medical necessity and assess the level of services needed.

Crisis intervention services are provided following a marked reduction in the individual's psychiatric, adaptive, or behavioral functioning or an extreme increase in personal distress. Individuals must meet both Criteria A and B to qualify for reimbursement.

Criteria A

Individuals qualifying for this service must demonstrate a clinical necessity for the service arising from an acute crisis of a psychiatric nature that puts the individual at risk of psychiatric hospitalization.

Criteria B

Individuals must meet two of the following criteria at the time of admission to the service: